bluuebunny/crossref_metadata_2025 huggingface dataset:
Catastrophic Kawasaki disease unresponsive to IVIG in a 3-month-old infant: a diagnostic and therapeutic challenge
Authors: de Magalhães Cristina Medeiros Ribeiro , Alves Natália Ribeiro de Magalhães , de Melo Adriana Valença , Junior Clodoaldo Abreu da Silveira , Nόbrega Yanna Karla de Medeiros , Gandolfi Lenora , Pratesi Riccardo
Published: August 2012

The present report describes the severe evolution of Kawasaki disease in a three-month-old infant. The ailment was initially atypical in its presentation, with the patient exhibiting only persistent fever in association with a progressive lethargy and maculopapular rash on the face, trunk and limbs erroneously diagnosed as roseola infantum. On the 10th day of the condition, mainly due to the unexplained persistence of fever, the infant was admitted to a local hospital. The typical features of KD appeared only on the 14th day of illness with the relapse of the maculopapular rash in association with non-purulent conjunctivitis; dry, reddish and fissured lips; tongue with reddish and hypertrophic papillae; erythema and edema of the palms and soles. During the following days, the ailment rapidly evolved to a catastrophic clinical picture characterized by generalized vasculitis, splenic infarction, pulmonary thrombosis, giant right and left coronary aneurysms, dilatation of common and internal iliac arteries and progressive ischemia of the distal third of the feet resulting in necrotic lesions of both halluces. Appropriate therapy was initiated, but repeated administration of intravenous immunoglobulin G (IVIG) followed by three days of administration of methylprednisolone did not abate the intense inflammatory activity. The remission of inflammation and regression of vascular lesions were only achieved during the following five weeks after the introduction of methotrexate associated with etanercept. The report of this case aims to draw attention to severe forms of KD that exhibit an unfavorable evolution and can be extremely refractory to the conventional therapy.
In vitroinfection with classical swine fever virus inhibits the transcription of immune response genes
Authors: Feng Li , Li Xiao-Quan , Li Xiao-ning , Li Jun , Meng Xian-Ming , Zhang Hong-Yun , Liang Jing-Jing , Li Hui , Sun Shi-Kai , Cai Xin-Bin , Su Li-Juan , Yin Shan , Li Yan-Sheng , Luo Ting Rong
Published: August 2012

Background

Classical swine fever virus (CSFV) can evade the immune response and establish chronic infection under natural and experimental conditions. Some genes related to antigen processing and presentation and to cytokine regulation are known to be involved in this response, but the precise mechanism through which each gene responds to CSFV infection remains unclear.

Results

In this study, the amplification standard curve and corresponding linear regression equations for the genes SLA-2, TAP1, SLA-DR, Ii, CD40, CD80, CD86, IFN-α, and IFN-β were established successfully. Real-time RT-PCR was used to quantify the immune response gene transcription in PK-15 cells post CSFV infection. Results showed that: (1) immune response genes were generally down-regulated as a result of CSFV infection, and (2) the expression of SLA-2, SLA-DR, Ii and CD80 was significantly decreased (p<0.001).

Conclusion

We conclude that in vitro infection with CSFV inhibits the transcription of host immune response genes. These findings may facilitate the development of effective strategies for controlling CSF.
In vitro inhibition of transmissible gastroenteritis coronavirus replication in swine testicular cells by short hairpin RNAs targeting the ORF 7 gene
Authors: He Lei , Zhang Yan-ming , Dong Ling-juan , Cheng Min , Wang Jing , Tang Qing-hai , Wang Gang
Published: August 2012

Background

Transmissible gastroenteritis (TGE) is a highly contagious viral disease of swine, characterized by severe vomiting, diarrhea, and high mortality. Currently, the vaccines for it are only partially effective and no specific drug is available for treatment of TGE virus (TGEV) infection. RNA interference has been confirmed as a new approach for controlling viral infections. In this study, the inhibitory effect of short hairpin RNAs (shRNAs) targeting the ORF 7 gene of TGEV on virus replication was examined.

Results

Four theoretically effective sequences of TGEV ORF 7 gene were designed and selected for construction of shRNA expression plasmids. In the reporter assays, three of four shRNA expression plasmids were able to inhibit significantly the expression of ORF 7 gene and replication of TGEV, as shown by real-time quantitative RT-PCR analysis of viral ORF 7 and N genes and detection of virus titers (TCID50/ml). Stable swine testicular (ST) cells expressing the shRNAs were established. Observation of the cytopathic effect and apoptosis, as well as a cell proliferation assay demonstrated that the three shRNAs were capable of protecting ST cells against TGEV destruction, with high specificity and efficiency.

Conclusions

Our results indicated that plasmid-transcribed shRNAs targeting the ORF 7 gene in the TGEV genome effectively inhibited expression of the viral target gene and viral replication in vitro. These findings provide evidence that the shRNAs have potential therapeutic application for treatment of TGE.
Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial
Authors:   The ART Investigators
Published: August 2012

Background

Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART).

Methods/Design

ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH2O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure ≤30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle.

Discussion

If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.

Trial registration

ClinicalTrials.gov Identifier: NCT01374022
Phase I-II study of hypofractionated simultaneous integrated boost using volumetric modulated arc therapy for adjuvant radiation therapy in breast cancer patients: a report of feasibility and early toxicity results in the first 50 treatments
Authors: Scorsetti Marta , Alongi Filippo , Fogliata Antonella , Pentimalli Sara , Navarria Pierina , Lobefalo Francesca , Garcia-Etienne Carlos , Clivio Alessandro , Cozzi Luca , Mancosu Pietro , Nicolini Giorgia , Vanetti Eugenio , Eboli Marco , Rossetti Carlo , Rubino Arianna , Sagona Andrea , Arcangeli Stefano , Gatzemeier Wolfgang , Masci Giovanna , Torrisi Rosalba , Testori Alberto , Alloisio Marco , Santoro Armando , Tinterri Corrado
Published: August 2012

Background

To report results in terms of feasibility and early toxicity of hypofractionated simultaneous integrated boost (SIB) approach with Volumetric Modulated Arc Therapy (VMAT) as adjuvant treatment after breast-conserving surgery.

Methods

Between September 2010 and May 2011, 50 consecutive patients presenting early-stage breast cancer were submitted to adjuvant radiotherapy with SIB-VMAT approach using RapidArc in our Institution (Istituto Clinico Humanitas ICH). Three out of 50 patients were irradiated bilaterally (53 tumours in 50 patients). All patients were enrolled in a phase I-II trial approved by the ICH ethical committee. All 50 patients enrolled in the study underwent VMAT-SIB technique to irradiate the whole breast with concomitant boost irradiation of the tumor bed. Doses to whole breast and surgical bed were 40.5 Gy and 48 Gy respectively, delivered in 15 fractions over 3 weeks. Skin toxicities were recorded during and after treatment according to RTOG acute radiation morbidity scoring criteria with a median follow-up of 12 months (range 8–16). Cosmetic outcomes were assessed as excellent/good or fair/poor.

Results

The median age of the population was 68 years (range 36–88). According to AJCC staging system, 38 breast lesions were classified as pT1, and 15 as pT2; 49 cases were assessed as N0 and 4 as N1. The maximum acute skin toxicity by the end of treatment was Grade 0 in 20/50 patients, Grade 1 in 32/50, Grade 2 in 0 and Grade 3 in 1/50 (one of the 3 cases of bilateral breast irradiation). No Grade 4 toxicities were observed. All Grade 1 toxicities had resolved within 3 weeks. No significant differences in cosmetic scores on baseline assessment vs. 3 months and 6 months after the treatment were observed: all patients were scored as excellent/good (50/50) compared with baseline; no fair/poor judgment was recorded. No other toxicities or local failures were recorded during follow-up.

Conclusions

The 3-week course of postoperative radiation using VMAT with SIB showed to be feasible and was associated with acceptable acute skin toxicity profile. Long-term follow-up data are needed to assess late toxicity and clinical outcomes.
Hyperthermophilic endoglucanase for in planta lignocellulose conversion
Authors: Klose Holger , Röder Juliane , Girfoglio Michele , Fischer Rainer , Commandeur Ulrich
Published: August 2012

Background

The enzymatic conversion of lignocellulosic plant biomass into fermentable sugars is a crucial step in the sustainable and environmentally friendly production of biofuels. However, a major drawback of enzymes from mesophilic sources is their suboptimal activity under established pretreatment conditions, e.g. high temperatures, extreme pH values and high salt concentrations. Enzymes from extremophiles are better adapted to these conditions and could be produced by heterologous expression in microbes, or even directly in the plant biomass.

Results

Here we show that a cellulase gene (sso1354) isolated from the hyperthermophilic archaeon Sulfolobus solfataricus can be expressed in plants, and that the recombinant enzyme is biologically active and exhibits the same properties as the wild type form. Since the enzyme is inactive under normal plant growth conditions, this potentially allows its expression in plants without negative effects on growth and development, and subsequent heat-inducible activation. Furthermore we demonstrate that the recombinant enzyme acts in high concentrations of ionic liquids and can therefore degrade α-cellulose or even complex cell wall preparations under those pretreatment conditions.

Conclusion

The hyperthermophilic endoglucanase SSO1354 with its unique features is an excellent tool for advanced biomass conversion. Here we demonstrate its expression in planta and the possibility for post harvest activation. Moreover the enzyme is suitable for combined pretreatment and hydrolysis applications.
Recent outbreak of cutaneous anthrax in Bangladesh: clinico-demographic profile and treatment outcome of cases attended at Rajshahi Medical College Hospital
Authors: Siddiqui Muhammad Afsar , Khan Md Azraf Hossain , Ahmed Sk Shamim , Anwar Kazi Selim , Akhtaruzzaman Shaikh Md , Salam Md Abdus
Published: August 2012

Background

Human cutaneous anthrax results from skin exposure to B. anthracis, primarily due to occupational exposure. Bangladesh has experienced a number of outbreaks of cutaneous anthrax in recent years. The last episode occurred from April to August, 2011 and created mass havoc due to its dreadful clinical outcome and socio-cultural consequences. We report here the clinico-demographic profile and treatment outcome of 15 cutaneous anthrax cases attended at the Dermatology Outpatient Department of Rajshahi Medical College Hospital, Bangladesh between April and August, 2011 with an aim to create awareness for early case detection and management.

Findings

Anthrax was suspected primarily based on cutaneous manifestations of typical non-tender ulcer with black eschar, with or without oedema, and a history of butchering, or dressing/washing of cattle/goat or their meat. Diagnosis was established by demonstration of large gram-positive rods, typically resembling B. anthracis under light microscope where possible and also by ascertaining therapeutic success. The mean age of cases was 21.4 years (ranging from 3 to 46 years), 7 (46.7%) being males and 8 (53.3%) females. The majority of cases were from lower middle socioeconomic status. Types of exposures included butchering (20%), contact with raw meat (46.7%), and live animals (33.3%). Malignant pustule was present in upper extremity, both extremities, face, and trunk at frequencies of 11 (73.3%), 2 (13.3%), 1 (6.7%) and 1 (6.7%) respectively. Eight (53.3%) patients presented with fever, 7 (46.7%) had localized oedema and 5 (33.3%) had regional lymphadenopathy. Anthrax was confirmed in 13 (86.7%) cases by demonstration of gram-positive rods. All cases were cured with 2 months oral ciprofloxacin combined with flucoxacillin for 2 weeks.

Conclusions

We present the findings from this series of cases to reinforce the criteria for clinical diagnosis and to urge prompt therapeutic measures to treat cutaneous anthrax successfully to eliminate the unnecessary panic of anthrax.
The peptide derived from the Ig-like domain of human herpesvirus 8 K1 protein induces death in hematological cancer cells
Authors: Daniluk Urszula , Kerros Celine , Tao Rong-Hua , Wise Jillian F , Ao Xue , Berkova Zuzana , Samaniego Felipe
Published: August 2012

Background

Although significant progress has been made in the treatment of lymphomas, many lymphomas exhibit resistance to cell death, suggesting a defective Fas signaling, which remains poorly understood. We previously reported that cells expressing the K1 protein of human herpesvirus 8 (HHV-8) resist death through the complex formation of the Ig-like domain of K1 with Fas. Recently, we investigated whether peptides derived from the Ig-like domain of the K1 protein may affect cell death.

Methods

K1 positive and negative cell lines were incubated with the K1-derived peptides, and cell death (apoptotic and necrotic) was assessed by flow cytometry and LDH assay. Activation of caspases was assessed by fluorometric assay and flow cytometry. Fas receptor-independent, peptide-mediated cell killing was tested in the Fas-resistant Daudi cell line and Jurkat cell clones deficient in caspase-8 and FADD functionality. Activation of TNF receptors I and II was blocked by pre-incubation with corresponding blocking antibodies. The effect of the K1 peptidein vivowas tested in a mouse xenograft model.

Results

We observed that the peptide S20-3 enhanced cell death in K1-positive BJAB cells and HHV-8 positive primary effusion lymphoma (PEL) cell lines. Similar effects of this peptide were observed in B-cell lymphoma and T-lymphoblastic leukemia cells without K1 expression but not in normal human peripheral blood mononuclear cells. A single intratumoral injection of the S20-3 peptide decreased the growth of Jurkat xenografts in SCID mice. The mechanism of tumor cell death induced by the S20-3 peptide was associated with activation of caspases, but this activity was only partially inhibited by the pan-caspase inhibitor z-VAD. Furthermore, the K1 peptide also killed Fas-resistant Daudi cells, and this killing effect was inhibited by pre-incubation of cells with antibodies blocking TNFRI.

Conclusion

Taken together, these findings indicate that the S20-3 peptide can selectively induce the death of malignant hematological cell lines by Fas- and/or TNFRI-dependent mechanisms, suggesting the K1-derived peptide or peptidomimetic may have promising therapeutic potential for the treatment of hematological cancers.
Use of Aspirin, Other Nonsteroidal Anti-Inflammatory Drugs, and Acetaminophen and Postmenopausal Breast Cancer Incidence
Authors: Zhang Xuehong , Smith-Warner Stephanie A. , Collins Laura C. , Rosner Bernard , Willett Walter C. , Hankinson Susan E.
Published: August 2012

Purpose

The associations between use of aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen and breast cancer incidence in postmenopausal women are uncertain. We examined these associations with breast cancer, both overall and by molecular subtype.

Patients and Methods

We observed 84,602 postmenopausal women, free of cancer in 1980, until June 2008 and prospectively collected data on analgesic use, reproductive history, and other lifestyle factors using biennial questionnaires. Proportional hazards models were used to estimate multivariable relative risks (RRs) and 95% CIs.

Results

We documented 4,734 cases of incident invasive breast cancer. Compared with nonuse of aspirin, multivariable RRs of regular aspirin use (≥ two tablets per week) for more than 20 years were 0.91 for overall breast cancer (95% CI, 0.81 to 1.01; Ptrend= 0.16), 0.90 for estrogen receptor (ER) –positive progesterone receptor (PR) –positive breast cancer (95% CI, 0.77 to 1.06; Ptrend= 0.17), and 0.91 for ER-negative PR-negative breast cancer (95% CI, 0.68 to 1.22; Ptrend= 0.97). Results did not vary appreciably by past or current use, days per week of use, or dosage of use. Use of other NSAIDs and acetaminophen was largely not significantly associated with breast cancer risk. Additionally, use of higher doses of each analgesic (≥ six tablets per week) for more than 10 years was generally not significantly associated with risk of breast cancer, either overall or by subtype. Furthermore, largely no substantial associations were noted for breast cancer molecular subtypes, including luminal A, luminal B, triple negative, basal-like, human epidermal growth factor receptor 2 positive, cyclooxygenase-2 (COX-2) negative, and COX-2 positive.

Conclusion

Our study suggests that use of aspirin, other NSAIDs, and acetaminophen is not importantly associated with risk of postmenopausal breast cancer, either overall or by specific subtype.
On Cowboys and Aliens
Authors: Schroeder William F.
Published: August 2012

This essay argues for an affective methodology based on an attention to how visceral connections to film help queer people from the People's Republic of China interpret their subjectivity. The essay follows a theory of affect that focuses not only on emotion but also on the crucial relationship between the actual and the virtual — what is and what could be or could have been — to construct a story of emergence. In comparing the huge impact in China of the blockbuster cowboy film Brokeback Mountain with a limited-release queer Chinese digital production about space aliens, titled fly, the essay suggests that affect is taking queer subjects beyond normative concepts of place and time and into a realm of potential. This realm constitutes a “queer hyperspace,” from which emerges a reparative reading of contemporary global queer connections. Such a reading allows us to understand not only the variety of motivations queer people have in places that have not traditionally been the focus of queer theory but also the contours of contemporary queer scholarship from places that have not traditionally produced it.
“Where Did Gender Go?” Same-Sex Desire and the Persistence of Gender in Gay Male Historiography
Authors: Valocchi Stephen
Published: August 2012

The scholarship on gay male social history identifies a shift that supposedly takes place in the landscape of same-sex desire, practice, subjectivities, and associations during the nineteenth and twentieth centuries. According to this historiography, these landscapes were fundamentally and diversely gendered in that the organization of same-sex desire flowed from the varying performances of, and identifications with, masculinity and femininity. Beginning with World War II, however, object choice displaces gender as the defining feature of homosexuality. This essay disputes this periodization and offers a somewhat different perspective on writing histories of male homosexuality. Using insights from queer studies and from ethnographic methods, I argue that gender does not disappear from these landscapes. The dominant narrative glosses over the nonnormative expressions and subcultures that persist throughout these periods that exist parallel to, and at times interrupt, the dominant model of the hetero-homo binary. Just as importantly, the dominant model glosses over the gender sameness — normatively masculine men desiring normatively masculine men — that also defines an important form of erotic subjectivity in the modern period. That sameness — an erotics of normative masculinity — is left uninterrogated as an important historical formation in and of itself and also as a means by which the hetero-homo binary was constructed. Instead, the histories shift their attention from sexual-gender subcultures and subjectivities to gay community building with its attendant “problems” of organization formation, infrastructural development, and liberal politics.
Homophobia as the State of Reason
Authors: Wahab Amar
Published: August 2012

The stigmatization of Caribbean postcolonial nation-states in the Western imagination as exemplifying some of the most homophobic nationalisms masks a more-nuanced reading of the complexities of Caribbean modernity. As such, the hardening of homophobic nationalisms in settings such as Trinidad and Tobago forces us to question how and why compulsory homophobia is deployed as a form of moral discipline that is made to seem compatible with postcolonial modernity. This article explores the “problem space” of state-sanctioned homophobia as a regulative and generative (not simply repressive) force in postcolonial nationstates. It first briefly theorizes how compulsory homophobia has become a mandate of state-popular affinity in the postindependent era that conditions the possibility of pluralistic consensus in the postcolonial nation-state. Within this context, the author further explores a historic court case involving the “wrongful arrest” and alleged strip search of an out gay subject by state police officials. Some analytic insights into the strip search and subsequent court case testimonies are offered with a view to understanding the regulatory and generative potentials of institutionalized homophobia. The implications of this case for an incipient LGBT activist platform are also discussed as an expansion of the complex debates about sexual citizenship and political community within the postcolonial condition.
Preoperative embolization of spinal tumors: variables affecting intraoperative blood loss after embolization
Authors: Kobayashi Katsuhiro , Ozkan Efe , Tam Alda , Ensor Joe , Wallace Michael J , Gupta Sanjay
Published: August 2012

Background

Preoperative embolization of spinal tumors is often used to reduce blood loss from surgery. Intraoperative blood loss, even in patients who undergo embolization, is potentially multifactorial; embolization techniques, surgical procedures or tumor characteristics may affect intraoperative blood loss.

Purpose

To retrospectively analyze factors affecting intraoperative blood loss in patients who had undergone spinal tumor embolization; and to assess the safety of the procedure.

Material and Methods

Sixty-two patients (median age, 60 years) with a tumor involving the thoracic ( n = 42) or lumbar ( n = 20) spine underwent preoperative tumor embolization with particles. Multiple variables, including patient characteristics, tumor characteristics, embolization techniques, and surgical procedures, were evaluated with respect to intraoperative blood loss and transfusion requirement. Complications related to the embolization procedures were also recorded. Univariate and multivariate analysis were performed to analyze the variables affecting the intraoperative blood loss and transfusion requirement.

Results

Complete or near-complete tumor embolization was achieved in 47 patients. The average estimated blood loss (EBL) and packed red blood cells units transfused during surgery were 2554 mL (range, 250–11,000 mL) and 7 units (range, 0–28 units), respectively. Univariate analysis indicated tumor volume, surgical approach, and invasiveness of the spinal surgery to be significant variables affecting EBL. Tumor histology and extent, tumor vascularity, degree of embolization, and size of embolic particle did not affect operative blood loss. On multivariate analysis, invasiveness of the surgery was the only variable that influenced EBL. Two patients developed irreversible neurologic deficits following embolization.

Conclusion

Embolization technique or completeness has a limited effect on operative blood loss after preoperative spinal tumor embolization. Operative blood loss from spinal surgery is dependent primarily on the invasiveness of the surgery. Although preoperative embolization is a relatively safe procedure, there remains a risk of cord ischemia.
Screening for hazardous alcohol consumption in a sexual health clinic: a service evaluation
Authors: Thorley N , Hettiarachchi N , Nightingale P , Radcliffe K
Published: August 2012

On the basis of National Institute for Health and Clinical Excellence (NICE) guidance we conducted a survey in a sexual health clinic to assess acceptability of an alcohol screening questionnaire, rates of hazardous drinking and success of referral to a specialist alcohol service (Aquarius). Seventy-two percent of patients accepted the offer of screening, of whom 34% were hazardous drinkers; 2.6% consented to referral to Aquarius but failed to attend. We estimate the cost range to screen and deliver a five-minute brief intervention at £3.62–£9.19 per case. Opportunistic alcohol screening identifies high rates of hazardous drinkers and is acceptable to patients, but onward referral by untrained staff to an external specialist alcohol service is unsatisfactory to patients. Research into the cost-effectiveness of screening and delivery of brief interventions within sexual health clinics is required.
Cumulative exposure to stimulants and immune function outcomes among HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study
Authors: Shoptaw S , Stall R , Bordon J , Kao U , Cox C , Li X , Ostrow D G , Plankey M W
Published: August 2012

We examined associations between stimulant use (methamphetamine and cocaine) and other substances (nicotine, marijuana, alcohol and inhaled nitrites) with immune function biomarkers among HIV-seropositive (HIV +) men taking highly active antiretroviral therapy (ART) and HIV-seronegative (HIV−) men in the Multicenter AIDS Cohort Study. Among HIV + men, cumulative adherence to ART (4.07, 95% confidence interval [CI]: 3.52, 4.71, per 10 years of adherent ART use), and recent cohort enrolment (1.38; 95% CI: 1.24, 1.55) were multiplicatively associated with increase in CD4+/CD8+ ratios. Cumulative use of methamphetamine (0.93; 95% CI: 0.88, 0.98, per 10 use-years), cocaine (0.93; 95% CI: 0.89, 0.96, per 10 use-years) and cumulative medical visits (0.99; 95% CI: 0.98, 0.99, per 10 visit-years), each showed small negative associations with CD4+/CD8+ ratios. Among HIV− men, cumulative medical visits (0.996; 95% CI: 0.993, 0.999), cumulative number of male sexual partners (0.999; 95% CI: 0.998, 0.9998, per 10 partner-years) and cigarette pack-years (1.10; 95% CI: 1.02, 1.18, per 10 pack-years) were associated with CD4+/CD8+ ratios over the same period. ART adherence is associated with a positive immune function independent of stimulant use, underscoring the influence of ART on immune health for HIV+ men who engage in stimulant use.
Bacterial vaginosis is conducive to the persistence of HPV infection
Authors: Guo Y-l , You K , Qiao J , Zhao Y-m , Geng L
Published: August 2012

We investigated the effects of bacterial vaginosis (BV) on the outcomes of high-risk human papillomavirus infection (HR-HPV). BV was diagnosed on Papanicolaou-stained cytology slides of 707 HPV-positive patients. HR-HPV DNA expression was analysed using the Hybrid Capture II (HC-II) assay. Of the 707 HR-HPV-positive female patients, 298 (42.1%) exhibited clearance of HR-HPV. The remaining 409 patients had persistent HR-HPV infection. The persistent HR-HPV group and the clearing group had similar rates of BV at the beginning of the study. At the end of the study, the persistent HR-HPV group had a BV prevalence of 11.2% while the clearing group had a significant lower BV prevalence of 5.0%. A decreased clearance of HPV was found in women with current BV, compared with women without BV. Furthermore, the natural history of HPV was not affected by the HPV viral load or the BV prevalence at the beginning of the study ( P > 0.05). Bacterial vaginosis appears conducive to the persistence of HPV infection.
A dedicated clinic for HIV-positive individuals over 50 years of age: a multidisciplinary experience
Authors: Waters L , Patterson B , Scourfield A , Hughes A , de Silva S , Gazzard B , Barton S , Asboe D , Pozniak A , Boffito M
Published: August 2012

The HIV-infected population is ageing. Issues including polypharmacy and co-morbidities led us to develop a dedicated clinic for HIV-infected individuals over 50. We describe our service evaluation after two years. The over 50 clinic commenced in January 2009. The team comprises a registrar, consultant, nurse practitioner and is supported by a pharmacist and mental health services. Patients undergo a full medication and drug interactions review, neurocognitive assessment, adherence self-assessment and investigations including therapeutic drug monitoring (TDM), coronary artery calcium scores (CACS) and bone mineral density. Over two years of activity, 150 patients attended the service. Median (range) age was 58 (50–88), all were on combined antiretroviral therapy and 38% (57/150) were on ≥3 non-HIV drugs. CACS was high (>90th centile) in 14%. Thirty-eight percent had osteopaenia and 18% had osteoporosis requiring treatment. Thirteen out of 125 men had an increased prostate specific antigen, four were diagnosed with prostate cancer. Drug interaction, TDM and neurocognitive assessments were useful for several patients. Asymptomatic patients over 50 in long-term follow-up had new pathologies detected through targeted screening. The clinic has improved general practitioner (GP) liaison and facilitated closer working relationships with other specialties. Patients have reacted positively to the clinic, particularly as many do not routinely access their GP.
Trends in attendances to genitourinary medicine services by older women
Authors: Fish R , Robinson A , Copas A , Jungmann E , Lascar R M
Published: August 2012

We sought to analyse reasons for attendance of older women (defined as aged 46 years and over) to genitourinary (GU) medicine services at two UK clinics. We used KC60 coding data to count new episode attendances by year from 1998 to 2008 and to further dissect reason for attendance in 2827 new episodes during 2003–2008. The total number of new episodes of attendance in older women increased from 167 in 1998 to 701 in 2008. Within this overall increase, there was a stable proportion of acute sexually transmitted infections (STIs) over time, alongside significant increases in the proportion of women requesting STI screening and HIV testing and those attending GU medicine for other reasons, such as dermatological or gynaecological complaints. In our clinic population it was encouraging to see that older women increasingly use GU medicine services for STI screening and HIV testing. Services may need to adapt to older women's specific health-care needs.
Ultrasound measurement and grading of rotator cuff and shoulder joint disease in patients with inflammatory arthritis: a reliability study
Authors: Disini Luisa , Boddu Srinivas , Cahir John , Marshall Tarnya , Toms Andoni
Published: August 2012

Introduction

To determine the inter-observer reliability of ultrasound measurements and grading of rotator cuff and shoulder joint disease in patients with inflammatory arthritis.

Methods

Both shoulders of 50 patients (56 ± 18 years, 39F:11M) with inflammatory arthritis, being treated with biologics, were scanned by two experienced radiologists. Rotator cuff and articular surface features in the shoulder joint were measured and graded using previously published ultrasound scoring methods. The inter-observer agreements for rotator cuff tendon, glenohumeral joint (GHJ) and subacromial subdeltoid bursal (SSB) measurements were obtained with intraclass correlation coefficients (ICC) for continuous data. Those for the grade of rotator cuff tendon tear, humeral head (HH) and acromio-clavicular joint (ACJ) appearances were analysed with kappa ( K) statistics for categorical data.

Results

Moderate inter-observer agreement (ICC = 0.58, P ≤ 0.01) was shown for the supraspinatus tendon thickness. Poor agreement (ICC < 0.49) was found for the thickness of the subscapularis ( P ≤ 0.01), infraspinatus ( P ≤ 0.05) and biceps tendons. There was excellent agreement for the SSB thickness (ICC = 0.88, P ≤ 0.01) and poor agreement for GHJ distance. Moderate agreement ( K = 0.57, P ≤ 0.01) for grading of a supraspinatus tendon tear was found while excellent agreement for the subscapularis ( K = 0.81, P ≤ 0.01), infraspinatus and biceps (both K = 1, P ≤ 0.01) tendons was noted. The most common agreement occurred for no tear or a complete tear. Poor agreement ( K < 0.49) was demonstrated for grading of HH erosions and ACJ appearances.

Conclusion

Ultrasound measurement of the subacromial subdeltoid bursa was reliable between observers, as was detection of the presence or absence of a complete rotator cuff tendon tear. Reliability was limited for measurements of rotator cuff tendon thickness, grading partial tendon tears or identification of subtle shoulder joint pathology.
The Sales Lead Black Hole: On Sales Reps' Follow-Up of Marketing Leads
Authors: Sabnis Gaurav , Chatterjee Sharmila C. , Grewal Rajdeep , Lilien Gary L.
Published: August 2012

The sales lead black hole—the 70% of leads generated by marketing departments that sales representatives do not pursue—may result from competing demands on sales reps' time. Using the motivation–opportunity–ability framework, the authors consider factors that influence sales reps' pursuit (or lack thereof) of marketing and self-generated leads. The proportion of time that sales reps devote to marketing leads depends on organizational lead prequalification and managerial tracking processes (extrinsic motivation), as well as marketing lead volume (opportunity), and sales rep experience and performance (ability). Consistent with a person–situation framework, individual sales rep factors should also moderate the influence of organizational processes on lead follow-up. Data from 461 sales reps employed by four firms confirm that as sales reps' experience increases, their responses to managerial tracking of lead follow-up and marketing lead volume decrease; responses to the quality of the lead prequalification process increase. As sales reps' performance improves, their response to the volume of marketing leads increases, but their response to managerial tracking decreases. The interplay of individual sales reps' abilities and organizational marketing and sales processes explains differences in sales reps' follow-up of marketing leads.’
An Investigation of the Effectiveness of Uncertainty in Marketing Promotions Involving Free Gifts
Authors: Laran Juliano , Tsiros Michael
Published: August 2012

The authors provide a framework to predict when uncertainty will have a beneficial or detrimental impact on marketing promotions involving free gifts. Whereas uncertainty (i.e., not knowing which free gift will be offered) decreases purchase likelihood when the decision is cognitive, it increases purchase likelihood when the decision is affective. Using field and laboratory studies, the authors demonstrate that when the decision involves affect, people like to be surprised and appreciate uncertainty in the purchase process. When the decision is cognitive, consumers appreciate having information about the product offer. This research has both theoretical implications for research on affect and uncertainty and practical implications for marketing managers designing and implementing promotional campaigns.
Aesthetic Amputations: Absolute Music and the Deleted Endings of Hanslick's Vom Musikalisch-Schönen
Authors: Bonds Mark Evan
Published: August 2012

Eduard Hanslick's Vom Musikalisch-Schönen (1854) is the single most important document in the history of the construct known as absolute music, the idea that music functions as an entirely self-contained and self-referential art. Hanslick deleted—and did not replace—the final paragraph of the first edition, cutting most of it for the second edition of 1858 and the remainder for the third edition of 1865. This original ending evokes imagery that stands out from most of the rest of the treatise, including references to the “great motions of the cosmos” and “profound and secret connections to nature.” Scholars have pointed to the apparent inconsistencies of both tone and substance in this paragraph over and against the rest of the treatise to explain its later deletion but have not suggested why Hanslick might have ended his treatise in this way originally. The evocation of “connections to nature” points to the influence of Naturphilosophie, a mode of thought particularly prevalent in Germany in the first half of the nineteenth century that posited a basic unity of all nature. Proponents of Naturphilosophie, including such major figures as Schelling, Ritter, Goethe, and Ørsted, believed that the basic forces of nature were all interconnected. Ernst Chladni's demonstrations of the geometric patterns that could be created by sound under certain conditions fascinated his contemporaries and provide an example of how motion, sound, form, and beauty might all be interrelated. Hanslick saw tönend bewegte Formen (“forms set in motion through tones”) as the essence of music, and his original ending suggests that the kind of motion resulting in sound was related to the motions at work in physics, light, magnetism, and other forces, the “great motions of the cosmos.”
The Floral Poetics of Schumann's Blumenstück, Op. 19
Authors: Watkins Holly
Published: August 2012

Robert Schumann's Blumenstück, op. 19, a short piano piece dating from 1839, is generally not included among the composer's more poetically inspired or formally adventurous pieces. Thanks in part to Schumann's own disparaging remarks about the piece, Blumenstück, like the stylistically similar Arabeske, op. 18, has been viewed as a fairly straightforward effort to appeal to amateur consumers—especially women consumers—of domestic piano music. Rather than recuperate Schumann's piece through a revelation of its structural achievements, this article links the piece's mixed aesthetic status to the similar standing of flowers (and the genre of flower painting to which Schumann's title alludes) in early-nineteenth-century German culture. Emblematic of women and the expression of conventional sentiments, flowers nonetheless constituted a remarkably evocative symbol in Romantic literature. Sentimental and Romantic discourses of the flower converged in the trope of Blumensprache (the language of flowers), an idea that found expression in both popular manuals cataloguing the meanings of flowers and the more esoteric environments of Schumann's criticism, E. T. A. Hoffmann's tales, and Heinrich Heine's poetry. In each of these venues, flowers served as imaginary conduits joining mundane and transcendent realms. Drawing on the work of Friedrich Kittler, I argue that Schumann's Blumenstück, with its conflicting imperatives of pleasure and instruction, congenial melody and motivic intertwining, conflates aesthetic and reception-based categories in a related manner and, as a result, undermines traditional means of generic classification.
The Brahmsian Hairpin
Authors: Kim David Hyun-Su
Published: August 2012

Hairpins, the notation symbols < and >, are today universally accepted as equivalent to the markings crescendo and diminuendo, calling for an increase or decrease in volume. This view is irreconcilable with the scores of the core German repertoire of the nineteenth century. This article offers a new understanding of hairpins based on careful examination of the scores of Brahms and of early-twentieth-century recordings by artists close to him. In Brahms's milieu hairpins did not prescribe sounds, but rather described meanings. The difference between prescription and description is central, suggesting that instead of “growing louder/quieter,” hairpins are better understood as “becoming more/less.” The means by which “more/less” was realized by nineteenth-century musicians included many techniques beyond dynamics, most notably agogic inflection.
Micro-Dynamics of Protests: The Political and Cultural Conditions for Anti-U.S. Beef Protests in South Korea
Authors: Lee Jung-Eun
Published: August 2012

Theoretical developments on the temporalities of social movements have been grounded in both long-term and mid-term perspectives. This focus has obscured the processes of short-term mobilizations, leaving it unclear whether the established models explain the micro-dynamics of short-term protests. Considering the important effects short-term protests have on political processes, it is crucial to analyze how they develop in interaction with their external environment every day. This article seeks to address this research lacuna by extending the current perspectives into short-term protests. It tests whether the daily fluctuations of political and cultural contexts shaped the anti-U.S. beef protests in South Korea in 2008, with a temporal span of 121 days. The findings emphasize the importance of political and discursive opportunities for protests to develop: While state repression as well as state actors' dissonant/incoherent statements spurred protests, third-party actors' dissonant/incoherent opinions in the conservative media led to a decline in protests.
Disease, War, Hunger, and Deprivation: A Cross-National Investigation of the Determinants of Life Expectancy in Less-Developed and Sub-Saharan African Nations
Authors: Austin Kelly F. , McKinney Laura A.
Published: August 2012

Researchers note a recent trend of increasing inequality in cross-national life expectancy rates, largely due to conditions in the poorest of nations. Threats to life expectancy in less-developed nations include poverty, warfare, intense hunger, and disease, particularly AIDS/HIV. This article utilizes structural equation models for a sample of less-developed nations and a subsample of Sub-Saharan African nations to test interrelationships among predictors. Findings indicate modernization to be the most robust predictor of life expectancy across less-developed nations and HIV to be the strongest determinant of life expectancy in Sub-Saharan African nations. Somewhat surprisingly, warfare and hunger do not have direct impacts on life expectancy among less-developed nations; however, important linkages among warfare, hunger, and disease are evidenced in the Sub-Saharan African sample, along with a notable positive influence of modernization on HIV rates. The findings demonstrate the significance of HIV on cross-national life expectancy scores and illuminate unique dynamics in Sub-Saharan Africa.
Cobedding and Recovery Time After Heel Lance in Preterm Twins: Results of a Randomized Trial
Authors: Campbell-Yeo Marsha L. , Johnston C. Celeste , Joseph K.S. , Feeley Nancy , Chambers Christine T. , Barrington Keith J.
Published: August 2012

OBJECTIVES:

Cobedding of preterm twin infants provides tactile, olfactory, and auditory stimulation and may affect pain reactivity. We carried out a randomized trial to assess the effect of cobedding on pain reactivity and recovery in preterm twin neonates.

METHODS:

Stable preterm twins (n = 67 sets) between 28 and 36 weeks of gestational age were randomly assigned to a cobedding group (cared for in the same incubator or crib) or a standard care group (cared for in separate incubators or cribs). Pain response (determined by the Premature Infant Pain Profile [PIPP]) and time to return to physiologic baseline parameters were compared between groups with adjustment for the nonindependence of twin infants.

RESULTS:

Maternal and infant characteristics were not significantly different between twin infants in the cobedding and standard care groups except for 5-minute Apgar <7 and postnatal age and corrected gestational age on the day of the heel lance. Mean PIPP scores were not different between groups at 30, 60, or 120 seconds. At 90 seconds, mean PIPP scores were higher in the cobedding group (6.0 vs 5.0, P = .04). Recovery time was shorter in the cobedding group compared with the standard care group, (mean = 75.6 seconds versus 142.1 seconds, P = .001). No significant adverse events were associated with cobedding. Adjustment for nonindependence between twins and differences in baseline characteristics did not change the results.

CONCLUSIONS:

Cobedding enhanced the physiologic recovery of preterm twins undergoing heel lance, but did not lead to lower pain scores.
Proficiency and Retention of Neonatal Resuscitation Skills by Pediatric Residents
Authors: Patel Jay , Posencheg Michael , Ades Anne
Published: August 2012

BACKGROUND:

The basic knowledge and skill base to resuscitate a newborn infant is taught in the Neonatal Resuscitation Program (NRP). We hypothesize that caregivers will perform below current acceptable standards before the recertification period of two years.

METHODS:

This is a prospective descriptive study evaluating performance of pediatric residents’ NRP knowledge and skills over time. NRP scores are used as baseline data. Follow-up is performed before the resident's first NICU rotation. Differences in the mean scores are analyzed for degree of retention. Subset score analysis is also performed.

RESULTS:

Eighty-eight subjects completed both evaluations. Knowledge scores maintained close to passing throughout the academic year. Subset evaluation revealed significant deficits within the intubation lesson. Alarming deficits were seen in skills evaluation starting at initial NRP certification with 39.1% residents having failing scores. Mean scores were below passing for every group on follow-up testing. Subgroup analysis of skills revealed deficits in the initial phases of resuscitation (lessons 1–3).

CONCLUSIONS:

Deterioration of skills is seen shortly after training. It appears that knowledge is generally better retained. Discrepancies between areas of knowledge and skill deterioration indicate that proficiency in one does not necessarily indicate proficiency of the other.