bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved Characterization of Small “u” for Jacob Pumping Test Analysis Methods
Authors: Alexander Scott C. , Saar Martin O.
Published: July 2011

Numerous refinements have been proposed to traditional pumping test analyses, yet many hydrogeologists continue to use the Jacob method due to its simplicity. Recent research favors hydraulic tomography and inverse numerical modeling of pumping test data. However, at sites with few wells, or relatively short screens, the data requirements of these methods may be impractical within physical and fiscal constraints. Alternatively, an improved understanding of the assumptions and limitations of Theis and, due to their widespread usage, Jacob analyses, leads to improved interpretations in data‐poor environments. A fundamental requirement of Jacob is a “small” value of u = f(r2/t), with radial distance, r, and pumping time, t. However, selection of a too stringent (i.e., too low) maximum permissible u‐value, umax, results in rejection of usable data from wells beyond a maximum radius, rmax. Conversely, data from small radii, less than rmin, where turbulent‐ and vertical‐flow components arise, can result in acceptance of inappropriate data. Usage of drawdown data from wells too close to the pumping well, and exclusion of data from wells deemed too far, can cause unrealistic aquifer transmissivity, permeability, and storativity determinations. Here, data from an extensive well field in a glacial‐outwash aquifer in north‐central Minnesota, USA, are used to develop a new estimate for umax. Traditionally quoted values for umax range from 0.01 to 0.05. Our proposed value for Jacob distance‐drawdown analyses is significantly higher with umax up to 0.2, resulting in larger allowable rmax‐values and a higher likelihood of inclusion of additional wells in such pumping test analyses.
CARE/CEASA Roundtable on Managing Uncertainty and Risk
Authors: Harris Trevor , Shear Neal , Galbraith Steve
Published: July 2011

Two distinguished Morgan Stanley “alumni” discuss how their management of risk and uncertainty has not only preserved but increased the profitability of their businesses. In both cases—one involving a commodities trading operation and the other a long‐short hedge fund—the key has been to find cost‐effective ways to “cut off the left tails” of the distribution by avoiding naked long or short positions and creating option‐like payoffs with limited downside.

In the case of the hedge fund, the combination of longs and shorts with the use of other risk‐reducing strategies has enabled the fund's managers to produce twice the market's returns with only half the volatility (and only one losing year) during the 18‐year life of the fund. In the case of the commodities trading operation, the strategy is described as combining ownership of physical assets with the use of option pricing models to create what amount to “long gamma positions in the asset” that “produce payoffs regardless of whether the asset goes up or down in value.”
Accounting for Risk and Return in Equity Valuation
Authors: Penman Stephen
Published: July 2011

Standard valuation models forecast cash flows or earnings, add a growth rate, and discount the cash flows to their present value with a discount rate that typically reflects the cost of capital. But as the author argues, projecting the long‐term growth rate is essentially speculative; and along with uncertainty about the growth rate, analysts generally do not have a good grasp of the discount rate either. Thus, instead of reducing uncertainty, these two features effectively compound uncertainty in valuations in the sense that slight changes in the growth rate or discount rate can change the valuation considerably.

In this article, the author proposes an alternative approach that views the investor's problem as one of challenging the speculations that are built into the current market price, particularly the speculation about growth. Rather than building in a speculative growth rate (and thereby treating it as if it were a certainty), the author's approach turns the problem on its head by using an accounting analysis of the firm's current earnings and cash flows that provides a basis for recognizing the speculative component of the current stock price.

More specifically, the author's analysis identifies the future earnings growth path that is implied by the market price, which can then be evaluated with the question: Do I want to pay for this growth? Because growth expectations are risky, additional analysis can be used to provide an understanding of the risk and return to buying growth, and of the upside and downside if risk growth expectations are not realized. By taking such an approach, investors incorporate their understanding of risk not by increasing the discount rate, but by recognizing that the primary risk in investing is the risk of overpaying for growth.
Morgan Stanley's Risk‐Reward Views: Unlocking the Full Potential of Fundamental Analysis
Authors: Weyns Guy , Perez Juan‐Luis , Hurewitz Barry , Jenkins Vlad
Published: July 2011

Since 2008, Risk‐Reward Views have been the basis for the recommendations on all the stocks covered by Morgan Stanley's equity research analysts globally. The firm's analysts use this systematic approach to communicate a broader range of fundamental insights about expected returns and risks, and to articulate more clearly the logic underlying their price targets and calls, and the level of conviction associated with them. The rationale for this approach is to align the firm's research product with its clients' thinking and investment discipline while also creating a link between traditional equity analysis and widely accepted principles of modern portfolio management.

Too many sell‐side analysts still try to manifest expertise and conviction with one‐sided investment theses backed by single‐point estimates and “table pounding.” That does a disservice to investors who are looking to sell‐side analysts for an ongoing dialogue about the future with experts on company fundamentals. Risk‐Reward Views are designed to produce a more complete view of the risk‐reward trade‐off in a given stock. They are meant to supplement the use of quant‐only risk models that, while offering at least the illusion of precision, are also often opaque and backward looking. The approach aims to increase transparency while avoiding unnecessary complexity by focusing on a handful of critical uncertainties and modeling a manageable number of coherent scenarios that are relevant to investor debates and cover a full range of plausible outcomes.

This article focuses on the theoretical underpinnings of the department's Risk‐Reward initiative. For a more detailed discussion of the institutional setting and the processes followed to implement these ideas, readers are referred to the recently published Harvard Business School case study, “The Risk‐Reward Framework at Morgan Stanley Research” (Harvard Business School Case N9–111–011).
Effects of Slow, Sustained, and Rate‐Tunable Nitric Oxide Donors on Human Aortic Smooth Muscle Cells Proliferation
Authors: Yu Hao , Payne Thomas J. , Mohanty Dillip K.
Published: July 2011

Smooth muscle cell (SMC) proliferation has been accepted as a common event in the pathophysiology of vascular diseases, including atherogenesis and intimal hyperplasia. Delivery of the nitric oxide synthase (NOS) substrate l‐arginine, pharmacological nitric oxide (NO) donors, NO gas or overexpression of NOS proteins can inhibit SMC proliferation and reduce the injury responses within the blood vessel wall. Although commercial development of NO donors that attempt to provide exogenous delivery of NO has accelerated over the last few years, none of the currently available products can provide controlled, sustained, time‐tunable release of NO. Nitrosamine‐based NO donors, prepared in our laboratory, present a unique and innovative alternative for possible treatments for long‐term NO deficiency‐related diseases, including atherosclerosis, asthma, erectile dysfunction, cancer, and neurodegenerative diseases. A family of secondary amines prepared via nucleophilic aromatic displacement reactions could be readily N‐nitrosated to produce NO donors. NO release takes place in three distinct phases. During the initial phase, the release rate is extremely fast. In the second phase, the release is slower and the rate remains essentially the same during the final stage. These compounds inhibited up to 35% human aortic smooth muscle cell proliferation in a concentration‐dependent manner.
Effect of chloroform, orange solvent and eucalyptol on the accuracy of four electronic apex locators
Authors: Al‐Hadlaq Solaiman M.
Published: July 2011

The aim of this study was to evaluate the effect of three retreatment solutions on the accuracy of four electronic apex locators, the Root ZX mini, the Mini Apex Locator, the Root ZX and the Elements Diagnostic Unit and Apex Locator. Forty extracted single‐rooted human teeth were used in this study. The four electronic apex locators were operated according to the manufacturer's instructions to locate the ‘apical constriction’ in the presence of chloroform, orange solvent or eucalyptol in the canal. The accuracy of each apex locator was not affected by the type of retreatment solution present in the root canal. In addition, the accuracy of the four apex locators was similar in the presence of each of the tested solutions.
Listening to Fluoxetine: A Hot Message from the FLAME Trial of Poststroke Motor Recovery
Authors: Cramer Steven C.
Published: July 2011

The fluoxetine for motor recovery after acute ischemic stroke study was a double blind, placebo-controlled trial examining the effects of fluoxetine in patients five- to 10 days after an ischemic stroke. The study found motor improvement to 90 days poststroke, measured as the change in the Fugl–Meyer score, was significantly greater in the fluoxetine group as compared with the placebo group, and that this finding was significant after adjusting for depression. Patients randomized to fluoxetine also had less disability (modified Rankin Scale 0–2). The study adds to the weight of data suggesting that viable strategies exist to improve patient outcomes by initiating a restorative agent, days after stroke injury is fixed. Stroke remains among the leading causes of human disability. Currently, a minority of patients can access approved reperfusion therapies, and among those so treated a substantial fraction derives limited benefit. Therapies that target restorative events have a time window measured in days–weeks and so hold the potential to help many patients with stroke.
Current Role of Biomarkers in Carotid Disease: A Systematic Review
Authors: Avgerinos Efthimios D. , Kadoglou Nikolaos P. E. , Moulakakis Konstantinos G. , Giannakopoulos Triantafillos G. , Liapis Christos D.
Published: July 2011

Background and purpose

Accumulating evidence suggests that carotid plaque vulnerability can be used as a determinant of ischemic stroke risk stratification and carotid intervention. Novel markers of high-risk carotid plaque in patients are needed.

Summary of review

Advances in cellular and molecular pathophysiology, the demand for accurately predicting carotid risk, and choosing the optimal prevention strategy are stimulating great interest in the development of novel surrogate markers. Biomarkers in cardiovascular disease are expected to predict the natural history, clinical outcomes, and the efficacy of disease-modifying interventions. We aimed to review the literature regarding clinical data on novel serum biomarkers related to ischemic cerebrovascular events associated with carotid artery disease. We provide background information on the biomarkers related to all aspects of carotid disease: natural history, carotid intervention strategies for symptomatic and asymptomatic patients, perioperative risk prediction, and their therapeutic implications.

Conclusion

At present, heterogeneous data support evidence that biological markers can help existing practices to more accurately assess patients at risk for stroke. Randomized-controlled trials for carotid artery disease and carotid intervention, incorporating biomarkers, are needed.
Poststroke Fatigue: An Emerging, Critical Issue in Stroke Medicine
Authors: Choi-Kwon Smi , Kim Jong S.
Published: July 2011

Poststroke fatigue is a common and disabling condition. However, few studies on or therapeutic trials addressing poststroke fatigue have appeared in the literature. We aimed to review the prevalence, natural course, potential predisposing factors (physiological, psychocognitive, and organic), and pharmacological and nonpharmacological treatments of poststroke fatigue. Using PubMed CINAHL and PsycINFO, we reviewed all the available literature on poststroke fatigue and related issues. The prevalence of poststroke fatigue ranges from 23% to 75%, depending on the definition of fatigue and the characteristics of the patients included. Post-stroke fatigue seems to be of complex etiology. Predisposing factors were physiological ones including functional disability, prestroke fatigue, medical comorbidities, medication, sleep disturbances, and nutritional problems; psychocognitive ones including depression and cognitive dysfunction; and organic ones including damage to particular brain areas with consequent neurochemical alterations, perfusion deficit, and neuroinflammation. Poststroke fatigue is a persistent and debilitating symptom in some patients, and can have adverse affects on patient's neurological recovery, quality of life, and mortality. Few therapeutic trials have been reported, and the therapy was rarely successful, possibly because of the complex nature of poststroke fatigue. Poststroke fatigue is a common and frequently disabling problem of complex etiology. Further studies are urgently needed to improve our understanding of the pathophysiology of post-stroke fatigue and to develop better treatments for this condition.
Have Medical Therapy and Stenting Been Fairly Compared? A Repercussion upon Termination of Recruitment in the SAMMPRIS Trial
Authors: Leung Thomas W. , Yu Simon C. H. , Wong K. S. Lawrence
Published: July 2011

The recruitment of the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis, an National Institute of Neurological Disorders and Stroke-funded clinic trial evaluating aggressive medical therapy vs. adjunctive intracranial angioplasty and stenting in high-grade symptomatic intracranial stenosis, was prematurely terminated by the study Data Safety Monitoring Board. The significantly higher 30-day stroke and death rate in the stenting arm led to a conclusion from the National Institute of Neurological Disorders and Stroke and the Executive Committee that aggressive medical management alone was superior to angioplasty combined with stenting. The authors discussed on the potential pitfalls, which may render this conclusion premature and explained the needs for continuing efforts in investigating treatment for intracranial stenosis.
Artificial Photosynthesis: From Molecular Catalysts for Light‐driven Water Splitting to Photoelectrochemical Cells
Authors: Andreiadis Eugen S. , Chavarot‐Kerlidou Murielle , Fontecave Marc , Artero Vincent
Published: July 2011

Photosynthesis has been for many years a fascinating source of inspiration for the development of model systems able to achieve efficient light‐to‐chemical energetic transduction. This field of research, called “artificial photosynthesis,” is currently the subject of intense interest, driven by the aim of converting solar energy into the carbon‐free fuel hydrogen through the light‐driven water splitting. In this review, we highlight the recent achievements on light‐driven water oxidation and hydrogen production by molecular catalysts and we shed light on the perspectives in terms of implementation into water splitting technological devices.
Des‐gamma‐carboxyprothrombin in patients with hepatocellular carcinoma and liver cirrhosis
Authors: INAGAKI Yoshinori , XU Huan Li , HASEGAWA Kiyoshi , AOKI Taku , BECK Yoshifumi , SUGAWARA Yasuhiko , TANG Wei , KOKUDO Norihiro
Published: July 2011

OBJECTIVES:  To ascertain serum and tissue expression of des‐gamma‐carboxyprothrombin (DCP) in patients with hepatocellular carcinoma (HCC) and liver cirrhosis and clarify the relationship between DCP expression and prognosis.

METHODS:  Expression of DCP in tissues was evaluated with immunohistochemical staining using anti‐DCP antibody in 74 patients with a single primary HCC nodule and liver cirrhosis. Their serum DCP levels were determined using an enzyme immunoassay with a double antibody sandwich system.

RESULTS:  Positive DCP expression in cancerous and non‐cancerous tissues was related to a worse prognosis for patients with HCC and liver cirrhosis. The combined evaluation of tissue DCP expression and serum DCP level showed that prognosis was the worst for patients with positive tissue DCP expression and a high serum DCP level. Univariate analysis indicated that a lower 5‐year survival rate was significantly correlated with positive tissue DCP expression, a high serum DCP level and the combined factor of positive tissue DCP expression and a high serum DCP level. Multivariate analysis indicated that the combined factor of positive tissue DCP expression and a high serum DCP level was a significant prognostic factor.

CONCLUSION:  The combined evaluation of tissue DCP expression and serum DCP level is more useful than either factor alone in predicting prognosis for patients with HCC and liver cirrhosis.
Anti‐nuclear antibody positivity and the use of certolizumab in inflammatory bowel disease patients who have had arthralgias or lupus‐like reactions from infliximab or adalimumab
Authors: VERMA Himanshu Dev , SCHERL Ellen Janice , JACOB Vinita Elizabeth , BOSWORTH Brian Paul
Published: July 2011

OBJECTIVE:  Tumor necrosis factor (TNF) inhibitors can be used to treat inflammatory bowel disease (IBD) but may lead to anti‐nuclear antibody (ANA) positivity and lupus‐like reactions. Because of its unique structure, certolizumab has lower rates of these complications. We sought to investigate whether patients who have had lupus‐like reactions to infliximab or adalimumab would be able to tolerate certolizumab.

METHODS:  We performed a retrospective analysis on the 23 patients at the Roberts Inflammatory Bowel Disease Center who received certolizumab for the treatment of Crohn's disease from March 2008 to June 2009. We identified 6 patients who were switched to this drug because of lupus‐like reactions from prior anti‐TNF therapy and had documented ANA after the reaction and prior to certolizumab initiation. We then rechecked the ANA status after certolizumab initiation.

RESULTS:  Five out of 6 patients had a resolution of their arthralgias or lupus‐like symptoms after being switched to certolizumab (P < 0.001). Of the 4 patients who were ANA positive after receiving infliximab or adalimumab, 2 became ANA negative after induction with certolizumab (P = 0.17). There was no difference in Harvey Bradshaw index scores (10.3 vs. 9.8) pre‐certolizumab and post‐certolizumab (P = 0.73).

CONCLUSION:  Nearly all patients experienced relief from their lupus‐like symptoms with certolizumab and 2 out of 4 patients reversed their ANA positivity. While future investigation is warranted, patients who have lupus‐like reactions from infliximab or adalimumab may benefit from switching to certolizumab.
The role of p38 mitogen‐activated protein kinase in the pathogenesis of inflammatory bowel disease
Authors: FENG Ya Jing , LI Yong Yu
Published: July 2011

Inflammatory bowel disease (IBD) includes ulcerative colitis and Crohn's disease which is characterized by the recurrent intestinal inflammation and overactive immune responses. The signaling pathways of p38 mitogen‐activated protein kinase (MAPK) play an important role in bowel inflammation. The inhibition of p38 MAPK can effectively suppress the expression of inflammatory mediators. However, due to the obvious preclinical and clinical side effects, p38 inhibitors are unacceptable in safety profiles and cannot be applied in the treatment of IBD. MAPK‐activated protein kinase 2 (MK2), as the direct substrate of p38α and p38β, is a multifunctional signaling protein in the progression of inflammation and several lines of evidence demonstrate that the inhibition of MK2 may produce the same beneficial effect as the inhibition of p38 MAPK. Hence, MK2 is likely to be a potential drug target for the treatment of IBD.
Role of Mercury Toxicity in Hypertension, Cardiovascular Disease, and Stroke
Authors: Houston Mark C.
Published: July 2011

J Clin Hypertens (Greenwich). 2011;13:621–627. ©2011 Wiley Periodicals, Inc.

Mercury has a high affinity for sulfhydryl groups, inactivating numerous enzymatic reactions, amino acids, and sulfur‐containing antioxidants (N‐acetyl‐L‐cysteine, alpha‐lipoic acid, L‐glutathione), with subsequent decreased oxidant defense and increased oxidative stress. Mercury binds to metallothionein and substitute for zinc, copper, and other trace metals, reducing the effectiveness of metalloenzymes. Mercury induces mitochondrial dysfunction with reduction in adenosine triphosphate, depletion of glutathione, and increased lipid peroxidation. Increased oxidative stress and reduced oxidative defense are common. Selenium and fish containing omega‐3 fatty acids antagonize mercury toxicity. The overall vascular effects of mercury include increased oxidative stress and inflammation, reduced oxidative defense, thrombosis, vascular smooth muscle dysfunction, endothelial dysfunction, dyslipidemia, and immune and mitochondrial dysfunction. The clinical consequences of mercury toxicity include hypertension, coronary heart disease, myocardial infarction, cardiac arrhythmias, reduced heart rate variability, increased carotid intima‐media thickness and carotid artery obstruction, cerebrovascular accident, generalized atherosclerosis, and renal dysfunction, insufficiency, and proteinuria. Pathological, biochemical, and functional medicine correlations are significant and logical. Mercury diminishes the protective effect of fish and omega‐3 fatty acids. Mercury inactivates catecholaminei‐0‐methyl transferase, which increases serum and urinary epinephrine, norepinephrine, and dopamine. This effect will increase blood pressure and may be a clinical clue to mercury‐induced heavy metal toxicity. Mercury toxicity should be evaluated in any patient with hypertension, coronary heart disease, cerebral vascular disease, cerebrovascular accident, or other vascular disease. Specific testing for acute and chronic toxicity and total body burden using hair, toenail, urine, and serum should be performed.
Cerebral Microangiopathy in Treatment‐Resistant Hypertension
Authors: Schmieder Roland E. , Schmidt Bernhard M.W. , Raff Ulrike , Bramlage Peter , Dörfler Arnd , Achenbach Stephan , Schwab Johannes , Kolominsky‐Rabas Peter
Published: July 2011

J Clin Hypertens (Greenwich). 2011;13:582–587. ©2011 Wiley Periodicals, Inc.

Cerebral microangiopathy is a cause of cognitive impairment and indicates high risk for clinically overt cerebrovascular disease. It develops in patients with or without hypertension, and different pathologies may play a supporting role. In this pilot study, the authors aimed to elucidate risk factors contributing to the deleterious action of hypertension on cerebral small vessels. A cross‐sectional study in 42 patients with treatment‐resistant hypertension was performed. Microangiopathy was investigated by cerebral magnetic resonance imaging (MRI). Determinants were identified by clinical investigation, computed tomography, intima‐media thickness and pulse wave velocity measurement, and urinary albumin excretion. Nineteen of 42 patients had cerebral microangiopathy (23 controls). Patients were different with respect to heart rate (60.5±10.2 vs 69.7±15.1 beats per minute; P=.029) and systolic blood pressure during nighttime (138±13 mm Hg vs 126±18 mm Hg; P=.019). In addition, there were significant differences in pulse wave velocity (10.7±2.0  m/s vs 9.4±1.4 m/s; P=.034), peripheral pulse pressure (70.8±16.3 mm Hg vs 59.2±13.6 mm Hg; P=.016), central pulse pressure (62.9±15.8 mm Hg vs 50.3±14.2 mm Hg; P=.012), and aortic augmentation pressure (15.9±6.0 vs 11.8±6.6; P=.040). Systolic blood pressure and signs of hypertensive vasculopathy such as peripheral and central pulse pressure and pulse wave velocity were associated with cerebral microangiopathy in patients with long‐standing treatment‐resistant hypertension.
The all‐ceramic, inlay supported fixed partial denture. Part 2. Fixed partial denture design: a finite element analysis
Authors: Thompson MC , Field CJ , Swain MV
Published: July 2011

The clinical use of all‐ceramic crowns and fixed partial dentures has seen widespread adoption over the past few years due to their increasing durability and longevity. However, the application of inlays as an abutment design has not been as readily embraced because of their relatively high failure rates. With the use of an idealized inlay preparation design and prosthesis form which better distributes the tensile stresses, it is possible to utilize the inlay as support for an all‐ceramic fixed partial denture. Utilizing a three‐dimensional finite element analysis, a direct comparison of the inlay supported all‐ceramic bridge against the traditional full crown supported all‐ceramic bridge is made. The results demonstrate that peak stresses in the inlay bridge are around 20% higher than in the full crown supported bridge with von Mises peaking at about 730 MPa when subjected to theoretical average maximum bite force in the molar region of 700 N, which is similar to the ultimate tensile strengths of current zirconia based ceramics.
Turnover in dirty work occupations: A focus on pre‐entry individual characteristics
Authors: Lopina Erika C. , Rogelberg Steven G. , Howell Brittany
Published: July 2011

The current study explored newcomer turnover in a unique population: dirty workers. Based on social identity theory (SIT) and conservation of resources theory (COR), a set of individual level predictors theoretically relevant to dirty work turnover were identified. We examined whether differences in access to job information prior to hire, career commitment, belief in the value of the job, negative affectivity (NA), and maladaptive coping style were related to turnover of animal shelter employees with euthanasia responsibilities. Results supported the potential importance of all variables for understanding turnover amongst these dirty workers. Access to job information, NA, and maladaptive coping style were found to have the highest relative importance amongst the set of predictors.
Stress Intensity Factor Equations for Internal Semi-Elliptical Cracks in Pressurized Cylinders
Authors: Alegre J. M. , Cuesta I. I.
Published: July 2011

In order to calculate the fatigue life of cylinders subjected to internal pressure using the fracture mechanics approach, the stress intensity factors (SIFs) for internal semi-elliptical cracks are needed. Nowadays, the most accurate procedure for fatigue life calculation consists in starting from a postulated internal semi-elliptical crack and updating the flaw aspect ratio during the crack propagation. In this sense, assuming a semi-elliptical shape during crack propagation, SIFs both at the deepest crack point and at the surface point must be calculated in order to update the crack aspect ratio through its fatigue propagation. This continuous crack shape updating cannot be done using the conventional tabulated solutions, as those provided in the main design codes and SIF handbooks. This paper presents a number of closed-form equations, which very accurately fit the tabulated results in ASME Boiler and Pressure Vessel Code, Section VIII, Division 3, to calculate the SIF for internal semi-elliptical cracks in cylinders subjected to internal pressure. These equations can be used to avoid the use of the tabulated solutions, and, as a consequence, an automatic numerical integration of the propagation law can be done.
Effect of Lüders Plateau on Fracture Response and Toughness of Pipelines Subject to Extreme Plastic Bending
Authors: Nourpanah Nikzad , Taheri Farid
Published: July 2011

The reeling technique presents an economical pipeline installation method for offshore oil and gas applications, especially for thick-wall (low D/t) pipelines. During reeling, the pipe is subjected to large plastic bending strains up to 3%. In thick-wall pipes, the tensile fracture response of the pipeline/girth weld would normally be the governing limit state. Seamless line pipes are preferred for the reeling applications in which the Lüders plateau is often exhibited in materials stress-strain response. In this paper, the fracture response of such pipelines is investigated from a continuum perspective using a nonlinear 3D finite element analysis. A typical pipeline with a hypothetical defect is considered, with the material having a range of Lüders strains and strain hardening indices. Results show that the Lüders plateau modifies the shape of the moment-strain response curves of the pipe, as well as the J-integral fracture response. It is observed that the response is always bounded between two limiting material models, which are (i) the elastic-perfectly plastic stress-strain response and (ii) the conventional elastic-strain hardening plasticity response, without a Lüders plateau. Also, the Lüders plateau was observed to decrease the crack opening stress ahead of the crack tip and thus the crack tip constraint. On the other hand, the presence of a Lüders plateau elevates the near tip plastic strain and stress triaxiality fields, thus promoting ductile fracture. A micromechanical damage integral model coupled with a modified boundary layer analysis was incorporated to study this aspect. Based on the findings of this study, it is believed that the presence of Lüders plateau could significantly alter the fracture response and toughness of pipes subject to relatively high strains.
Use of Functionally Graded Material Layers in a Two-Layered Pressure Vessel
Authors: Carrera E. , Soave M.
Published: July 2011

This work explores the possibilities of using functionally graded material (FGM) layers to reduce normal and shear stress gradients due to internal pressure and thermal loadings at the interface of a two-layered wall pressure vessel. The two walls are made of an internal thin metallic layer (titanium used as a liner to avoid a chemical/physical reaction between the gas and the external layer) and an external thick layer (carbon fiber used as a structural restraint). Two main geometrical elements are investigated: a cylindrical shell and a spherical panel. The shell analysis has been made by referring to mixed layerwise theories, which lead to a three-dimensional description of the stress/strain fields in the thickness shell direction; results related to the first order shear deformation theory are given for comparison purposes. It has been concluded that it is convenient to use FGM layers to reduce shear and normal stress gradients at the interfaces. Furthermore, the FGM layers lead to benefits as far as buckling load is concerned; lower values of in-plane shear and longitudinal compressive stresses are, in fact, obtained with respect to a pure two-layered wall.
S3.5 Scaling up novel biomedical HIV prevention strategies: evidence for action
Authors: Hankins C
Published: July 2011

Randomised controlled trial results can provide the scientific rationale for implementing new biomedical HIV prevention strategies but are not sufficient. Generalisability of trial findings, good participatory trial conduct, acceptability studies, demand creation, costing and impact studies, human resource constraints, supply chain management, risk compensation, gender implications, opportunity costs, regulatory issues, and sociopolitical considerations also influence policy makers and programme planners considering adoption and implementation. Knowledge translation examples drawn from male circumcision, tenofovir gel microbicide, and oral pre-exposure prophylaxis will be presented to illustrate the evidence to be considered in scale-up.
S4.5 Maternal syphilis testing and treatment to improve maternal and child health services: progress and challenges
Authors: Kamb M
Published: July 2011

Background

In 2007, WHO released the document Global Elimination of Congenital Syphilis, Rationale and Strategy for Action, developed in collaboration with a team of expert consultants. The strategy aims to prevent mother to child transmission of syphilis through the strengthening of antenatal care programs to ensure:

Early antenatal care for all women, with universal syphilis screening and prompt treatment of those infected

Treatment of all sexual partners of infected women, promotion of condom use during pregnancy, and counselling of all women on how to prevent infection

All neonates born to RPR-positive mothers are given a single dose of penicillin as prophylactic treatment.

This presentation documents progress in the global elimination initiative thus far, notes challenges towards substantial reduction in congenital syphilis by 2015, and proposes areas for focus in the next 2 years.

Methods/results

Most progress has been made in areas of advocacy and recognition of the public health problem, the emergence of rapid diagnostic tests and (in some areas of the world) integrated intervention initiatives such as those linking prevention of mother to child transmission of HIV and congenital syphilis. Progress has also been made in integration of a handful of critical indicators into existing data collection systems, allowing better monitoring of national and global program progress. Publication of program evaluations has been mixed, with increased reporting on evaluations of implementing testing and treatment strategies, but still limited research on validation of proposed impact targets (eg, use of stillbirth as an indicator of impact). Additionally, specific funding remains limited, although an Investment Case for donors is near completion and some new opportunities for funding integrated services have arisen.

Conclusions

Some emerging global issues such recent initiatives and trends in global public health financing may influence future progress. National guidelines on testing strategies are needed to avoid less than optimal or more costly than needed testing strategies. More focused efforts on earlier and higher quality antenatal care will likely support congenital syphilis elimination along with promoting better overall antenatal services.
S5.1 The other vaginitides: update on desquammative inflammatory vaginitis and refractoryCandida vaginitis
Authors: Sobel J D
Published: July 2011

Desquammative Inflammatory Vaginitis (DIV) is now recognised as a not uncommon caused of purulent vaginitis with a profuse discharge accompanying dyspareunia and vaginal burning. Less well recognised are the vestibular and vulvar manifestations of this chronic idiopathic and likely immune mediated inflammatory process which occurs exclusively in Caucasian women usually in the peri-menopausal period. The syndrome must be differentiated from trichomoniasis since both share several clinical manifestations including markedly elevated vaginal pH and inflammatory cell infiltrate, but several features to be discussed allow correct diagnosis.

DIV is likely precipitated by oestrogen deficiency explaining it's unique epidemiology. Treatment consisting of high potency steroids and other local anti-inflammatory agents results in rapid improvement but cure frequently requires prolonged long term therapy.

A new clinical entity of recurrent vaginitis due either to drug resistant Candida albicans and other Candida species including Candida glabrata will be discussed. These frustrating cases constitute a major therapeutic challenge because of intrinsic or acquired fluconazole resistance and frequent cross resistance to the entire Azole drug class. Therapeutic options are few, moreover, in vitro breakpoints defining Azole drug resistance have not been established. Prolonged exposure to fluconazole appears responsible. Cases will be presented describing several forms of refractory drug resistant vaginal candidiasis.
S1.2 Applying semen biomarkers to HIV/STI research
Authors: Gallo M F
Published: July 2011

Research on the prevention of HIV/STIs generally has relied on self reports of sexual activity, which are vulnerable to bias. Self-reported data on sexual behaviours could have poor validity for several reasons, namely social desirability bias, recall bias, lack of awareness of exposure (eg, undetected condom breakage), and poor comprehension or misinterpretations of the survey questions. This presentation will briefly describe biomarkers of semen exposure, in particular, prostate-specific antigen detected in vaginal fluid, and will give examples of the ways in which biomarkers could be used to strengthen research on (1) effectiveness of barrier methods against HIV/STIs; (2) effectiveness of behavioural interventions to prevent HIV/STIs; (3) condom “migration” from HIV/STI interventions; (4) the validity of self-reported data; and (5) methods to improve the validity of self-reported data. Limitations of biomarkers include their narrow scope, cost, relatively quick clearance, and unknown biological significance of biomarker levels in relation to risk of HIV/STIs. Finally, examples of future areas of research will be provided.
S5.3 New data on pelvic inflammatory disease: implications for screening and management
Authors: Ross J
Published: July 2011

Pelvic inflammatory disease is a common cause of morbidity in young sexually active women, but many of our preventive efforts and management strategies are based on empirical approaches. Central to the implementation of chlamydia screening programmes is an understanding of the risk of PID following chlamydial infection. The recent POPI study helps to inform this risk and also provides information about the role of other potential pathogens. The importance of Mycoplasma genitalium as a cause of PID needs to be clarified, but its implications for testing and treatment are now becoming clearer. Women with PID are often poorly adherent to antimicrobial treatment and recent trials suggest that newer treatment regimens may be easier to take and have the potential to improve outcomes.
S7.4 Cost-effectiveness of targeted HIV preventions for female sex workers: an economic evaluation of the Avahan programme in Southern India
Authors: Chandrashkar S , Vassall A , Guinness L , Pickles M , Reddy B , Shetty G , Boily M C , Lowndes K , Alary M , Vickerman P
Published: July 2011

Objective(s)

The aim of the presentation paper is to assess the cost-effectiveness of HIV prevention interventions for female sex workers in India, in the context of large-scale programme effort, the Avahan Programme.

Design/methods

We estimate cost-effectiveness using comprehensive measurements of cost; and, impact estimates based on dynamical transmission models of HIV and STI transmission that are fitted to observed prevalence trends. Our primary outcome measure is incremental cost per DALY averted (ICER) for the HIV prevention programme compared to a “do-nothing” base case.

Results

In 2007, the implementing NGO cost per person reached at least once in a year ranges from US$47 to US$154. When all costs are taken into account (including expertise enhancement, management and contracting costs), the cost per person reached increases to US$112 to US$ 213, depending on location and year. Median incremental costs per infection averted range from US$ 876 (370, 3040) to US$2574 (1344, 7132). Median incremental costs per DALY averted range from US$49 (20 171) in to US$ 143 (74, 388). These costs per DALY may increase as results from other states are included.

Conclusions

This study presents robust evidence that demonstrates that HIV prevention interventions targeted at high risk vulnerable groups can achieve substantial reductions in HIV infections at an acceptable cost in a concentrated epidemic setting. Moreover, we demonstrate cost-effectiveness in the context of a programme that is delivering HIV prevention at scale. However, the achievement of cost-effectiveness varies by setting. Our findings suggest that those responsible for HIV programmes should therefore consider funding targeted HIV prevention programmes at high risk groups in India and beyond, but should take into account setting specific drivers of the HIV epidemic.
S8.2 Synergy: public health, clinicians, laboratories and management guidelines
Authors: Martin I , Wong T
Published: July 2011

There is growing concern that the increasing prevalence of AMR inN gonorrhoeaewill compromise effective treatment and disease control efforts. Early warning systems and the creation of, public health, clinical and laboratory networks are critical to detect the emergence of resistance and treatment failures.

Using specific examples to illustrate best practises, this presentation will focus on mechanisms to:

Enable adequate, timely AMR surveillance to inform treatment guidelines;

Establish a strategy to rapidly detect patients with gonococcal infections who experience a clinical and/or microbiological treatment failure especially with recommended cephalosporin or azithromycin therapy; and

Promote effective public health and clinical management of patients and their sexual partners.
S8.3 Research and training needs
Authors: Dillon J A
Published: July 2011

Establishing treatment guidelines, improving capacity to monitor antimicrobial susceptibility, and adequate supply of quality medications are key strategies to slow the spread of resistant gonorrhoea. Advances in the public health and clinical management ofN gonorrhoeaestem from basic research on the biology of the organism, the development of diagnostic capabilities, and the availability of more effective drugs. The “bench to practise” translation of this research is vital to building capacity.

This presentation will focus on the gonorrhoea resistance research and training opportunities to contribute to the prevention and control efforts.
S9.1 The role of mathematical models in planning and evaluating programmes
Authors: Garnett G
Published: July 2011

The potential use of mathematical models in programme science will be reviewed. The adoption, planning, implementation, and evaluation of programmes in global health should be an iterative process where the collection and analysis of data plays a significant role in planning and evaluation. Mathematical models provide a framework for the integration of data from multiple sources, predicting the impact of programmes based on efficacy data for the range of interventions combined and providing counterfactuals to estimate effect sizes in evaluating impact. Mathematical models describing the impact of alternative interventions are central in health economic analyses. Models can usefully be combined with theories describing why programmes should have an impact in the design and evaluation of the programmes. Synergies in interventions can be considered at multiple levels: in the individual both in enhancing behaviour changes and combining to reduce risks; in populations changing the epidemiological context; in programme activities; and in creating environments where interventions can succeed. Models explain what we can expect from these synergies and help us identify how to integrate new technologies into programmes.
S9.3 The programme science of scale: the Avahan experience
Authors: RamaKrishnan A
Published: July 2011

The Avahan HIV prevention programme of the Bill & Melinda Gates Foundation in India has achieved scale/quality/coverage, and is beginning to show signs of HIV impact on high risk groups and the general population. The approach of the programme has been to combine business principles of scaling up with technical aspects of HIV programming to develop a model for scaling up public health interventions through designing, organising, executing and sustaining for scale. This presentation will share the background of the Avahan programme, its results, and a framework for the programme science of scaling up.
S9.4 International AIDS policy choices for a changing financing landscape
Authors: Wilson D
Published: July 2011

Background

In 2009, AIDS financing fell for the first time, reflecting the global financial crisis and shifting health and development priorities. In this context, future international AIDS policy must focus on efficiency, effectiveness and sustainability.

Efficiency

The surge of financing for AIDS over the last decade has sometimes led to sub-optimal efficiency. There is an urgent need to improve allocative efficiency, by ensuring resources are allocated for the best proven and most relevant interventions among the right groups in the right geographic areas. AIDS responses globally are beset by mismatches between investments and epidemiological context and program choices. There is also a need to improve technical efficiency, so that selected interventions are delivered at scale, for the lowest cost. Several studies show how the same services in the same context in the same country can vary by several orders of magnitude. In a resource constrained future, such variances must be reduced and technical efficiency constantly improved. Integration of health-related HIV services and other health services may also yield greater efficiencies.

Effectiveness

In concentrated epidemics, particularly among sex workers, where we have well validated interventions, our major priorities are to improve allocative and technical efficiency, so we direct our resources towards effective interventions for priority populations. In generalised epidemics, we need to strengthen our evidence of what works. Beyond male circumcision, we have limited proven interventions to reduce general population adult sexual transmission. We also need to move from efficacy to effectiveness, demonstrating that proven approaches can have real world effect at scale. We need to strengthen the middle-ground between randomised control trials and observation, by using quasi-experimental techniques to construct robust counterfactuals—that is, what would have happened without the counterfactual. We also need to make biological end-points, primarily HIV incidence or credible incidence proxy measures.

Sustainability

We must move from an emergency response to longer-term sustainability. This will include increasing and diversifying domestic resource mobilisation, especially in middle-income countries and diversifying the sources of international financing. Services that are related to AIDS but also related to other elements of the health sector, such as blood safety and universal precautions will increasingly be financed from overall health sector resources.

Conclusion

We must urgently re-position the global AIDS response, guided by the drive for greater efficiency, effectiveness and sustainability—we have no time to lose.