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OBJECTIVES/GOALS: Patient online portal (POP) allows patients to access electronic health records (EHRs) and have efficient communication with their clinicians. We assessed disparities in access to POP by families with different SES and its impact on asthma research which is little known in the literature. METHODS/STUDY POPULATION: A randomized controlled trial testing the efficacy of an EHRs-based clinical decision support (CDS) system was conducted at a pediatric primary care setting of Mayo Clinic. Asthma Control Test (ACT) questionnaire was administered to parents every 3 months through phone or email for this study after consenting, and reminders were sent to unanswered subjects through the POP. SES was measured by HOUSES (in quartiles), a validated individual-level SES index based on housing features (the higher HOUSES, the higher SES).The association of HOUSES with availability of POP access and missing ACT score rate was assessed. RESULTS/ANTICIPATED RESULTS: The mean age of 184 participants was 9.0 years (57% male) and parents of 152 (83%) children had POP. Only 68% of children from lowest HOUSES (Q1) had access to POP (vs. 74% (Q2), 88% (Q3), and 92% (Q4; highest SES); p = .02). ACT score was completed by 144 (78%), 150 (82%), 171 (94%), and 164 (95%) at each intervention conducted every 3 months with a total of 61 (33%) missing at least once. Overall, children whose parents had access to POP had a lower missing rate in ACT score at all interventions during the study; 16% (those with access to POP) vs. 47% (those without), 13% vs. 44%, 3% vs. 16%, and 1% vs. 23% for 1st, 2nd, 3rd, and 4th intervention, respectively (p < .007 for all). DISCUSSION/SIGNIFICANCE OF IMPACT: There are significant disparities in access to POP by SES defined by HOUSES which impact availability of ACT score resulting in a systematic bias in asthma research and potentially widening disparities in asthma care. CONFLICT OF INTEREST DESCRIPTION: NA.
There have been many changes in the treatment of bipolar disorder.
It is necessary to develop guidelines that can more aptly respond to cultural issues and specifics in different countries.
The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) was firstly published in 2002, with updates in 2006 and 2010. This third update reviewed the experts' consensus of opinion on the pharmacological treatments of bipolar disorder.
The newly revised questionnaire composed of 55 key questions about clinical situations including 223 sub-items was sent to the experts.
Combination of mood stabilizer (MS) and atypical antipsychotic (AAP) was the first-line treatment option in acute mania. For the management of severe psychotic bipolar depression, combination of MS and AAP, combination of AAP and LTG, combination of MS, AAP and AD or LTG, combination of AAP and AD, and combination of AAP, AD and LTG was the first-line treatments. Combination of MS and AAP was the treatment of choice for management of mixed features. Combination of MS and AAP, MS or AAP monotherapy was the first-line options for management of maintenance phase after manic episode. For maintenance treatment after bipolar I depression, combination of MS and AAP, combination of MS and LTG, combination of AAP and LTG, MS or LTG monotherapy, and combination of MS, AAP and LTG were the first-line options.
Despite the limitations of expert consensus guideline, KMAP-BP 2014 may reflect the current patterns of clinical practice and recent researches.
Response inhibition, a crucial factor of executive function, involves the ability to suppress irrelevant or interfering information and impulses. Clinical evidence suggests that Sex addicts have impairment of response inhibition as measured by behavioral task of response inhibition (Go-No go task) and a self report questionnaire (BIS-2 scale). To date, almost no studies have been conducted using functional imaging techniques to directly compare inhibitory control between Sex Addicts and controls. The present study examined neural substrates of response inhibition in Sex Addicts. Ten male with Sexual Addiction (20-35 age), age and intelligence quotient matched healthy controls were imaged using fMRI while performing Go-No go task. The results indicate that Sex Addicts find it difficult to inhibit their own actions (t = 2.72, p < 0.01). There were no differences in the neural substrates during Go trials between the groups. However, the controls were significantly hyperactive during No go trials in the right superior medial frontal gyrus (BA 6), left middle frontal gyrus (BA 46). Our result suggest that the frontal cortex may be involved in the circuit modulating inhibitory control, and its impaired function may relate to pathologic sexuality in Sex Addicts (i.e. an inability to control one's sexual behavior, thought, fantasy). These results also reveal a neurofunctional basis for this dysexecutive factor to Sexual Addiction.
We present recent observation results of Sgr A* at millimeter obtained with VLBI arrays in Korea and Japan.
7 mm monitoring of Sgr A* is part of our AGN large project. The results at 7 epochs during 2013-2014, including high resolution maps, flux density and two-dimensional size measurements are presented. The source shows no significant variation in flux and structure related to the G2 encounter in 2014. According to recent MHD simulations by kawashima et al., flux and magnetic field energy can be expected to increase several years after the encounter; We will keep our monitoring in order to test this prediction.
Astrometric observations of Sgr A* were performed in 2015 at 7 and 3.5 millimeter simultaneously. Source-frequency phase referencing was applied and a combined ”core-shift” of Sgr A* and a nearby calibrator was measured. Future observations and analysis are necessary to determine the core-shift in each source.
The reasons for the unprecedented mortality during the 1918 influenza pandemic remain poorly understood. We examined morbidity records from three military cohorts from years prior to and during the 1918 pandemic period to assess the effects of previous respiratory illnesses on experiences during the pandemic. Clinical registers and morbidity lists were examined to identify all medical encounters for acute respiratory illnesses in students at two U.S. military officer training academies and Australian soldiers deployed in Europe. Influenza-like illness prior to the major pandemic wave of 1918 predisposed Australian soldiers [relative risk (RR) 1·37, 95% confidence interval (CI) 1·18–1·60, P < 0·0001] and US officer trainees at West Point (RR 3·10, 95% CI 2·13–4·52, P < 0·0001) and Annapolis (RR 2·03, 95% CI 1·65–2·50, P < 0·0001) to increased risks of medically treated illnesses in late 1918. The findings suggest that susceptibility to and/or clinical expressions of the 1918 pandemic influenza virus depended on previous experiences with respiratory infectious agents. The findings are consistent with observations during the 2009 pandemic in Canada and may reflect antibody-dependent enhancement of influenza infection.
We present the first measurement of the anisotropy parameter β using 3D kinematic information outside of the solar neighborhood. Our sample consists of 13 Milky Way halo stars with measured proper motions and radial velocities in the line of sight of M31. Proper motions were measured using deep, multi-epoch HST imaging, and radial velocities were measured from Keck II/DEIMOS spectra. We measure β = −0.3−0.9+0.4, which is consistent with isotropy, and inconsistent with measurements in the solar neighborhood. We suggest that this may be the kinematic signature of a relatively early, massive accretion event, or perhaps several such events.
Glutathione peroxidase (GPx; EC 220.127.116.11) is an important antioxidant enzyme that catalyses the reduction of organic and inorganic hydroperoxides to water in oxygen-consuming organisms, using glutathione as an electron donor. Here, we report the characterization of a GPx of Cryptosporidium parvum (CpGPx). CpGPx contained a standard UGU codon for cysteine instead of a UGA opal codon for seleno-cysteine (SeCys) at the active site, and no SeCys insertion sequence (SECIS) motif was identified within the 3′-untranslated region (UTR) of CpGPx, which suggested its selenium-independent nature. In silico and biochemical analyses indicated that CpGPx is a cytosolic protein with a monomeric structure. Recombinant CpGPx was active over a wide pH range and was stable under physiological conditions. It showed a substrate preference against organic hydroperoxides, such as cumene hydroperoxide and t-butyl hydroperoxide, but it also showed activity against inorganic hydroperoxide, hydrogen peroxide. Recombinant CpGPx was not inhibited by potassium cyanide or by sodium azide. The enzyme effectively protected DNA and protein from oxidative damage induced by hydrogen peroxide, and was functionally expressed in various developmental stages of C. parvum. These results collectively suggest the essential role of CpGPx for the parasite's antioxidant defence system.
Cysteine proteases of pathogenic protozoan parasites play pivotal roles in the life cycle of parasites, but strict regulation of their activities is also essential for maintenance of parasite physiology and interaction with hosts. In this study, we identified and characterized cryptostatin, a novel inhibitor of cysteine protease (ICP) of Cryptosporidium parvum. Cryptostatin showed low sequence identity to other chagasin-family ICPs, but 3 motifs (NPTTG, GXGG, and RPW/F motifs), which are evolutionarily conserved in chagasin-family ICPs, were found in the sequence. The overall structure of cryptostatin consisted of 8 β-strands that progressed in parallel and closely resembled the immunoglobulin fold. Recombinant cryptostatin inhibited various cysteine proteases, including papain, human cathepsin B, human cathepsin L, and cryptopain-1, with Ki's in the picomolar range. Cryptostatin was active over a wide pH range and was highly stable under physiological conditions. The protein was thermostable and retained its inhibitory activity even after incubation at 95°C. Cryptostatin formed tight complexes with cysteine proteases, so the complexes remained intact in the presence of sodium dodecyl sulfate and β-mercaptoethanol, but they were disassembled by boiling. An immunogold electron microscopy analysis demonstrated diffused localization of cryptostatin within oocystes and meronts, but not within trophozoites, which suggests a possible role for cryptostatin in host cell invasion by C. parvum.
Leucine aminopeptidases (LAPs) are a group of metalloexopeptidases that catalyse the sequential removal of amino acids from the N-termini of polypeptides or proteins. They play an important role in regulating the balance between catabolism and anabolism in living cells. LAPs of apicomplexa parasitic protozoa have been intensively investigated due to their crucial roles in parasite biology as well as their potentials as drug targets. In this study, we identified an M17 leucine aminopeptidase of Cryptosporidium parvum (CpLAP) and characterized the biochemical properties of the recombinant protein. Multiple sequence alignment of the deduced amino acid sequence of CpLAP with those of other organisms revealed that typical amino acid residues essential for metal binding and active-site formation in M17 LAPs were well conserved in CpLAP. Recombinant CpLAP shared similar biochemical properties such as optimal pH, stability at neutral pHs, and metal-binding characteristics with other characterized LAPs. The enzyme showed a marked preference for Leu and its activity was effectively inhibited by bestatin. These results collectively suggest that CpLAP is a typical member of the M17 LAP family and may play an important role in free amino acid regulation in the parasite.
Localized surface plasmon resonances (LSPR), collective electron oscillations in nanoparticles, are being heavily scrutinized for applications in chemical and biological sensing, as well as in prototype nanophotonic devices. This phenomenon exhibits an acute dependence on the particle’s size, shape, composition, and environment. The detailed characterization of the structure-function relationship of nanoparticles is obscured by ensemble averaging. Consequently, single-particle data must be obtained to extract useful information from polydisperse reaction mixtures. Recently, a correlated high resolution transmission electron microscopy (HRTEM) LSPR technique has been developed and applied to silver nanocubes. We report here a second generation of experiments using this correlation technique, in which statistical analysis is performed on a large number of single particles. The LSPR dependence on size, shape, material, and environment was probed using silver right bipyramids, silver cubes, and gold cubes. It was found that the slope of the dependence of LSPR peak on size for silver bipyramids increases as the edges become sharper. Also, a plasmon shift of 96 nm was observed between similar silver and gold cubes, while a shift of 26 nm was observed, for gold cubes, between substrates of refractive index (RI) of 1.5 and 2.05.
Cryptosporidium parvum is an intracellular protozoan parasite that causes cryptosporidiosis in mammals including humans. In the current study, the gene encoding the cysteine protease of C. parvum (cryptopain-1) was identified and the biochemical properties of the recombinant enzyme were characterized. Cryptopain-1 shared common structural properties with cathepsin L-like papain family enzymes, but lacked a typical signal peptide sequence and contained a possible transmembrane domain near the amino terminus and a unique insert in the front of the mature domain. The recombinant cryptopain-1 expressed in Escherichia coli and refolded to the active form showed typical biochemical properties of cathepsin L-like enzymes. The folding determinant of cryptopain-1 was characterized through multiple constructs with or without different lengths of the pro-domain of the enzyme expressed in E. coli and assessment of their refolding abilities. All constructs, except one that did not contain the full-length mature domain, successfully refolded into the active enzymes, suggesting that cryptopain-1 did not require the pro-domain for folding. Western blot analysis showed that cryptopain-1 was expressed in the sporozoites and the enzyme preferentially degraded proteins, including collagen and fibronectin, but not globular proteins. This suggested a probable role for cryptopain-1 in host cell invasion and/or egression by the parasite.
Melt-spun Fe73-Si16-B7-Nb3-Cu1 (at%) amorphous strip was pulverized and then crystallized to obtain nano-grain structure at 540° for 1h under a nitrogen atmosphere. Carbon black of 0.1∼ 1wt% and its dispersant were mixed with the nano-grain structured Fe-based powder for 1h via ball milling for 1h. The mixture was tape-cast with a polymer-based organic binder, and dried at 100° to make a thin sheet. The microstructure and electromagnetic wave absorption properties of the sheet were investigated using a network analyzer. As a result, the properties of electromagnetic wave absorption were improved by the increase of dielectric loss, which was mainly caused by the increase of complex permittivity with the addition of carbon black.
Lithium based complex hydrides, including lithium aluminum hydrides and lithium borohydride (LiAlH4, Li3AlH6 and LiBH4), are among the most promising materials due to their high hydrogen contents. In the present work, we investigated the hydrogen storage properties of a new combined system of Li3AlH6-LiBH4. The samples were made with small amounts of catalyst under low energy milling conditions. Thermogravimetric analysis (TGA) of a Ti-doped Li3AlH6/2LiBH4 indicated that the degree of hydrogen release reached 7.3 wt. % by the time the sample reached 450iÆc under a heating rate of 2iÆC/min. This increased to 8.8 wt. % when the sample was held at 450iÆCfor additional 8 hours minutes under this condition. The dehydrogenation product was a mixture of LiH and AlB2. This product could be rehydrogenated up to 3.8 wt. % under 24.1 MPa hydrogen pressure and 450iÆC.
This study was performed to assess the efficacy and safety profile of combination treatment with S-1 and cisplatin in patients with locally advanced squamous cell carcinoma of the head and neck.
Eligibility criteria comprised: histologically confirmed squamous cell carcinoma of the head and neck; stage three or four disease with no evidence of distant metastasis; evaluable lesions; adequate organ function; age 20–80 years; and a performance status of two or less. Cisplatin was infused over one hour on day one (75 mg/m2) and S-1 was administered orally for 14 consecutive days (days two to 15). The dosages of S-1 were calculated according to the patients' body surface area: 50 mg twice a day (body surface area <1.5 m2) or 60 mg twice a day (body surface area >1.5 m2). Each course was repeated every three weeks. After two courses, tumour response was evaluated by computed tomography and laryngoscopy. If a response was evident (either complete or partial), the patient received one more course of chemotherapy, before undergoing radical treatment such as radiotherapy or surgery.
All 30 patients were assessable for toxicity, and 29 patients for treatment response. The overall response was 89.7 per cent (complete response: nine; partial response: 17). The two-year estimated overall survival rate was 79.2 per cent. Adverse reactions occurred 128 times during 81 courses in the 30 cases. The most common grade three to four adverse event was neutropenia, which occurred in eight patients. Cases of non-haematological grade three or four toxicity included nausea and vomiting in four patients, stomatitis in two and diarrhoea in one.
S-1 plus cisplatin combination chemotherapy is effective against locally advanced squamous cell carcinoma of the head and neck, with only mild toxicity.
Using the (J − K, K) color-magnitude diagrams (CMDs) of 16 metal-poor globular clusters in the Galactic bulge, we investigate the morphological properties of their red-giant branch (RGB), comparing with those of metal-rich clusters in the Galactic bulge and metal-poor clusters in the Galactic halo. The RGB morphological parameters, such as colors at fixed magnitudes, magnitudes at a fixed color, the RGB slope, and a difference of color indices at two fixed magnitudes have been derived from the near-IR CMDs for each cluster. Metal-poor Galactic bulge clusters follow the previous empirical relations between colors at fixed magnitudes and magnitudes at a fixed color of the RGB and the cluster's metallicity. However, the RGB slope and the color difference parameters of some bulge clusters deviate slightly from the previous empirical linear relations for the other globular clusters, implying that the metal-poor bulge clusters may have different formation origin from the other globular clusters in the Galaxy.
We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection (SSI) rates among neurosurgical patients in Ho Chi Minh City, Vietnam.
A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15, 2000 (before the intervention), and July 14 and August 18, 2001 (after the intervention). A hand sanitizer with 70% isopropyl alcohol and 0.5% Chlorhexidine gluconate was introduced, and healthcare workers were trained in its use on ward A in September 2000. No intervention was made in ward B. Centers for Disease Control and Prevention definitions of SSI were used. Patient SSI data were collected on standardized forms and were analyzed using Stata software (Stata).
A total of 786 patients were enrolled: 377 in the period before intervention (156 in ward A and 221 in ward B) and 409 in the period after intervention (159 in ward A and 250 in ward B). On ward A after the intervention, the SSI rate was reduced by 54% (from 8.3% to 3.8%; P = .09), and more than half of superficial SSIs were eliminated (7 of 13 vs 0 of 6 in ward B; P = .007). On ward B, the SSI rate increased by 22% (from 7.2% to 9.2%; P = .8). In patients without SSI, the median postoperative length of stay and the duration of antimicrobial use were reduced on ward A (both from 8 to 6 days; P <.001) but not on ward B.
Our study demonstrates that introduction of a hand sanitizer can both reduce SSI rates in neurosurgical patients, with particular impact on superficial SSIs, and reduce the overall postoperative length of stay and the duration of antimicrobial use. Hand hygiene programs in developing countries are likely to reduce SSI rates and improve patient outcomes.