Search

This study identifies and summarizes potential risks to operations, regulatory compliance, supply chains, and infrastructure of the electric power industry from changing surface water conditions resulting from global climate change. The results help inform companies/utilities seeking to incorporate climate change risk in their planning and decision‐making processes by ranking risk severity and likelihood of occurrence on both a regional basis and by risk receptor. The assessment includes identification of potential risks to: (1) thermal generating, (2) hydroelectric, (3) land‐based renewable generating, and (4) transmission and distribution assets. These risks may result from such projected changes as reduced water availability (e.g., for hydroelectric or once‐through cooling), increased water temperatures (e.g., decrease in cooling efficiency, inability to meet discharge permit conditions), increased flood severity (e.g., increased streambank erosion and/or damage to river‐adjacent infrastructure), and decreased water quality (e.g., from increased transport of sediment and dissolved solids). The potential risks identified from this qualitative risk‐assessment are documented in a graphical format depicting both severity and likelihood. This approach allows for comparison of risks across a portfolio and for future prioritization of adaptation strategies. A total of 32 risks were identified in the study, including nine risks to infrastructure, six risks to operations, four risks to supply chain, and 13 environmental/regulatory risks. [ABSTRACT FROM AUTHOR]

Efficient protein turnover is essential for cellular homeostasis and organ function. Loss of proteostasis is a hallmark of aging culminating in severe dysfunction of protein turnover. To investigate protein turnover dynamics as a function of age, we performed continuous in vivo metabolic stable isotope labeling in mice along the aging continuum. First, we discovered that the brain proteome uniquely undergoes dynamic turnover fluctuations during aging compared to heart and liver tissue. Second, trends in protein turnover in the brain proteome during aging showed sex-specific differences that were tightly tied to cellular compartments. Next, parallel analyses of the insoluble proteome revealed that several cellular compartments experience hampered turnover, in part due to misfolding. Finally, we found that age-associated fluctuations in proteasome activity were associated with the turnover of core proteolytic subunits, which was recapitulated by pharmacological suppression of proteasome activity. Taken together, our study provides a proteome-wide atlas of protein turnover across the aging continuum and reveals a link between the turnover of individual proteasome subunits and the age-associated decline in proteasome activity. Synopsis: Continuous pulse-step metabolic labeling with quantitative proteomics in mice reveals sex-specific differences in protein turnover linked to subcellular compartments. Age-related changes in protein turnover result in part from altered proteasome activity and subunit turnover. Brain protein turnover trends during aging display sex-specific differences tied to subcellular compartments. Misfolded proteins contribute to differential turnover trends in the brain. Reduced proteasome activity is associated with slowed turnover of proteasome subunits during aging. Continuous pulse-step metabolic labeling with quantitative proteomics in mice reveals sex-specific differences in protein turnover linked to subcellular compartments. Age-related changes in protein turnover result in part from altered proteasome activity and subunit turnover. [ABSTRACT FROM AUTHOR]

Background: The accumulation of amyloid beta (Aβ) peptides in fibrils is prerequisite for Alzheimer's disease (AD). Our understanding of the proteins that promote Aβ fibril formation and mediate neurotoxicity has been limited due to technical challenges in isolating pure amyloid fibrils from brain extracts. Methods: To investigate how amyloid fibrils form and cause neurotoxicity in AD brain, we developed a robust biochemical strategy. We benchmarked the success of our purifications using electron microscopy, amyloid dyes, and a large panel of Aβ immunoassays. Tandem mass-spectrometry based proteomic analysis workflows provided quantitative measures of the amyloid fibril proteome. These methods allowed us to compare amyloid fibril composition from human AD brains, three amyloid mouse models, transgenic Aβ42 flies, and Aβ42 seeded cultured neurons. Results: Amyloid fibrils are primarily composed by Aβ42 and unexpectedly harbor Aβ38 but generally lack Aβ40 peptides. Multidimensional quantitative proteomics allowed us to redefine the fibril proteome by identifying 20 new amyloid-associated proteins. Notably, we confirmed 57 previously reported plaque-associated proteins. We validated a panel of these proteins as bona fide amyloid-interacting proteins using antibodies and orthogonal proteomic analysis. One metal-binding chaperone metallothionein-3 is tightly associated with amyloid fibrils and modulates fibril formation in vitro. Lastly, we used a transgenic Aβ42 fly model to test if knock down or over-expression of fibril-interacting gene homologues modifies neurotoxicity. Here, we could functionally validate 20 genes as modifiers of Aβ42 toxicity in vivo. Conclusions: These discoveries and subsequent confirmation indicate that fibril-associated proteins play a key role in amyloid formation and AD pathology. [ABSTRACT FROM AUTHOR]

Water resources managers must increasingly consider climate change implications of, whether the concern is floods, droughts, reservoir management, or reliably supplying consumers. Hydrologic and water quality modeling of future climate scenarios requires understanding global climate models (GCMs), emission scenarios and downscaling GCM output, since GCMs generate climate predictions at a resolution too coarse for watershed modeling. Here we present theoretical considerations needed to understand the various downscaling methods. Since most watershed modelers will not be performing independent downscaling, given the resource and time requirements needed, we also present a practical workflow for selecting downscaled datasets. Even given the availability of a number of downscaled datasets, a number of decisions are needed regarding downscaling approach (statistical vs. dynamic), GCMs to consider, options, climate statistics to consider for the selection of model(s) that best predict the historical period, and the relative importance of different climate statistics. Available dynamically-downscaled datasets are more limited in GCMs and time periods considered, but the watershed modeler should consider the approach that best matches the historical observations. We critically assess the existing downscaling approaches and then provide practical considerations (which scenarios and GCMs have been downscaled? What are some of the limitations of these databases? What are the steps to selecting a downscaling approach?) Many of these practical questions have not been addressed in previous reviews. While there is no "best approach" that will work for every watershed, having a systematic approach for selecting the multiple options can serve to make an informed and supportable decision. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to compare the effects of yoga program with supportive therapy counseling on mood states, treatment-related symptoms, toxicity, and quality of life in Stage II and III breast cancer patients on conventional treatment. Methods: Ninety-eight Stage II and III breast cancer patients underwent surgery followed by adjuvant radiotherapy (RT) or chemotherapy (CT) or both at a cancer center were randomly assigned to receive yoga (n = 45) and supportive therapy counseling (n = 53) over a 24-week period. Intervention consisted of 60-min yoga sessions, daily while the control group was imparted supportive therapy during their hospital visits. Assessments included state-trait anxiety inventory, Beck's depression inventory, symptom checklist, common toxicity criteria, and functional living index-cancer. Assessments were done at baseline, after surgery, before, during, and after RT and six cycles of CT. Results: Both groups had similar baseline scores. There were 29 dropouts 12 (yoga) and 17 (controls) following surgery. Sixty-nine participants contributed data to the current analysis (33 in yoga, and 36 in controls). An ANCOVA, adjusting for baseline differences, showed a significant decrease for the yoga intervention as compared to the control group during RT (first result) and CT (second result), in (i) anxiety state by 4.72 and 7.7 points, (ii) depression by 5.74 and 7.25 points, (iii) treatment-related symptoms by 2.34 and 2.97 points, (iv) severity of symptoms by 6.43 and 8.83 points, (v) distress by 7.19 and 13.11 points, and (vi) and improved overall quality of life by 23.9 and 31.2 points as compared to controls. Toxicity was significantly less in the yoga group (P = 0.01) during CT. Conclusion: The results suggest a possible use for yoga as a psychotherapeutic intervention in breast cancer patients undergoing conventional treatment. [ABSTRACT FROM AUTHOR]

Background: Autism is characterized by difficulties in social interaction, communication, and repetitive behaviors; with different degrees of severity in each of the core areas. Haploinsufficiency and point mutations of RAI1 are associated with Smith-Magenis syndrome (SMS), a genetic condition that scores within the autism spectrum range for social responsiveness and communication, and is characterized by neurobehavioral abnormalities, intellectual disability, developmental delay, sleep disturbance, and self-injurious behaviors. Methods: To investigate the relationship between Rai1 and social impairment, we evaluated the Rai1+/- mice with a battery of tests to address social behavior in mice. Results: We found that the mutant mice showed diminished interest in social odors, abnormal submissive tendencies, and increased repetitive behaviors when compared to wild type littermates. Conclusions: These findings suggest that Rai1 contributes to social behavior in mice, and prompt it as a candidate gene for the social behaviors observed in Smith-Magenis Syndrome patients. [ABSTRACT FROM AUTHOR]

Ecosystem-based adaptation (EbA) is increasingly being promoted as a cost-effective means of adaptation to climate change. However, in spite of considerable international press, there is still little evidence to substantiate this claim. This study proposes a method through which the cost-effectiveness of EbA strategies can be evaluated against alternative adaptation options, and contributes to South African literature on the subject. The potential cost-effectiveness of wetland restoration is assessed as a means of securing the carrying capacity of land for pastoralist communities of the Kamiesberg communal area in South Africa under projected future climate conditions. The conventional alternatives would be to respond to increasingly dry conditions by drilling boreholes and using supplemental feed for livestock. It was assumed that the EbA interventions would occur upfront, whereas the alternatives are more likely to be implemented in reaction to droughts over a longer time period. The study found the implementation of conventional alternatives to be more cost-effective than EbA as a means to sustaining livestock stocking rates, with EbA being twice as costly. However, this is framed from the perspective of those directly affected (the landowners), and does not include the benefits to broader society. [ABSTRACT FROM AUTHOR]

The aim of the paper is to understand the role of royal charitable gifts or dāna in the background of Hindu religious ideology of dharma, temple urbanism and political power in pre-modern South India. It examines the phenomena of large royal charities between the 14 and 16 centuries ACE under the Vijayanagar kings in the capital city of Vijayanagar (modern Hampi). The temple cities in the capital city owed their wealth largely to royal benefaction which was a continuation of Hindu religious tradition from ancient times. Drawing on iconographical, inscriptional and literary sources the paper explores the symbolic and religious values of benevolence which can shed light on temple patronage and Vijayanagar kingship. With the help of artistic and historical evidences, it provides a glimpse into the workings of mahādānas (large gifts) and relationship between the palace, bazaar and the temple. Through the mechanism of ritual gifting as an intrinsic aspect of ' dharmic' kingship, the Vijayanagar kings were able to maintain a complex set of interrelationships and networks of power. The institutionalization of traditional system of gifting, represented in official architecture and visual imagery reflects the dyanamism of a complex system of royal gifting that played an important role in the maintenance of religious and political power. [ABSTRACT FROM AUTHOR]

Aim: To compare the effects of yoga program with supportive therapy on self-reported symptoms of depression in breast cancer patients undergoing conventional treatment. Patients and Methods: Ninety-eight breast cancer patients with stage II and III disease from a cancer center were randomly assigned to receive yoga (n = 45) and supportive therapy (n = 53) over a 24-week period during which they underwent surgery followed by adjuvant radiotherapy (RT) or chemotherapy (CT) or both. The study stoppage criteria was progressive disease rendering the patient bedridden or any physical musculoskeletal injury resulting from intervention or less than 60% attendance to yoga intervention. Subjects underwent yoga intervention for 60 min daily with control group undergoing supportive therapy during their hospital visits. Beck's Depression Inventory (BDI) and symptom checklist were assessed at baseline, after surgery, before, during, and after RT and six cycles of CT. We used analysis of covariance (intent-to-treat) to study the effects of intervention on depression scores and Pearson correlation analyses to evaluate the bivariate relationships. Results: A total of 69 participants contributed data to the current analysis (yoga, n = 33, and controls, n = 36). There was 29% attrition in this study. The results suggest an overall decrease in self-reported depression with time in both the groups. There was a significant decrease in depression scores in the yoga group as compared to controls following surgery, RT, and CT (P < 0.01). There was a positive correlation (P < 0.001) between depression scores with symptom severity and distress during surgery, RT, and CT. Conclusion: The results suggest possible antidepressant effects with yoga intervention in breast cancer patients undergoing conventional treatment. [ABSTRACT FROM AUTHOR]

This study examines the process of dyadic coping among couples who are managing stress related to a partner's breast cancer diagnosis and identifies cultural factors that affect how couples cope together. Utilizing a qualitative method based on relational psychologies, the “Listening Guide,” the authors analyzed the narratives of 28 couples who where coping with early-stage breast cancer and lived in Hong Kong-China, India, and the United States. Analysis revealed four cultural factors influencing the process of coping with breast cancer. These factors included (1) family boundaries, (2) gender roles, (3) personal control, and (4) interdependence. Some couples were able to transcend prevailing cultural norms to re-establish balance in their lives and adapt to the cancer. Implications for using couple-based interventions with cancer patients in differing cultural contexts are discussed. [ABSTRACT FROM PUBLISHER]

Across the tropics, smallholder farmers already face numerous risks to agricultural production. Climate change is expected to disproportionately affect smallholder farmers and make their livelihoods even more precarious; however, there is limited information on their overall vulnerability and adaptation needs. We conducted surveys of 600 households in Madagascar to characterize the vulnerability of smallholder farmers, identify how farmers cope with risks and explore what strategies are needed to help them adapt to climate change. Malagasy farmers are particularly vulnerable to any shocks to their agricultural system owing to their high dependence on agriculture for their livelihoods, chronic food insecurity, physical isolation and lack of access to formal safety nets. Farmers are frequently exposed to pest and disease outbreaks and extreme weather events (particularly cyclones), which cause significant crop and income losses and exacerbate food insecurity. Although farmers use a variety of risk-coping strategies, these are insufficient to prevent them from remaining food insecure. Few farmers have adjusted their farming strategies in response to climate change, owing to limited resources and capacity. Urgent technical, financial and institutional support is needed to improve the agricultural production and food security of Malagasy farmers and make their livelihoods resilient to climate change. [ABSTRACT FROM AUTHOR]

Background: There have been increasing reports of methicillin-resistant Staphylococcus aureus (MRSA) infections in the community, but it is unclear whether infectious organisms in open fracture infections have changed and if our current regimen of antibiotic prophylaxis is therefore obsolete.Questions/purposes: We determined the recent incidence of MRSA and Gram-negative organism infections after open fractures.Methods: We performed a retrospective cohort study on 189 patients with 202 open fractures treated from 2009 to 2010. During the followup, patients were evaluated for signs of infection using the Centers for Disease Control and Prevention criteria. We determined the organisms using routine microbiology culture. The minimum followup was 3 months (median, 47 months; range, 3-108 months).Results: Of the 202 open fractures, 20 (10%) developed infections. The most common organism was Staphylococcus, whereas five (25%) of those infected were positive for MRSA, and 11 (55%) of those with infection were cultured for at least one Gram-negative organism. Six (30%) open fractures had infections that grew out multiple organisms. The incidence of MRSA infections in our open fracture population was 2.5%.Conclusions: There is a high incidence of MRSA and Gram-negative infections after open fractures, which may indicate that current antibiotic regimens need to be changed.Level Of Evidence: Level IV, retrospective case-series. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Staphylococcus aureus is the most common organism responsible for orthopaedic surgical site infections (SSIs). Patients who are carriers for methicillin-sensitive S. aureus or methicillin-resistant S. aureus (MRSA) have a higher likelihood of having invasive S. aureus infections. Although some have advocated screening for S. aureus and decolonizing it is unclear whether these efforts reduce SSIs. Questions/purposes: The purposes of this study were to determine (1) whether S. aureus screening and decolonization reduce SSIs in orthopaedic patients and (2) if implementing this protocol is cost-effective. Methods: Studies for this systematic review were identified by searching PubMed, which includes MEDLINE (1946-present), EMBASE.com (1974-present), and the Cochrane Library's (John Wiley & Sons) Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTAD), and the NHS Economic Evaluation Database (NHSEED). Comprehensive literature searches were developed using EMTREE, MeSH, and keywords for each of the search concepts of decolonization, MRSA, and orthopedics/orthopedic surgery. Studies published before 1968 were excluded. We analyzed 19 studies examining the ability of the decolonization protocol to reduce SSIs and 10 studies detailing the cost-effectiveness of S. aureus screening and decolonization. Results: All 19 studies showed a reduction in SSIs or wound complications by instituting a S. aureus screening and decolonization protocol in elective orthopaedic (total joints, spine, and sports) and trauma patients. The S. aureus screening and decolonization protocol also saved costs in orthopaedic patients when comparing the costs of screening and decolonization with the reduction of SSIs. Conclusions: Preoperative screening and decolonization of S. aureus in orthopaedic patients is a cost-effective means to reduce SSIs. Level of Evidence: Level IV, systematic review of Level I-IV studies. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation. [ABSTRACT FROM AUTHOR]

The incidence of infection by methicillin-resistant Staphylococcus aureus (MRSA) in total knee arthroplasty (TKA) is becoming a more frequent concern, as increased morbidity following TKA has been reported for infections by resistant organisms. This study investigates whether MRSA infections are associated with decreased functional scores. We therefore compared the functional scores, operative times, and rates of reinfection of revision TKA following MRSA infection versus other indications for revision. We retrospectively reviewed charts of 101 patients (103 knees) who underwent mobile bearing TKA revision from January 2003 to September 2006, with a minimum clinical followup of 2 years in 45 knees (44%). We obtained the following indices: WOMAC, Activities of Daily Living Score (ADLS), SF-36, and Knee Society scores (KSS). Three groups of revisions were compared: MRSA infection (n = 6), non-MRSA infection (n = 9), and aseptic failure (n = 30). The three groups were similar in demographics and comorbidities. The MRSA (166 minutes) and non-MRSA groups (149 minutes) had longer operative times than the aseptic group (121 minutes). With numbers available, there were no differences in ROM, WOMAC, ADLS, KSS, and SF-36, with MRSA separate or combined with all infections. Infection recurrence between MRSA-infected knees and non-MRSA-infected knees was similar. While our study was underpowered to detect functional differences between MRSA-infected knees and non-MRSA-infected knees it does add data to the literature. Knees revised for infection have longer operative times and more frequent infection after revision. The reason for increased operative times is unclear. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Objectives: This study compares the effects of an integrated yoga program with brief supportive therapy on distressful symptoms in breast cancer outpatients undergoing adjuvant radiotherapy. Materials and Methods: Eighty-eight stage II and III breast cancer outpatients were randomly assigned to receive yoga (n = 44) or brief supportive therapy (n = 44) prior to their radiotherapy treatment. Intervention consisted of yoga sessions lasting 60 min daily while the control group was imparted supportive therapy once in 10 days during the course of their adjuvant radiotherapy. Assessments included Rotterdam Symptom Check List and European Organization for Research in the Treatment of Cancer-Quality of Life (EORTC QoL C30) symptom scale. Assessments were done at baseline and after 6 weeks of radiotherapy treatment. Results: A GLM repeated-measures ANOVA showed a signifi cant decrease in psychological distress (P = 0.01), fatigue (P = 0.007), insomnia (P = 0.001), and appetite loss (P = 0.002) over time in the yoga group as compared to controls. There was signifi cant improvement in the activity level (P = 0.02) in the yoga group as compared to controls. There was a signifi cant positive correlation between physical and psychological distress and fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, and constipation. There was a signifi cant negative correlation between the activity level and fatigue, nausea and vomiting, pain, dyspnea, insomnia, and appetite loss. Conclusion: The results suggest beneficial effects with yoga intervention in managing cancer- and treatment-related symptoms in breast cancer patients. [ABSTRACT FROM AUTHOR]

Unlabelled: Staphylococcus aureus (S. aureus) is an independent risk factor for orthopaedic surgical site infection (SSI). To determine whether a preoperative decolonization protocol reduces S. aureus SSIs, we conducted a prospective observational study of patients undergoing elective total joint arthroplasty (TJA) at our institution, with two control groups. The concurrent control group comprised patients of surgeons who did not participate in the intervention study. The preintervention control group comprised patients of participating surgeons who had undergone elective TJA during the year before the study. Patients in the intervention group were screened preoperatively for S. aureus by nasal swab cultures. S. aureus carriers were decolonized with mupirocin ointment to the nares twice daily and chlorhexidine bath once daily for 5 days before surgery. All 164 of 636 participants (26%) who tested positive completed the decolonization protocol without adverse events and had no postoperative S. aureus SSIs at 1-year followup. In contrast, 1330 concurrent control patients had 12 S. aureus infections. If these infections had occurred in the 26% of patients expected to be nasal carriers of S. aureus at a given time, the infection rate would have been 3.5% (12 of 345) in the control group. In addition, the overall infection rate of the participating surgeons, including nonstaphylococcal infections, decreased from 2.6% during the preintervention period to 1.5% during the intervention period, translating to an adjusted economic gain of $231,741 for the hospital. The data suggest a preoperative decolonization protocol reduces S. aureus SSIs in patients undergoing TJA.Level Of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Foot infections are common and the most serious lower extremity complication contributing to amputations, particularly in patients with diabetes mellitus. Infection is most often a consequence of foot ulcerations, which typically follows trauma to a neuropathic foot. Foot infections may be classified as mild, moderate and severe; this largely determines the approach to therapy. Gram-positive bacteria are the sole causative pathogens for most mild and moderate infections. These infections can usually be treated with culture-based narrow-spectrum antibacterials along with appropriate surgical debridement in an outpatient setting. In contrast, severe infections are often polymicrobial, requiring hospitalisation and treatment with broad-spectrum antibacterials along with appropriate medical and surgical interventions. The initial empirical antibacterial regimen may be tailored based on the results of culture and sensitivity tests from properly obtained specimens. Several antibacterial regimens have demonstrated effectiveness in randomised controlled trials, but no single regimen has shown superiority. Managing diabetic foot osteomyelitis is particularly controversial and requires reliable cultures to select an appropriate antibacterial regimen. Surgical resection of the infected and necrotic bone favours a good outcome in chronic osteomyelitis. The recommended duration of antibacterial therapy ranges from 1 to 4 weeks for soft tissue infection, to >6 weeks for unresected osteomyelitis. The incidence of meticillin-resistant Staphylococcus aureus infection is increasing in both the healthcare setting and the community. This should be considered when selecting an antibacterial, especially if the patient does not improve with initial antibacterial therapy. Certain other organisms, such as Pseudomonas aeruginosa and Enterococcus spp., while potentially pathogenic, are often colonisers that do not require targeted therapy. [ABSTRACT FROM AUTHOR]

Started in 1993, in a small way, by a social worker as a response to the growing destitution of mentally ill women and with the objective of giving shelter, treatment and main streaming them, The Banyan has so far given 'Adaikalam' (refuge) to 413 women, of whom 252 have been rehabilitated. The entire care process starts from the time the women are picked from the streets in a disheveled and deranged state and brought to the home after much difficulty. On arrival they are spruced up and clinically assessed by a psychiatrist and put on medication. Slowly and steadily they return to the world of reality. Simultaneously, the inmates are put through various therapies like individual counseling, music, art, yoga, and vocational training. Finally, the address of the inmates is traced, and a team from The Banyan accompanies them, and they are rehabilitated. The family is enlightened about the illness, the woman' s stay at The Banyan, need for continuous medication. The Banyan is a lifetime service provider of medicines, keeping track by regular follow up and above all a friend to whom they can seek any help at any time. The role played by the social workers is so vital that the success of the programme hinges on their repertoire of skill and commitment. [ABSTRACT FROM AUTHOR]

Linezolid is an alternative to vancomycin for the long-term treatment of gram-positive bacterial orthopedic infections because of its antibacterial spectrum and oral bioavailability, but duration-related myelosuppression could offset its advantages. To evaluate the hematologic effects of these agents, we prospectively studied 65 consecutive adults with gram-positive bacterial orthopedic infections requiring &ges;2 weeks of vancomycin therapy (n = 52) or linezolid therapy (n = 20). Trends suggesting higher incidence of hematologic effects among the patients receiving vancomycin were not significant, regardless of whether the end point was lowest cell count during therapy or change from baseline. The only difference was a higher incidence of thrombo-cytopenia (<150 × 109 platelets/L) in the subset of the linezolid recipients who had received vancomycin within 2 weeks before starting linezolid therapy than in the linezolid recipients who had not received vancomycin (5 [71%] of 7 patients vs. 2 [15%] of 13; p = .02). All hematologic effects were reversible. In conclusion, hematologic effects were detectable through weekly monitoring and were reversible; therefore, concern about myelosuppression need not preclude linezolid use for orthopedic infections requiring long-term therapy. [ABSTRACT FROM AUTHOR]

Background: Proven clinical benefits of leukoreduced blood components include reduced febrile nonhemolytic transfusion reactions, alloimmunization against HLA antigens, and CMV transmission. Immunomodulatory effects of leukoreduction have also been postulated to play a significant role in the clinical outcome of open heart surgery.Study Design and Methods: A prospective case control study was implemented in which all patients admitted over a 1-year period for open heart surgery at a single hospital were given leukoreduced blood products. Clinical outcomes were prospectively measured and compared to a historical cohort of patients from the previous year when leukoreduced blood products were not routinely used.Results: A significant improvement in the mean postoperative length of stay was seen in the study group (N = 645) versus control group (N = 501; 10.1 vs. 9.5 days; p = 0.005). No significant changes were seen in the rate of mediastinitis, operative mortality, or stay in the intensive care unit. There was no difference in the postoperative length of stay among study patients who did not receive transfusion (N = 308) versus control patients who did not receive transfusion (N = 296; 6.2 vs. 6.4 days; p = 0.104).Conclusions: The use of leukoreduced blood was associated with a decrease in the postoperative length of stay in the setting of open heart surgery. The mechanisms through which these changes in clinical outcomes are generated remain unknown. [ABSTRACT FROM AUTHOR]

A response from the authors of the article on the Infectious Diseases Society of America (IDSA) guidelines on prosthetic joint infection (PJI) in the 2013 issue is presented.

Discusses the case of a 78-year-old male patients who was successfully treated with linezolid for gram-positive bacteria Enterococcus faecalis prosthetic valve endocarditis. Resistance of E. faecalis to gentamicin; Bioavailability; Hematological side effects.

Many human populations are dependent on marine ecosystems for a range of benefits, but we understand little about where and to what degree people rely on these ecosystem services. We created a new conceptual model to map the degree of human dependence on marine ecosystems based on the magnitude of the benefit, susceptibility of people to a loss of that benefit, and the availability of alternatives. We focused on mapping nutritional, economic, and coastal protection dependence, but our model is repeatable, scalable, applicable to other ecosystems, and designed to incorporate additional services and data. Here we show that dependence was highest for Pacific and Indian Ocean island nations and several West African countries. More than 775 million people live in areas with relatively high dependence scores. By identifying where and how people are dependent on marine ecosystems, our framework can be used to design more effective large‐scale management and policy interventions. [ABSTRACT FROM AUTHOR]

Deletions and mutations involving the Retinoic Acid Induced 1 (RAI1) gene at 17p11.2 cause Smith-Magenis syndrome (SMS). Here we report a patient with autism as the main clinical presentation, with some SMS-like features and a rare de novo RAI1 gene mutation, c.3440G > A (p.R1147Q). We functionally characterized the RAI1 p.R1147Q mutant protein. The mutation, located near the nuclear localization signal, had no effect on the subcellular localization of the mutant protein. However, similar to previously reported RAI1 missense mutations in SMS patients, the RAI1 p.R1147Q mutant protein showed a significant deficiency in activating in vivo transcription of a reporter gene driven by a BDNF (brain-derived neurotrophic factor) intronic enhancer. In addition, expression of other genes associated with neurobehavioral abnormalities and/or neurodevelopmental disorders were found to be altered in this patient. These results suggest a likely contribution of RAI1, either alone or in combination of other factors, to social behavior and reinforce the RAI1 gene as a candidate gene in patients with autistic manifestations or social behavioral abnormalities. [ABSTRACT FROM AUTHOR]

PURPOSE: To compare radiotherapy using accelerated fractionation (6 fractions per week) and concurrent chemotherapy with conventional radiotherapy (5 fractions per week) and concurrent chemotherapy to assess acute toxicities, response at 6 weeks and locoregional control at 3 months in locally advanced carcinoma cervix patients. MATERIALS & METHODS : 40 patients with histologically proven carcinoma cervix (International Federation of Gynecology and Obstetrics, FIGO stage IIB-IIIB) were prospectively non-randomized to arm A (study arm): 20 patients and arm B (control arm): 20 patients. Arm A received External Beam Radiotherapy with accelerated fractionation (6 fractions per week) and arm B received EBRT with conventional fractionation (5 fractions per week). Patients in both the arms received radiation to a dose of 45- 50.4 Gy in 25-28 fractions using the conformal radiation technique (3DCRT). All patients received concurrent chemotherapy with Inj. Cisplatin 40mg/m2 weekly as a radio sensitizer. After completion of brachytherapy, patients inboth the arms received High dose rate (HDR) brachytherapy either intracavitary or interstitial brachytherapy to a dose of 21-24 Gy in 3 or 4 fractions after completion of EBRT. The patients were assessed weekly for toxicities during EBRT. Toxicities were recorded as per RTOG criteria. Response at 6 weeks and locoregional control at 3 months after treatment was assessed by clinical examination. RESULTS : Data was analyzed from 17 patients in study arm and 20 patients in control arm. The median Overall treatment time (OTT) was statistically significantly shortened in accelerated arm when compared to conventional fractionated arm (44 vs. 51 days, p value = 0.0008). Lower GI toxicity was statistically significantly higher in accelerated arm (p value = 0.0436). Upper GI, skin and haematological toxicities were comparable between two arms. Overall response at 6 weeks and locoregional control at 3 months after treatment were comparable CONCLUSION : The results of our study indicate that accelerated fractionation with concurrent cisplatin is a viable option to conventional fractionation with concurrent cisplatin in patients with advanced cervical cancer. However, further randomized trials with larger sample sizes and longer duration of follow-up are required [ABSTRACT FROM AUTHOR]

A response from the author of the article "Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections" in the 2013 issue is presented.

A letter to the editor is presented in response to the article "Quality of life assessment in survivors of breast cancer" by S. Q. Wani and colleagues, that was published in the April-June 2012 issue of the periodical.

These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation. [ABSTRACT FROM AUTHOR]