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How genetics can help diagnosis and treatment in psychiatric conditions
- B. Chaumette, C. Laurent-Levinson, P. Almos, F. Degenhardt
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S49
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The understanding of the genetic architecture of psychiatric disorders has made significant advances in the last decade and some scientific findings can now be translated into clinical practice. The rise of genetic testing and the awareness of patients and their families motivate psychiatrists to examine this approach. The COST Action EnGagE (CA17130) is promoting these developments in Europe. Whereas the findings of common variants are the domain of research, screening for rare variants at the genome-wide level is already applicable in clinical practice. It is now possible to return meaningful results to the individual to help him/her understanding the disease and the comorbidities, to guide treatment and to perform genetic counseling. In this presentation, we will give meaningful examples for psychiatric practice. For instance, around one-third of the patients diagnosed with autism spectrum disorder can benefit from a molecular diagnosis (fragile X syndrome, SHANK3 deletion…). Microdeletion or microduplication may explain a fraction of schizophrenic cases (e.g. del22q11). Identification of rare variants causing the disease may decrease the stigma and feeling of guilt often reported by patients and families. This could also help to detect and manage other comorbidities. It is expected that treatment guidelines and clinical trials would be developed in the near future for patients carrying a rare variant, opening the way to personalized psychiatry. Finally, this effort has a huge impact on the family, by enhancing genetic counseling in psychiatry. The rise of psychiatric genetics might align our field more closely with the other medical specialties.
DisclosureNo significant relationships.
The dopamine D2 receptor gene TaqI A polymorphism is not associated with Novelty Seeking, Harm Avoidance and Reward Dependence in healthy subjects
- B de Brettes, I Berlin, C Laurent, JP Lépine, J Mallet, AJ Puech
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- European Psychiatry / Volume 13 / Issue 8 / December 1998
- Published online by Cambridge University Press:
- 16 April 2020, pp. 427-430
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Allele A1 of the TaqI A restriction fragment length polymorphism (RFLP) of the dopamine D2 receptor gene has been found to be associated with substance abuse and alcoholism. The personality trait of Novelty Seeking (NS) is also associated with substance abuse and dependence. We hypothesised, on the basis of involvement of dopaminergic mechanisms in substance abuse, that the presence of allele A1 of the dopamine D2 receptor gene may represent a genetic predisposition for the NS personality trait. We investigated, therefore, whether the allele A1 of the TaqI A RFLP of the dopamine D2 receptor gene is associated with the NS dimension of the Tridimensional Personality Questionnaire (TPQ) in healthy Caucasian subjects with no history of alcohol or substance abuse or dependence. We genotyped 204 subjects aged 18 to 30 years. There was no association between any of the alleles of the D2 receptor genes and any of the TPQ scores (NS, Harm Avoidance, Reward Dependence). We conclude that allele A1 of the TaqI A RFLP of the dopamine D2 receptor is not associated with NS personality trait in healthy Caucasian subjects.
A new 122 mm electromechanical drill for deep ice-sheet coring (DISC): 5. Experience during Greenland field testing
- Jay A. Johnson, William P. Mason, Alexander J. Shturmakov, Scott T. Haman, Paul J. Sendelbach, Nicolai B. Mortensen, Laurent J. Augustin, Kristina R. Dahnert
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- Journal:
- Annals of Glaciology / Volume 47 / 2007
- Published online by Cambridge University Press:
- 14 September 2017, pp. 54-60
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The Deep Ice Sheet Coring (DISC) drill developed by Ice Coring and Drilling Services under contract with the US National Science Foundation is an electromechanical ice-drill system designed to take 122mm ice cores to depths of 4000 m. The new drill system was field-tested near Summit camp in central Greenland during the spring/summer of 2006. Testing was conducted to verify the performance of the DISC drill system and its individual components and to determine the modifications required prior to the system’s planned deployment for coring at the WAIS Divide site in Antarctica in the following year. The experiments, results and the drill crew’s experiences with the DISC drill during testing are described and discussed.
The SUBGLACIOR drilling probe: concept and design
- O. Alemany, J. Chappellaz, J. Triest, M. Calzas, O. Cattani, J.F. Chemin, Q. Desbois, T. Desbois, R. Duphil, S. Falourd, R. Grilli, C. Guillerme, E. Kerstel, B. Laurent, E. Lefebvre, N. Marrocco, O. Pascual, L. Piard, P. Possenti, D. Romanini, V. Thiebaut, R. Yamani
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- Journal:
- Annals of Glaciology / Volume 55 / Issue 68 / 2014
- Published online by Cambridge University Press:
- 26 July 2017, pp. 233-242
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In response to the ‘oldest ice’ challenge initiated by the International Partnerships in Ice Core Sciences (IPICS), new rapid-access drilling technologies through glacier ice need to be developed. These will provide the information needed to qualify potential sites on the Antarctic ice sheet where the deepest section could include ice that is >1Ma old and still in good stratigraphic order. Identifying a suitable site will be a prerequisite for deploying a multi-year deep ice-core drilling operation to elucidate the cause and mechanisms of the mid-Pleistocene transition from 40 ka glacial–interglacial cycles to 100 ka cycles. As part of the ICE&LASERS/SUBGLACIOR projects, we have designed an innovative probe, SUBGLACIOR, with the aim of perforating the ice sheet down to the bedrock in a single season and continuously measuring in situ the isotopic composition of the melted water and the methane concentration in trapped gases. Here we present the general concept of the probe, as well as the various technological solutions that we have favored so far to reach this goal.
Late Holocene precipitation variability recorded in the sediments of Reloncaví Fjord (41°S, 72°W), Chile
- Lorena Rebolledo, Carina B. Lange, Sébastien Bertrand, Práxedes Muñoz, Marco Salamanca, Pablo Lazo, José L. Iriarte, Gabriel Vargas, Silvio Pantoja, Laurent Dezileau
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- Journal:
- Quaternary Research / Volume 84 / Issue 1 / July 2015
- Published online by Cambridge University Press:
- 20 January 2017, pp. 21-36
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We present reconstructions of late Holocene changes in the source of organic matter and siliceous export production in the Relocanví Fjord (41°S, 72°W), Northern Chilean Patagonia, based on organic carbon content, δ13Corg, N/C ratio, diatom assemblages and biogenic silica contents from three sediment cores. The age models are based on a combination of 210Pb profiles, AMS 14C dating, and on the first occurrence of the diatom Rhizosolenia setigera f. pungens, as a stratigraphic marker in the fjords. The cores span the last 300 to 700 yr. Diatoms dominate the siliceous assemblages in the three cores (98% on average). Our results suggest that precipitation seasonality in the region of Reloncaví was high in CE 1300–1400 and CE 1700–1850, with a clear decreasing trend since CE 1850. The latter trend is in agreement with instrumental records and tree-ring reconstructions. These fluctuations seem to be associated with the Southern Annular Mode (SAM).
Linkage to the CCM2 Locus and Genetic Heterogeneity in Familial Cerebral Cavernous Malformation
- Nicolas Dupré, Dominique J. Verlaan, Collette K. Hand, Sandra B. Laurent, Gustavo Turecki, W. Jeptha Davenport, Nicola Acciarri, Johannes Dichgans, Akio Ohkuma, Adrian M. Siegel, Guy A. Rouleau
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 30 / Issue 2 / May 2003
- Published online by Cambridge University Press:
- 16 December 2016, pp. 122-128
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Background:
Cerebral cavernous malformation (CCM) is a form of intracranial vascular disease that may arise sporadically or be dominantly inherited. Linkage studies have revealed genetic heterogeneity among the dominantly inherited forms suggesting the existence of at least three loci called CCM1, CCM2 and CCM3.
Methods:In the present study, we screened five families with dominantly inherited CCM for CCM1 gene mutations with denaturing high performance liquid chromatography (DHPLC). Then, we performed linkage analysis and haplotyping on these five families using highly polymorphic markers at the candidate CCM loci.
Results:None of the five families tested with DHPLC were found to have mutations in the CCM1 gene. Based on haplotyping, we identified three families segregating alleles for CCM2, while two families segregated alleles for CCM3. Using linkage analysis, we could confirm that one family (IFCAS-1) had a positive Lod score of 2.03 (p<0.0001) at the CCM2 locus using marker D7S678.
Conclusions:The present study is the first one to replicate linkage at the CCM2 locus and provides a fifth family identified as such. It also supports the concept of genetic heterogeneity in CCM, identifying four other families that showed no mutations in the CCM1 gene.
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- By Jean-Jacques Aubert, R. H. Helmholz, Caroline Humfress, David Ibbetson, David Johnston, Wolfgang Kaiser, Andrew Lewis, Andrew Lintott, Laurent Mayali, Ernest Metzger, Elizabeth A. Meyer, Paul du Plessis, John Richardson, Magnus Ryan, A. J. B. Sirks, Bernard H. Stolte, Laurens Winkel, Joseph Georg Wolf, Reinhard Zimmermann
- Edited by David Johnston
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- The Cambridge Companion to Roman Law
- Published online:
- 05 February 2015
- Print publication:
- 16 February 2015, pp vii-viii
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Clinical Stringency Greatly Improves Mutation Detection in Rett Syndrome
- Julie Gauthier, Giovana de Amorim, Gevork N. Mnatzakanian, Carol Saunders, John B. Vincent, Sylvie Toupin, David Kauffman, Judith St-Onge, Sandra Laurent, Patrick M. Macleod, Berge A. Minassian, Guy A. Rouleau
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- Canadian Journal of Neurological Sciences / Volume 32 / Issue 3 / August 2005
- Published online by Cambridge University Press:
- 02 December 2014, pp. 321-326
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Background:
Rett syndrome (RTT) is a severe neurodevelopmental disorder of girls, caused by mutations in the X-linked MECP2 gene. Worldwide recognition of the RTT clinical phenotype in the early 1980's allowed many cases to be diagnosed, and established RTT as one of the most common mental retardation syndromes in females. The years since then led to a refinement of the phenotype and the recent elaboration of Revised Diagnostic Criteria (RDC). Here, we study the impact of the presence versus the absence of the use of diagnostic criteria from the RDC to make a diagnosis of RTT on MECP2 mutation detection in Canadian patients diagnosed and suspected of having RTT.
Methods:Using dHPLC followed by sequencing in all exons of the MECP2 gene, we compared mutation detection in a historic cohort of 35 patients diagnosed with RTT without the use of specific diagnostic criteria to a separate more recent group of 101 patients included on the basis of strict fulfillment of the RDC.
Results:The MECP2 mutation detection rate was much higher in subjects diagnosed using a strict adherence to the RDC (20% vs. 72%).
Conclusions:These results suggest that clinical diagnostic procedures significantly influence the rate of mutation detection in RTT, and more generally emphasize the importance of diagnostic tools in the assessment of neurobehavioral syndromes.
Molecular epidemiology of tuberculosis in Cambodian children
- K. SCHOPFER, H. L. RIEDER, J. F. STEINLIN-SCHOPFER, D. van SOOLINGEN, T. BODMER, Y. CHANTANA, P. STUDER, D. LAURENT, M. ZWAHLEN, B. RICHNER
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- Journal:
- Epidemiology & Infection / Volume 143 / Issue 5 / April 2015
- Published online by Cambridge University Press:
- 22 July 2014, pp. 910-921
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We analysed Mycobacterium tuberculosis strains from children, hospitalized from January 2004 to July 2008 in the largest paediatric hospital complex in Cambodia. Specimens were tested for drug susceptibility and genotypes. From the 260 children, 161 strains were available. The East African-Indian genotype family was the most common (59·0%), increasing in frequency with distance from the Phnom Penh area, while the frequency of the Beijing genotype family strains decreased. The drug resistance pattern showed a similar geographical gradient: lowest in the northwest (4·6%), intermediate in the central (17·1%), and highest in the southeastern (30·8%) parts of the country. Three children (1·9%) had multidrug-resistant tuberculosis. The Beijing genotype and streptomycin resistance were significantly associated (P < 0·001). As tuberculosis in children reflects recent transmission patterns in the community, multidrug resistance levels inform about the current quality of the tuberculosis programme.
Impact of vitamin D supplementation on health-care use in a 25-hydroxyvitamin D-tested population in France: a population-based descriptive cohort study
- Pascal Caillet, Susan B Jaglal, Laurent Laforest, Roland Chapurlat, Muriel Rabilloud, Michel Ducher, Anne-Marie Schott
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- Journal:
- Public Health Nutrition / Volume 18 / Issue 3 / February 2015
- Published online by Cambridge University Press:
- 31 March 2014, pp. 554-561
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Objective
Chronic vitamin D deficiency has been associated in some patients with diffuse musculoskeletal pain. These unspecific symptoms may partly explain why vitamin D deficiency is often diagnosed late. Our aim was to analyse health-care claims after vitamin D supplementation in patients likely to have vitamin D deficiency.
DesignAmbulatory health-care claims were compared before and after a vitamin D supplementation prescribed following a 25-hydroxyvitamin D assay.
SettingHealth Insurance Fund (FHIF) database of the Rhône-Alpes area, France.
SubjectsAmong patients reimbursed for a 25-hydroxyvitamin D assay between 1 December 2008 and 31 January 2009, those supplemented with vitamin D after the assay were matched on the date of assay to patients who did not receive vitamin D.
ResultsAmong the 3023 patients who had a 25-hydroxyvitamin D assay, 935 were consequently supplemented and matched to 935 patients not supplemented. Their median age was 50·0 and 49·5 years, respectively. Patients supplemented decreased their muscle relaxant consumption whereas no change was observed in the reference group, the difference between the two groups was significant (P=0·03). Second and third Pain Relief Ladder prescriptions decreased in both groups but not significantly differently between groups (P=0·58). There was a decrease in prescriptions of biological examination in both groups with no significant difference.
ConclusionsBesides a decrease in muscle relaxant prescriptions in the supplemented group, it was difficult to assess the impact of vitamin D supplementation in patients likely to have vitamin D deficiency. Prospective cohort studies and randomized trials are needed to assess the efficiency of screening and supplementing vitamin D deficiency.
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- By Ted Abel, Antoine Adamantidis, Karla V. Allebrandt, Simon N. Archer, Amelie Baud, Michel Billiard, Carlos Blanco-Centurion, Diane B. Boivin, Ethan Buhr, Matthew E. Carter, Nicolas Cermakian, Jennifer H.K. Choi, S.Y. Christin Chong, Chiara Cirelli, Marc Cuesta, Thomas Curie, Yves Dauvilliers, Luis de Lecea, Derk-Jan Dijk, Stephane Dissel, Annette C. Fedson, Jonathan Flint, Marcos G. Frank, Paul Franken, Ying-Hui Fu, Thorarinn Gislason, David Gozal, Devon A. Grant, Hakon Hakonarson, Makoto Honda, Hyun Hor, Christer Hublin, Peng Jiang, Takashi Kanbayashi, Jaakko Kaprio, Andrew Kasarskis, Leila Kheirandish-Gozal, RodaRani Konadhode, Michael Lazarus, Meng Liu, Michael March, Mark F. Mehler, Keivan Kaveh Moghadam, Valérie Mongrain, Charles M. Morin, Benjamin M. Neale, Seiji Nishino, Allan I. Pack, Dheeraj Pelluru, Rosa Peraita-Adrados, Giuseppe Plazzi, David A. Prober, Louis J. Ptáček, Irfan A. Qureshi, David M. Raizen, John J. Renger, Till Roenneberg, Elizabeth J. Rossin, Takeshi Sakurai, Paul Salin, Karen D. Schilli, Eva C. Schulte, Laurent Seugnet, Paul J. Shaw, Priyattam J. Shiromani, Patrick Sleiman, Mehdi Tafti, Joseph S. Takahashi, Matthew S. Thimgan, Katsushi Tokunaga, Giulio Tononi, Fred W. Turek, Yoshihiro Urade, Hans P.A. Van Dongen, Juliane Winkelmann, Christopher J. Winrow
- Edited by Paul Shaw, Mehdi Tafti, Michael J. Thorpy
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- Book:
- The Genetic Basis of Sleep and Sleep Disorders
- Published online:
- 05 November 2013
- Print publication:
- 24 October 2013, pp xi-xiv
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- By Pierre Amarenco, Adrià Arboix, Marcel Arnold, Robert W. Baloh, John Bamford, Jason J. S. Barton, Claudio L. Bassetti, Christopher F. Bladin, Julien Bogousslavsky, Julian Bösel, Marie-Germaine Bousser, Thomas Brandt, John C. M. Brust, Erica C. S. Camargo, Louis R. Caplan, Emmanuel Carrera, Carlo W. Cereda, Seemant Chaturvedi, Claudia Chaves, Chin-Sang Chung, Isabelle Crassard, Hans Christoph Diener, Marianne Dieterich, Ralf Dittrich, Geoffrey A. Donnan, Paul Eslinger, Conrado J. Estol, Edward Feldmann, José M. Ferro, Joseph Ghika, Daniel Hanley, Ahamad Hassan, Cathy Helgason, Argye E. Hillis, Marc Hommel, Carlos S. Kase, Julia Kejda-Scharler, Jong S. Kim, Rainer Kollmar, Joshua Kornbluth, Sandeep Kumar, Emre Kumral, Hyung Lee, Didier Leys, Eric Logigian, Mauro Manconi, Elisabeth B. Marsh, Randolph S. Marshall, Isabel P. Martins, Josep Lluís Martí-Vilalta, Heinrich P. Mattle, Jérome Mawet, Mikael Mazighi, Patrik Michel, Jay Preston Mohr, Thierry Moulin, Sandra Narayanan, Kwang-Yeol Park, Florence Pasquier, Charles Pierrot-Deseilligny, Nils Petersen, Raymond Reichwein, E. Bernd Ringelstein, Gabriel J. E. Rinkel, Elliott D. Ross, Arnaud Saj, Martin A. Samuels, Jeremy D. Schmahmann, Stefan Schwab, Florian Stögbauer, Mathias Sturzenegger, Laurent Tatu, Pariwat Thaisetthawatkul, Dagmar Timmann, Jan van Gijn, Ana Verdelho, Francois Vingerhoets, Patrik Vuilleumier, Fabrice Vuillier, Eelco F. M. Wijdicks, Shirley H. Wray, Wendy C. Ziai
- Edited by Louis R. Caplan, Jan van Gijn
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- Stroke Syndromes, 3ed
- Published online:
- 05 August 2012
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- 12 July 2012, pp vii-x
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A whole-grain cereal-rich diet increases plasma betaine, and tends to decrease total and LDL-cholesterol compared with a refined-grain diet in healthy subjects
- Alastair B. Ross, Stephen J. Bruce, Anny Blondel-Lubrano, Sylviane Oguey-Araymon, Maurice Beaumont, Alexandre Bourgeois, Corine Nielsen-Moennoz, Mario Vigo, Laurent-Bernard Fay, Sunil Kochhar, Rodrigo Bibiloni, Anne-Cécile Pittet, Shahram Emady-Azar, Dominik Grathwohl, Serge Rezzi
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- Journal:
- British Journal of Nutrition / Volume 105 / Issue 10 / 28 May 2011
- Published online by Cambridge University Press:
- 28 January 2011, pp. 1492-1502
- Print publication:
- 28 May 2011
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Epidemiological studies have repeatedly found that whole-grain (WG) cereal foods reduce the risk of several lifestyle-related diseases, though consistent clinical outcomes and mechanisms are elusive. To compare the effects of a WG-rich diet with a matched refined-grain (RG) diet on plasma biomarkers and bowel health parameters, seventeen healthy subjects (eleven females and six males) completed an exploratory cross-over study with a 2-week intervention diet based on either WG- or RG-based foods, separated by a washout of at least 5 weeks. Both diets were the same except for the use of WG (150 g/d) or RG foods. Subjects undertook a 4 h postprandial challenge on day 8 of each intervention diet. After 2 weeks, the WG diet tended to decrease plasma total and LDL-cholesterol (both P = 0·09), but did not change plasma HDL-cholesterol, fasting glucose, C-reactive protein or homocysteine compared with the RG diet. Plasma betaine and alkylresorcinol concentrations were elevated after 1 week of the WG diet (P = 0·01 and P < 0·0001, respectively). Clostridium leptum populations in faeces were increased after the WG diet, along with a trend for decreased faecal water pH (P = 0·096) and increased stool frequency (P < 0·0001) compared with the RG diet. A short controlled intervention trial with a variety of commercially available WG-based products tended to improve biomarkers of CVD compared with a RG diet. Changes in faecal microbiota related to increased fibre fermentation and increased plasma betaine concentrations point to both fibre and phytochemical components of WG being important in mediating any potential health effects.
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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Shape and stability of axisymmetric levitated viscous drops
- JOHN R. LISTER, ALICE B. THOMPSON, ANTOINE PERRIOT, LAURENT DUCHEMIN
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- Journal:
- Journal of Fluid Mechanics / Volume 617 / 25 December 2008
- Published online by Cambridge University Press:
- 25 December 2008, pp. 167-185
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We consider levitation of an axisymmetric drop of molten glass above a spherical porous mould through which air is injected at a constant velocity. Owing to the viscosity contrast, the float height for a given shape is established on a much shorter time scale than the subsequent deformation of the drop under gravity, surface tension and the underlying lubrication pressure. Equilibrium shapes, in which an internal hydrostatic pressure is coupled to the external lubrication pressure through the total curvature and the Young–Laplace equation, are determined using a numerical continuation scheme. The set of solution branches is surprisingly complicated and shows a rich bifurcation structure in the parameter space (Bo=ρgV2/3/γ, Ca=μav/γ), where Bo is bond number and Ca is capillary number, ρ and V are the drop density and volume, γ the surface tension, μa the air viscosity and v the injection velocity. The linear stability of equilibria is determined using a boundary-integral representation for drop deformation that factors out the rapid vertical adjustment of the float height. The results give good agreement with time-dependent simulations. For sufficiently large Ca there are intervals of Bo for which there are no stable solutions and, as Ca increases, these intervals grow and merge. The region of stability decreases as the mould radius aM increases with an approximate scaling Ca~aM−5, which imposes practical limitations on the use of this geometry for the manufacture of lenses.
Intensive Care Unit Outbreak of Extended-Spectrum β-Lactamase–Producing Klebsiella Pneumoniae Controlled by Cohorting Patients and Reinforcing Infection Control Measures
- C. Laurent, H. Rodriguez-Villalobos, F. Rost, H. Strale, J.-L. Vincent, A. Deplano, M. J. Struelens, B. Byl
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 29 / Issue 6 / June 2008
- Published online by Cambridge University Press:
- 02 January 2015, pp. 517-524
- Print publication:
- June 2008
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Objective.
To describe an outbreak of extended-spectrum β-lactamase (ESBL)–producing Klebsiella pneumoniae in the intensive care units (ICUs) of a hospital and the impact of routine and reinforced infection control measures on interrupting nosocomial transmission.
Design.Outbreak report.
Setting.A 31-bed intensive care department (composed of 4 ICUs) in a university hospital in Belgium.
Intervention.After routine infection control measures (based on biweekly surveillance cultures and contact precautions) failed to interrupt a 2-month outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures were implemented. The frequency of surveillance cultures was increased to daily sampling. Colonized patients were moved to a dedicated 6-bed ICU, where they received cohorted care with the support of additional nurses. Two beds were closed to new admissions in the intensive care department. Meetings between the ICU and infection control teams were held every day. Postdischarge disinfection of rooms was enforced. Broad-spectrum antibiotic use was discouraged.
Results.Compared with a baseline rate of 0.44 cases per 1,000 patient-days for nosocomial transmission, the incidence peaked at 11.57 cases per 1,000 patient-days (October and November 2005; rate ratio for peak vs baseline, 25.46). The outbreak involved 30 patients, of whom 9 developed an infection. Bacterial genotyping disclosed that the outbreak was polyclonal, with 1 predominant genotype. Reinforced infection control measures lasted for 50 days. After the implementation of these measures, the incidence fell to 0.08 cases per 1,000 patient-days (rate ratio for after the outbreak vs during the outbreak, 0.11).
Conclusion.These data indicate that, in an intensive care department in which routine screening and contact precautions failed to prevent and interrupt an outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures controlled the outbreak without major disruption of medical care.
Sensitive measure of prevalence and parasitaemia of haemosporidia from European blackbird (Turdus merula) populations: value of PCR-RFLP and quantitative PCR
- S. BENTZ, T. RIGAUD, M. BARROCA, F. MARTIN-LAURENT, D. BRU, J. MOREAU, B. FAIVRE
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- Journal:
- Parasitology / Volume 133 / Issue 6 / December 2006
- Published online by Cambridge University Press:
- 04 September 2006, pp. 685-692
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Haemosporidian parasites are common in birds in which they act as an important selective pressure. While most studies so far have focused on the effect of their prevalence on host life-history traits, no study has measured the effect of parasitaemia. We developed molecular methods to detect, identify and quantify haemosporidia in 2 natural populations of the Blackbird Turdus merula. Three different parasite genotypes were found – 1 Haemoproteus and 2 Plasmodium. A PCR-RFLP screening revealed that only approximately 3% of blackbirds were free of parasites, compared to the 34% of uninfected birds estimated by blood smear screening. A quantitative PCR (q-PCR) assay revealed a weaker parasitaemia in microscopically undetected parasites compared to microscopically detected ones. Large parasitaemia differences were found between parasite species, suggesting either differing parasite life-histories or host resistance. Parasitaemias were also weaker in male hosts, and in urban habitats, suggesting that both host factors (e.g. immunity) and habitat characteristics (e.g. vector availability) may modulate parasite density. Interestingly, these differences in parasitaemia were comparable to differences in parasite prevalence estimated by smear screening. This suggests that previous results obtained by smear screening should be reinterpreted in terms of parasitaemia instead of parasite prevalence.
Sedation with target-controlled propofol infusion during shoulder surgery under interscalene brachial plexus block in the sitting position: report of a series of 140 patients
- S. Vincent, D. Laurent, B. Francis
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- Journal:
- European Journal of Anaesthesiology / Volume 22 / Issue 11 / November 2005
- Published online by Cambridge University Press:
- 13 October 2005, pp. 853-857
- Print publication:
- November 2005
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Summary
Background and objective: The aim of this study was to assess target-controlled propofol infusion as a technique of sedation for shoulder surgery under interscalene brachial plexus block in the sitting position and to evaluate the effect of sedation on hypotensive/bradycardic events during this procedure. Methods: One hundred and forty patients undergoing elective shoulder surgery in the sitting position under interscalene brachial plexus block (with 30 mL of ropivacaine 0.75%) were prospectively enrolled. All patients were premedicated with hydroxyzine 1 mg kg−1, none received beta-blockers. No patients were given atropine except for the patients who experienced a vasovagal event either during the block procedure or intravenous catheter placement. The target-controlled propofol infusion was started immediately after positioning the patient on the operating table. The initial target concentration was 1 μg mL−1. The infusion rate was adjusted every 15 min by increasing or decreasing the target concentration by 0.2 μg mL−1 steps to maintain the patient rousable to verbal commands (score of 3 on Wilson sedation scale). The following parameters were assessed: minimal, maximal, optimal target concentration, respiratory and haemodynamic parameters, total propofol dose, additional alfentanil needs, occurrence of hypotensive/bradycardic events, complications. Results are mean ± SD. Statistical analysis used t-test and χ2-tests. Results: The optimal propofol target concentration was 0.8 μg mL−1. No respiratory complications or conversion to general anaesthesia was reported. Two patients experienced transient and inconsequential intraoperative agitation. The incidence of hypotensive/bradycardic events during the procedure was 5.7% (eight patients). Conclusion: Target-controlled propofol infusion (0.8–0.9 μg mL−1) following hydroxyzine premedication is a safe and effective technique for sedation when combined with interscalene brachial plexus block during shoulder surgery in the sitting position.
12 - Spasticity and pain after stroke
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- By Philippe Vuadens, Clinique Romande de Réadaptation, Av Grand-Champsec, Michael P. Barnes, Hunters Moor Regional Neurorehabilitation Centre, R. Peyron, Saint-Etienne Center for Pain, Department of Neurology, B. Laurent, Saint-Etienne Center for Pain, Department of Neurology Hôpital de Bellevue,
- Edited by Michael P. Barnes, University of Newcastle upon Tyne, Bruce H. Dobkin, University of California, Los Angeles, Julien Bogousslavsky, Université de Lausanne, Switzerland
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- Book:
- Recovery after Stroke
- Published online:
- 05 August 2016
- Print publication:
- 10 March 2005, pp 286-319
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Summary
Introduction
Since the studies of Sherrington(1947) on decerebrate rigidity in the cat, evidence has shown that spasticity is the result of modification of the sensitivity of the central reflex pathways. Lance defined spasticity in 1980 as a velocity-dependent increase in muscle tone in response to muscle stretch. This resistance to muscle stretch may also result in soft tissue modifications and eventually muscle and soft tissue contractures (Goldspink and Williams, 1990). In this way, it may limit movement and be a significant cause of disability and handicap. Usually spasticity is simply one part of the upper motor neuron syndrome and the other elements of the syndrome are responsible for further disability (Table 12.1).
Spasticity is a dynamic feature that can vary with the position of the limb or trunk, with time, with medication, and with a variety of other factors. Consequently, it is often difficult to evaluate the real impact of spasticity as an independent factor in its own right. The treatment must take into account all the features of the upper motor neuron syndrome, only some of which are responsive to clinical management. The main goal, as always in rehabilitation practice, is to identify the function limited by spasticity and introduce appropriate measures to improve that function. Sometimes a secondary goal can be simply to avoid unnecessary future complications associated with spasticity, such as contractures.
The aim of the first part of this chapter is to discuss the overall context of spasticity in terms of treatment decisions and outcome measures. The general management of spasticity will then be discussed both in terms of physical therapy and orthotic management as well as in terms of oral antispastic medication, focal treatments, and surgery. We will then discuss the management of various types of post-stroke pain, including hemiplegic shoulder pain.
Spasticity
Definition
Lance (1980) defined spasticity as “a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting fromhyperexcitability of the stretch reflex, as one component of the upper motor neurone syndrome.” There are three main mechanisms that induce spasticity: modification of the muscle, new nerve collaterals at the spinal level, and exaggeration of the spinal reflexes, which are not appropriatelymodulated by the supraspinal pathways (Brown, 1994; Young, 1994). It is likely that the perturbations of several of these mechanisms are necessary to produce clinical spasticity.
Wolf-Rayet stars at 1 - 2 Mpc
- Paul A. Crowther, Jay B. Abbott, Laurent Drissen, Hansrüdi Schild, Werner Schmutz, Pierre Royer, Stephen J. Smartt
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- Journal:
- Symposium - International Astronomical Union / Volume 212 / 2003
- Published online by Cambridge University Press:
- 26 May 2016, pp. 547-548
- Print publication:
- 2003
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We present new narrow-band imaging and optical spectroscopy of Wolf-Rayet stars in the Local Group dwarf galaxy IC 10 (Gemini-N- gmos) and Sculptor group spiral galaxy NGC 300 (VLT fors2).