The future of antimicrobial therapy in the era of antibiotic resistance in cystic fibrosis pulmonary infection

Cystic fibrosis (CF) is characterised by chronic polymicrobial airway infection and inflammation, which is the major cause of morbidity and mortality. Aggressive use of antimicrobials has been fundamental in increasing the life expectancy of CF patients in recent years. However, enhanced culture and non-culture based detection methods have identified bacteria in the CF lung not previously isolated from CF patients by routine diagnostic microbiology Coupled with increasing antimicrobial resistance, the future of antimicrobial therapy in CF respiratory infection remains challenging. New strategies are needed to address these problems and ensure improvements in life expectancy are maintained. Potential future strategies include the use of new antimicrobial agents and formulations currently in clinical trials, alternative methods of selecting appropriate therapeutic regimens, determination of the pathogenicity of species newly associated with CF and the development of new antimicrobials and adjuvants for use in clinical practice.

Software Patents and the Digital Environment

Software is patentable in Europe so long as there is sufficient ‘technical contribution’ under the decades-long interpretation of the European Patent Convention made by the Boards of Appeal of the European Patent Office. Despite the failure of the proposed Directive on Computer Implemented Inventions, opponents of software patents have failed to have any affect upon this technical contrivance. Yet, while national courts find the Boards of Appeal decisions persuasive, ‘technical contribution’ remains a difficult test for these various courts to apply. In this article I outline that the test is difficult to utilise in national litigation (it is an engineering approach, rather than a legal one) and suggest that as the Boards of Appeal become less important (and thus less persuasive) should the proposed Unified Patent Court come to fruition, the ‘technical contribution’ test is unlikely to last. This may again make the whole issue of what/whether/how software should be patentable open to debate, hopefully in a less aggressive environment than has existed to date.

Beowulf Hondbona: the Literary Context for Emending Line 1520b

In this article I consider the debate over whether line 1520b ought to be read as the emended “hond sweng” or the scribal “hord swenge.” It is a small point philologically but it raises interesting cultural and literary questions about the attitude of the Beowulf poet to arms and armour, to aggressive and defensive war gear, and to swords in particular. It has widely been assumed that swords are important in Beowulf and yet, the question of what their significance might be has received very little attention. Throughout the poem the hero is plagued by breaking, melting, and failing swords. He borrows, finds, and is given swords but unlike other English and Germanic heroes he is never identified with a single, great sword. I suggest that this is because, ultimately, Beowulf is conceived as a hondbana, a designation which has implications for what kind of a hero he proves to be.

Prevalence, phenomenology, aetiology and predictors of challenging behaviour in Smith-Magenis syndrome

Background

The prevalence, phenomenology aetiology and correlates of four forms of challenging behaviour in 32 children and adults with Smith-Magenis syndrome (SMS) were investigated.

Methods

Cognitive assessments, questionnaires and semi-structured interviews were used to gather data on intellectual disability, verbal and physical aggression, destructive behaviour and self-injury and on characteristics known to be associated with aggression.

Results

Aggression in SMS was more prevalent (87%), but not more severe than aggression in contrast groups. Aggressive behaviour was more frequently associated with environmental contingencies (e.g. attention, escape and access to tangibles) than self-injury and destructive behaviours. Severity of challenging behaviours was associated with high impulsivity.

Conclusion

Aggression is seen in the majority of people with SMS. Results suggest that behavioural disinhibition and operant social reinforcement are associated with the manifestation of aggression.

Behavioural outcomes at 3 years of age among late preterm infants admitted to neonatal intensive care: a cohort study

Objective: Examine the behavioural outcomes at age 3 years of late preterm infants (LPIs) who were admitted to neonatal intensive care (NIC) in comparison with LPIs who were not admitted.
Method: This cohort study prospectively recruited 225 children born late preterm (34–36+6 weeks gestation) in 2006 in Northern Ireland, now aged 3 years. Two groups were compared: LPIs who received NIC (study; n=103) and LPIs who did not receive NIC (control; n=122). Parents/guardians completed the Child Behaviour Checklist/1½-5. Descriptive maternal and infant data were also collected.
Results: As expected LPI children admitted to NIC had higher medical risk than the non-admitted comparison group (increased caesarean section, born at earlier gestation, lower birth weight and an episode of resuscitation at birth). LPIs admitted to NIC scored higher on the Child Behaviour Checklist/1½-5 compared with those who were not admitted indicating more behavioural problems; this was statistically significant for the Aggressive Behaviour Subscale (z=−2.36) and the Externalising Problems Scale (z=−2.42). The group difference on the Externalising Problems Scale was no longer significant after controlling for gender, gestational age and deprivation score.
Conclusions: This study provides valuable data on the behaviour at age 3 years of LPIs admitted to NIC compared with LPIs not admitted to NIC. Further research would be beneficial to explore medical and psychosocial explanations for observed differences between groups using large prospective cohort studies.

A highly potent and specific MET therapeutic protein antagonist with both ligand-dependent and ligand-independent activity

Activation of the MET oncogenic pathway has been implicated in the development of aggressive cancers that are difficult to treat with current chemotherapies. This has led to an increased interest in developing novel therapies that target the MET pathway. However, most existing drug modalities are confounded by their inability to specifically target and/or antagonize this pathway. Anticalins, a novel class of monovalent small biologics, are hypothesized to be "fit for purpose" for developing highly specific and potent antagonists of cancer pathways. Here, we describe a monovalent full MET antagonist, PRS-110, displaying efficacy in both ligand-dependent and ligand-independent cancer models. PRS-110 specifically binds to MET with high affinity and blocks hepatocyte growth factor (HGF) interaction. Phosphorylation assays show that PRS-110 efficiently inhibits HGF-mediated signaling of MET receptor and has no agonistic activity. Confocal microscopy shows that PRS-110 results in the trafficking of MET to late endosomal/lysosomal compartments in the absence of HGF. In vivo administration of PRS-110 resulted in significant, dose-dependent tumor growth inhibition in ligand-dependent (U87-MG) and ligand-independent (Caki-1) xenograft models. Analysis of MET protein levels on xenograft biopsy samples show a significant reduction in total MET following therapy with PRS-110 supporting its ligand-independent mechanism of action. Taken together, these data indicate that the MET inhibitor PRS-110 has potentially broad anticancer activity that warrants evaluation in patients.

Periodontal systemic associations: review of the evidence

Aim: To critically appraise recent research into associations between periodontal disease and systemic diseases and conditions specifically respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer.

Methods: A MEDLINE literature search of papers published between 2002 and April 2012 was conducted. Studies that included periodontitis as an exposure were identified. Cross-sectional epidemiological investigations on large samples, prospective studies and systematic reviews formed the basis of the narrative review. A threshold set for the identification of periodontitis was used to identify those studies that contributed to the conclusions of the review.

Results: Many of the investigations were cross-sectional secondary analyses of existing data sets in particular the NHANES studies. There were a small number of systematic reviews and prospective studies. There was substantial variability in the definitions of exposure to periodontitis. A small number of studies met the threshold set for periodontitis and supported associations; however, in some of the chronic diseases there were no such studies. There was strong evidence from randomized controlled trials that interventions, which improve oral hygiene have positive effects on the prevention of nosocomial pneumonias.

Conclusions: There was substantial heterogeneity in the definitions used to identify periodontitis and very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between periodontitis and some, although not all, of the diseases and conditions reviewed. There is a need to reach a consensus on what constitutes periodontitis for future studies of putative associations with systemic diseases.

The lifetime direct cost of periodontal treatment:A case study from a norwegian specialist practice

Background: Successful periodontal treatment requires a commitment to regular lifelong maintenance and may be perceived by patients to be costly. This study calculates the total lifetime cost of periodontal treatment in the setting of a specialist periodontal practice and investigates the cost implications of choosing not to proceed with such treatment. Methods: Data from patients treated in a specialist practice in Norway were used to calculate the total lifetime cost of periodontal treatment that included baseline periodontal treatment, regular maintenance, retreatment, and replacing teeth lost during maintenance. Incremental costs for alternative strategies based on opting to forego periodontal treatment or maintenance and to replace any teeth lost with either bridgework or implants were calculated. Results: Patients who completed baseline periodontal treatment but did not have any additional maintenance or retreatment could replace only three teeth with bridgework or two teeth with implants before the cost of replacing additional teeth would exceed the cost of lifetime periodontal treatment. Patients who did not have any periodontal treatment could replace ≤4 teeth with bridgework or implants before a replacement strategy became more expensive. Conclusions: Within the limits of the assumptions made, periodontal treatment in a Norwegian specialist periodontal practice is cost-effective when compared to an approach that relies on opting to replace teeth lost as a result of progressive periodontitis with fixed restorations. In particular, patients who have initial comprehensive periodontal treatment but do not subsequently comply with maintenance could, on average, replace ≤3 teeth with bridgework or two teeth with implants before this approach would exceed the direct cost of lifetime periodontal treatment in the setting of the specialist practice studied. © 2012 American Academy of Periodontology.

Incorporating Severity and Risk as Factors to the Fardal Cost-Effectiveness Model to Create a Cost-Benefit Model for Periodontal Treatment

Background: A previously described economic model was based on average values for patients diagnosed with chronic periodontitis (CP). However, tooth loss varies among treated patients and factors for tooth loss include CP severity and risk. The model was refined to incorporate CP severity and risk to determine the cost of treating a specific level of CP severity and risk that is associated with the benefit of tooth preservation.

Methods: A population that received and another that did not receive periodontal treatment were used to determine treatment costs and tooth loss. The number of teeth preserved was the difference of the number of teeth lost between the two populations. The cost of periodontal treatment was divided by the number of teeth preserved for combinations of CP severity and risk.

Results: The cost of periodontal treatment divided by the number of teeth preserved ranged from (US) $ 1,405 to $ 4,895 for high or moderate risk combined with any severity of CP and was more than $ 8,639 for low risk combined with mild CP. The cost of a three-unit bridge was $ 3,416, and the cost of a single-tooth replacement was $ 4,787.

Conclusion: Periodontal treatment could be justified on the sole basis of tooth preservation when CP risk is moderate or high regardless of disease severity.

Design methodology for low power and arametric robustness through output-quality modulation:Application to color-interpolation filtering

Power dissipation and robustness to process variation have conflicting design requirements. Scaling of voltage is associated with larger variations, while Vdd upscaling or transistor upsizing for parametric-delay variation tolerance can be detrimental for power dissipation. However, for a class of signal-processing systems, effective tradeoff can be achieved between Vdd scaling, variation tolerance, and output quality. In this paper, we develop a novel low-power variation-tolerant algorithm/architecture for color interpolation that allows a graceful degradation in the peak-signal-to-noise ratio (PSNR) under aggressive voltage scaling as well as extreme process variations. This feature is achieved by exploiting the fact that all computations used in interpolating the pixel values do not equally contribute to PSNR improvement. In the presence of Vdd scaling and process variations, the architecture ensures that only the less important computations are affected by delay failures. We also propose a different sliding-window size than the conventional one to improve interpolation performance by a factor of two with negligible overhead. Simulation results show that, even at a scaled voltage of 77% of nominal value, our design provides reasonable image PSNR with 40% power savings. © 2006 IEEE.

Process-variation resilient and voltage-scalable dct architecture for robust low-power computing

In this paper, we present a novel discrete cosine transform (DCT) architecture that allows aggressive voltage scaling for low-power dissipation, even under process parameter variations with minimal overhead as opposed to existing techniques. Under a scaled supply voltage and/or variations in process parameters, any possible delay errors appear only from the long paths that are designed to be less contributive to output quality. The proposed architecture allows a graceful degradation in the peak SNR (PSNR) under aggressive voltage scaling as well as extreme process variations. Results show that even under large process variations (±3σ around mean threshold voltage) and aggressive supply voltage scaling (at 0.88 V, while the nominal voltage is 1.2 V for a 90-nm technology), there is a gradual degradation of image quality with considerable power savings (71% at PSNR of 23.4 dB) for the proposed architecture, when compared to existing implementations in a 90-nm process technology. © 2006 IEEE.

VEDA:Variation-aware energy-efficient discrete Wavelet Transform architecture

In this paper, we present a unified approach to an energy-efficient variation-tolerant design of Discrete Wavelet Transform (DWT) in the context of image processing applications. It is to be noted that it is not necessary to produce exactly correct numerical outputs in most image processing applications. We exploit this important feature and propose a design methodology for DWT which shows energy quality tradeoffs at each level of design hierarchy starting from the algorithm level down to the architecture and circuit levels by taking advantage of the limited perceptual ability of the Human Visual System. A unique feature of this design methodology is that it guarantees robustness under process variability and facilitates aggressive voltage over-scaling. Simulation results show significant energy savings (74% - 83%) with minor degradations in output image quality and avert catastrophic failures under process variations compared to a conventional design. © 2010 IEEE.

Process variation tolerant low power DCT architecture

2-D Discrete Cosine Transform (DCT) is widely used as the core of digital image and video compression. In this paper, we present a novel DCT architecture that allows aggressive voltage scaling by exploiting the fact that not all intermediate computations are equally important in a DCT system to obtain "good" image quality with Peak Signal to Noise Ratio(PSNR) > 30 dB. This observation has led us to propose a DCT architecture where the signal paths that are less contributive to PSNR improvement are designed to be longer than the paths that are more contributive to PSNR improvement. It should also be noted that robustness with respect to parameter variations and low power operation typically impose contradictory requirements in terms of architecture design. However, the proposed architecture lends itself to aggressive voltage scaling for low-power dissipation even under process parameter variations. Under a scaled supply voltage and/or variations in process parameters, any possible delay errors would only appear from the long paths that are less contributive towards PSNR improvement, providing large improvement in power dissipation with small PSNR degradation. Results show that even under large process variation and supply voltage scaling (0.8V), there is a gradual degradation of image quality with considerable power savings (62.8%) for the proposed architecture when compared to existing implementations in 70 nm process technology.