Gram-positive infections in patients with end-stage renal disease

Gram-positive microorganisms, specifically coagulase-negative staphylococci are the most common species recovered from clinical culture specimens of patients with end-stage renal disease. The propensity of coagulase-negative staphylococci (CNS) to cause infection in this patient group has been widely debated. However, it is still unclear how this usually avirulent commensal microorganism produces infection that contributes to high rates of morbidity and mortality in patients with end-stage renal disease. The aim of this thesis was to investigate the rate, geographical distribution, molecular and phenotypic mechanisms of Gram-positive microorganisms associated with infection in renal dialysis patients. In addition, it sought to assess the value of early serological diagnosis of dialysis catheter-associated infection and the effect of antimicrobial treatment regimens on the faecal carriage of enteric microorganisms. In this study, the incidence of haemodialysis catheter-associated infection was established with the Meditrend audit tool. This tool was used to assess the infection outcomes of catheter insertion and management procedures until the catheter was explanted. Introduction of a catheter management protocol decreased the incidence of catheter-related infection. Staphylococcal species recovered from episodes of haemodialysis catheter-associated infection and continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis were genotyped by determination of macrorestriction profiles with pulsed-field gel electrophoresis. This highlighted horizontal transfer of microorganisms between different patients and the environment. The phenotypic characteristics of these strains were also investigated to determine characteristics that could be used as markers for dialysis catheter-associated infection. The expression of elastase, lipase and esterase by CNS was significantly associated with infection. A rapid enzyme-linked immunosorbent assay incorporating a novel staphylococcal antigen (lipid S) was used to evaluate the early detection of anti-staphylococcal immunoglobulin gamma in patient sera. The comparison of culture positive and culture negative patients demonstrated a steady state of immune activation in both groups. However anti-lipid S serum antibody titres > 1000 were found to be a predictor of infection. The effect on faecal carriage of vancomycin resistant enterococci (VRE) and Clostridium difficile toxins in patients treated with CAPD when empiric cephalosporin therapy was substituted for piperacillin/tazobactam was investigated. The introduction of piperacillin/tazobactam demonstrated a decrease in the faecal carriage of VRE.

The chemistry of some organotellurium compounds

Tbe formation of Pd(TeR)n and (CuTeR)n from the reaction between telluroesters and Pd(II)or Cu(II) suggested that these organa­tellurium reagents may be useful precursors of RTe- ligands in reactions with transition-metal substrates. Also the formation of telluronium salts Me2RTeI- from the reaction between telluroesters and methyl iodide, together with the above, confirm the cleavage of -cõ-Te bonds rather than -C-Te bonds. The formation of a carboxylic acid from the toluene solution of a ditelluride d palladium(O) complex in the presence of light oxygen (from air) is demonstrated. When the solvent employed is p-xylene an aldehyde is formed.The reaction proceeds via the free radical, RTeO, with Pd(PPh3)4 as a catalyst.It has also been shown that the oxidation of aldehydes to carboxylic acids is catalysed by ditelluride. Spin trapping experiments with PhCH=N(O)But (phenyl-t-butyl-nitrone) have provided evidence that the oxidative addition of an alkyl halide (RX=Mei, BunBr, BusecBr, ButBr, BrCH2-CH=CHCH2Br, and Br(CH2)4Br) to diphenyltelluride and reductive elimination of CH3SCN from Ph2(CH3)Te(NCS) proceeds via radical pathways. A mechanism is proposed for oxidative addition which involves the preformation of a charge transfer complex of alkyl halide and diphenyltelluride.The first step is the formation of a charge transfer complex, and the initial product of the oxidative addition is a "covalent" form of the tellurium(IV)compound. When the radical R is more stable, Ph2TeX2 may be the major tellurium(IV)product. The reaction of RTeNa (R=p-EtOC6H4, Ph) with organic dihalides X2(CH2)n (n=1,2,3,4) affords telluronium salts (n=3,4; X=Cl, Br) the nature of which is discussed.For n=l (X=Br, I)the products are formulated as charge transfer complexes of stoichiometry (RTe)2(CH2).CH2X2• For n=2, elimination of ditelluride occurs with the formation of an alkene. Some 125’Te Mõssbauer data are discussed and it is suggested that the unusually low value of 6 (7.58 mm.s-1 ) for  p-EtO.C6H4.Te)2(cH2)cH2Br2 relates to removal of 5's electronsfrom the spare pair orbltal via the charge transfer interaction. 125Te Mossbauer data for (p-EtO.C6H4)Te(CH2)4Br are typical of a tellurium (IV) compound and in particular ∇ is in the expected range for a telluronium salt. The product of the reaction of Na Te (C6H4.OEt), with 1,3-dibromopropane is, from the Mössbauer data, also a telluronium salt.

Challenges and opportunities for reverse logistics initiatives in the automotive industry

This paper investigates the main strategies automotive companies adopt to address the issue of dealing with end-of-life vehicles and spare parts. Furthermore, it investigates the reasons behind take-back strategies, i.e how and why automotive companies undertake initiatives in reverse logistics. The research findings indicate that companies are trying to respond to the end-of-life legislation based on cost-effective approaches as well as corporate environmental responsibility. Outsourcing is used when expertise is found to extract value from scrap and there is cooperation with suppliers and vendors to facilitate the dismantling of cars and recycling of parts.

Needleless connectors:the way forward in the prevention of catheter-related infections?

Letter to the Editor

Horizons régionaux et variations océaniennes des territoires français

« L’identité régionale […] repose sur une réalité concrète : la mer est aussi réelle que vous et moi […]. Je ne fais que constater qu’elle forge le caractère de cette planète, qu’elle est une source majeure de notre subsistance et que nous l’avons tous en partage, où que nous soyons en Océanie. Mais au-delà des épreuves quotidiennes, la mer nous lie les uns aux autres. Elle est source de sagesse infinie. La mer est notre métaphore la plus puissante. L’océan est en nous. » (Hau’Ofa, 2015 [1997] : 55-56). Souvent présentés de manière séparée, les territoires français dans le Pacifique Sud, objets de ce dossier, possèdent cependant des horizons régionaux intéressants qui mettent en exergue la variété des écosystèmes politiques de l’espace océanien1. Les facettes multidimensionnelles des évolutions humaines montrent une « mer d’îles » océaniennes en mouvement, selon l’intellectuel tongien Epeli Hau’Ofa (2008 [1993]). Sa pensée alimente la formation d’une identité régionale océanienne, à p... « Regional identity […] has been constructed on a foundation of concrete reality. That the sea is as real as you and I […], that it shapes the character of this planet, that it is a major source of our sustenance, that it is something that we all share in common wherever we are in Oceania – all of these are statements of fact. Yet beyond that level of everyday experience, the sea is our pathway to each other and to everyone else, the sea is our endless saga, the sea is our most powerful metaphor, the ocean is in us. » (Hau’Ofa, 2015 [1997]: 55-56). Often conceived of as separate entities, French overseas territories in the South Pacific, as the subject of this special issue, nevertheless possess interesting regional horizons, which highlight the variety of political ecosystems of Oceania. The multidimensional facets of human evolution show an Oceanian “Sea of Islands” in constant movement, according to the Tongan intellectual Epeli Hau’Ofa (2008 [1993]). His philosophy contributes to...

The impact of ageing and gender on visual mental imagery processes:a study of performance on tasks from the Complete Visual Mental Imagery Battery (CVMIB)

In this study we aim to evaluate the impact of ageing and gender on different visual mental imagery processes. Two hundred and fifty-one participants (130 women and 121 men; age range = 18–77 years) were given an extensive neuropsychological battery including tasks probing the generation, maintenance, inspection, and transformation of visual mental images (Complete Visual Mental Imagery Battery, CVMIB). Our results show that all mental imagery processes with the exception of the maintenance are affected by ageing, suggesting that other deficits, such as working memory deficits, could account for this effect. However, the analysis of the transformation process, investigated in terms of mental rotation and mental folding skills, shows a steeper decline in mental rotation, suggesting that age could affect rigid transformations of objects and spare non-rigid transformations. Our study also adds to previous ones in showing gender differences favoring men across the lifespan in the transformation process, and, interestingly, it shows a steeper decline in men than in women in inspecting mental images, which could partially account for the mixed results about the effect of ageing on this specific process. We also discuss the possibility to introduce the CVMIB in clinical assessment in the context of theoretical models of mental imagery.

The quality of inter- and intra-ethnic friendships among roma and non-roma students in Hungary

In this paper I compare the quality of inter- and intra-ethnic friendships. Findings of previous studies suggest that interethnic friendships are less likely to be characterized by closeness and intimacy than friendships among same-ethnic peers. I analyze data of a Hungarian panel study conducted among Roma and non-Roma Hungarian secondary school students. Descriptive analysis of 13 classes shows that interethnic friendships are indeed less often characterized by a co-occurring trust, perceived helpfulness, or jointly spent spare time nomination than intra-ethnic ones. This association holds if I include self-declared ethnicity as well as peer perceptions of ethnicity into the analysis. Analyzing self-declared ethnicity of students I also find that interethnic relations are less often reciprocated than intra-ethnic ones. If I concentrate on ethnic peer perceptions, however, I find that outgoing nominations of non-Roma students are more often reciprocated by classmates perceived as Roma than by classmates perceived as non-Roma.

Keynote Address by Karim Rashid

Karim Rashid is one of the most prolific designers of his generation. Over 3000 designs in production, over 300 awards and working in over 35 countries attest to Karim’s legend of design. Karim’s diversity affords him the ability to cross-pollinate ideas, materials, behaviors, aesthetics from one typology to the next, crossing boundaries and broadening consumer horizons. His award winning designs include democratic objects such as the ubiquitous Garbo waste can and Oh Chair for Umbra, interiors such as the Morimoto restaurant, Philadelphia and Semiramis hotel, Athens and exhibitions for LG Hausys and Audi. Karim has collaborated with clients to create democratic design for Method and Dirt Devil, furniture for Artemide and Magis, brand identity for Citibank and Hyundai, high tech products for LaCie and Samsung, and luxury goods for Veuve Clicquot and Swarovski, to name a few. Karim has recently been selected to design several real estate developments in New York City for HAP Investments, a New York City based International investment group. Karim’s work is featured in 20 permanent collections and he exhibits art in galleries world wide. Karim is a perennial winner of the Red Dot award, Chicago Athenaeum Good Design award, I.D. Magazine Annual Design Review, IDSA Industrial Design Excellence award. He holds honorary doctorates from the Ontario college of Art & Design and Corcoran College of Art & Design. 2011 highlighted Karim’s largest retrospective to date at the Triennale, in Milan, Italy. Karim is a frequent guest lecturer at universities and conferences globally disseminating the importance of design in everyday life. Karim has been featured in magazines including Time, Financial Times, NY Times, Esquire, GQ and countless more. His books include From the Beginning, Forma Edizioni (2014), Sketch, Frame (2012), a monograph of 300 drawings and computer renderings of selected works, KarimSpace, Rizzoli (2009), Design Your Self, Harper Collins (2006), Evolution, Rizzoli (2004) and I Want to Change the World, Universe (2001). In his spare time Karim’s pluralism flirts with art, fashion, and music and is determined to creatively touch every aspect of our physical and virtual landscape.

Les référendums sur la souveraineté de l'Écosse et de la Catalogne : le renvoi relatif à la sécession du Québec en comparaison

L’année 2014 est marquée par les référendums sur la souveraineté de l’Écosse et de la Catalogne, deux nations partageant de nombreux points communs sur les plans de l’histoire et de la culture. Le cadre juridique pré-référendaire de chacune de ces régions est fondamentalement le même: l’existence juridique de l’Écosse et de la Catalogne est directement issue de la volonté d’un État central unitaire, respectivement le Royaume-Uni et l’Espagne. La compétence législative de tenir un référendum sur l’autodétermination de ces régions est d’ailleurs ambiguë. Devant ce dilemme, le Royaume-Uni permet à l’Écosse d’organiser un référendum sur sa souveraineté. Il en résulte un processus démocratique juste, équitable, décisif et respecté de tous. De son côté, l’Espagne interdit à la Catalogne d’en faire de même, ce qui n’empêche pas Barcelone de tout mettre en œuvre afin de consulter sa population. Il en découle un processus de participation citoyenne n’ayant rien à voir avec un référendum en bonne et due forme. 20 ans après le dernier référendum sur la souveraineté du Québec, l’étude des référendums de l’Écosse et de la Catalogne nous permet de mettre en lumière la justesse, mais aussi l’incohérence partielle des enseignements de la Cour suprême du Canada dans son Renvoi relatif à la sécession du Québec. D’un côté, la nécessité d’équilibrer les principes constitutionnels sous-jacents de démocratie et de constitutionnalisme est mise en exergue. Parallèlement, les concepts de question et de réponse claires, d’effectivité et de négociations post-référendaires prennent une toute autre couleur face à un nouvel impératif absent des conclusions de la Cour suprême : celui des négociations pré-référendaires.

Profil des étudiants entamant des études universitaires et analyse des choix d’études

Cet article a pour objectif de développer, à partir d’une base de données inédite portant sur les étudiants s’inscrivant pour la première fois en première année à l’université en Belgique francophone, une étude socio-graphique du profil de ces étudiants et de leurs choix d’études, en prenant en compte plusieurs variables sociologiques et académiques : le sexe, le niveau de diplôme des parents, le statut de boursier et diverses variables décrivant le parcours scolaire antérieur. Il s’agit notamment de mesurer l’écart qui nous sépare d’une situation parfaite d’« égalité des chances » d’accès aux études universitaires, où la répartition des étudiants selon le domaine ou le secteur d’études serait indépendante des « variables héritées » liées au sexe ou aux origines sociales.

The Feasibly of Functionally Guided Intensity Modulated Radiation Therapy Treatment Planning Using Perfluoropropane-Enhanced MRI for Lung Cancer

Radiotherapy is commonly used to treat lung cancer. However, radiation induced damage to lung tissue is a major limiting factor to its use. To minimize normal tissue lung toxicity from conformal radiotherapy treatment planning, we investigated the use of Perfluoropropane(PFP)-enhanced MR imaging to assess and guide the sparing of functioning lung. Fluorine Enhanced MRI using Perfluoropropane(PFP) is a dynamic multi-breath steady state technique enabling quantitative and qualitative assessments of lung function(1).

Imaging data was obtained from studies previously acquired in the Duke Image Analysis Laboratory. All studies were approved by the Duke IRB. The data was de-identified for this project, which was also approved by the Duke IRB. Subjects performed several breath-holds at total lung capacity(TLC) interspersed with multiple tidal breaths(TB) of Perfluoropropane(PFP)/oxygen mixture. Additive wash-in intensity images were created through the summation of the wash-in phase breath-holds. Additionally, model based fitting was utilized to create parametric images of lung function(1).

Varian Eclipse treatment planning software was used for putative treatment planning. For each subject two plans were made, a standard plan, with no regional functional lung information considered other than current standard models. Another was created using functional information to spare functional lung while maintaining dose to the target lesion. Plans were optimized to a prescription dose of 60 Gy to the target over the course of 30 fractions.

A decrease in dose to functioning lung was observed when utilizing this functional information compared to the standard plan for all five subjects. PFP-enhanced MR imaging is a feasible method to assess ventilatory lung function and we have shown how this can be incorporated into treatment planning to potentially decrease the dose to normal tissue.

From the Cover: Arsenite Uncouples Mitochondrial Respiration and Induces a Warburg-like Effect in Caenorhabditis elegans.

Millions of people worldwide are chronically exposed to arsenic through contaminated drinking water. Despite decades of research studying the carcinogenic potential of arsenic, the mechanisms by which arsenic causes cancer and other diseases remain poorly understood. Mitochondria appear to be an important target of arsenic toxicity. The trivalent arsenical, arsenite, can induce mitochondrial reactive oxygen species production, inhibit enzymes involved in energy metabolism, and induce aerobic glycolysis in vitro, suggesting that metabolic dysfunction may be important in arsenic-induced disease. Here, using the model organism Caenorhabditis elegans and a novel metabolic inhibition assay, we report an in vivo induction of aerobic glycolysis following arsenite exposure. Furthermore, arsenite exposure induced severe mitochondrial dysfunction, including altered pyruvate metabolism; reduced steady-state ATP levels, ATP-linked respiration and spare respiratory capacity; and increased proton leak. We also found evidence that induction of autophagy is an important protective response to arsenite exposure. Because these results demonstrate that mitochondria are an important in vivo target of arsenite toxicity, we hypothesized that deficiencies in mitochondrial electron transport chain genes, which cause mitochondrial disease in humans, would sensitize nematodes to arsenite. In agreement with this, nematodes deficient in electron transport chain complexes I, II, and III, but not ATP synthase, were sensitive to arsenite exposure, thus identifying a novel class of gene-environment interactions that warrant further investigation in the human populace.

Les référendums sur la souveraineté de l'Écosse et de la Catalogne : le renvoi relatif à la sécession du Québec en comparaison

L’année 2014 est marquée par les référendums sur la souveraineté de l’Écosse et de la Catalogne, deux nations partageant de nombreux points communs sur les plans de l’histoire et de la culture. Le cadre juridique pré-référendaire de chacune de ces régions est fondamentalement le même: l’existence juridique de l’Écosse et de la Catalogne est directement issue de la volonté d’un État central unitaire, respectivement le Royaume-Uni et l’Espagne. La compétence législative de tenir un référendum sur l’autodétermination de ces régions est d’ailleurs ambiguë. Devant ce dilemme, le Royaume-Uni permet à l’Écosse d’organiser un référendum sur sa souveraineté. Il en résulte un processus démocratique juste, équitable, décisif et respecté de tous. De son côté, l’Espagne interdit à la Catalogne d’en faire de même, ce qui n’empêche pas Barcelone de tout mettre en œuvre afin de consulter sa population. Il en découle un processus de participation citoyenne n’ayant rien à voir avec un référendum en bonne et due forme. 20 ans après le dernier référendum sur la souveraineté du Québec, l’étude des référendums de l’Écosse et de la Catalogne nous permet de mettre en lumière la justesse, mais aussi l’incohérence partielle des enseignements de la Cour suprême du Canada dans son Renvoi relatif à la sécession du Québec. D’un côté, la nécessité d’équilibrer les principes constitutionnels sous-jacents de démocratie et de constitutionnalisme est mise en exergue. Parallèlement, les concepts de question et de réponse claires, d’effectivité et de négociations post-référendaires prennent une toute autre couleur face à un nouvel impératif absent des conclusions de la Cour suprême : celui des négociations pré-référendaires.

Profil des étudiants entamant des études universitaires et analyse des choix d’études

Cet article a pour objectif de développer, à partir d’une base de données inédite portant sur les étudiants s’inscrivant pour la première fois en première année à l’université en Belgique francophone, une étude socio-graphique du profil de ces étudiants et de leurs choix d’études, en prenant en compte plusieurs variables sociologiques et académiques : le sexe, le niveau de diplôme des parents, le statut de boursier et diverses variables décrivant le parcours scolaire antérieur. Il s’agit notamment de mesurer l’écart qui nous sépare d’une situation parfaite d’« égalité des chances » d’accès aux études universitaires, où la répartition des étudiants selon le domaine ou le secteur d’études serait indépendante des « variables héritées » liées au sexe ou aux origines sociales.

Life Experiences of Youth Who Were Born with HIV Infection in Puerto Rico: The Voices of Young Survivors

The effectiveness of antiretroviral therapy (ART) transformed the pediatric HIV epidemic. The disease changed significantly over the course of three decades: while early in the epidemic it was almost always fatal, it has become a chronic condition. This study examined how perinatally-infected youth experience the impact of HIV in their lives. A qualitative study using interpretative phenomenological analysis (IPA) was conducted. Twenty in-depth interviews were carried out among 12 women and 8 men aged 18 to 30 years in Puerto Rico. These were conducted in Spanish, audio-recorded, transcribed and translated into English. While narrating their experiences, participants were interpreting what the situation meant to them and how they make sense of it. Three topics emerged: (1) perception and response to treatment and illness, particularly their lived experiences with ART; (2) disclosure experiences; and (3) family matters. Most participants challenged their therapy, in most cases to force their caregivers to disclose their status. Problems with adherence were attributed to busy schedules or forgetfulness. Participants experienced the disfiguring adverse effects of ART, which they endured for years without being informed that ART was the cause of these. Participants’ experiences with disclosure demonstrated the importance of validating them as individuals capable of managing their health. The paternalistic approach of withholding their diagnosis to spare them suffering resulted in increased anxiety. Participants acknowledged the difficulties of revealing their HIV status to their partners. They referred to family and friends as essential in coping with HIV. However, some encountered discrimination and stigma within their families. Participants who had suffered the loss of their parents found other parental figures such as adoptive parents or other family members. Most participants expressed a desire to have children. Perinatally HIV-infected youth will require health services for the rest of their lives. The adult health care into which they transition should consider their needs and journey. Services should consider including family members. This study underscores the need for improved access to mental health services. It is also essential to transcend medical treatment and develop a broader perspective of health care. Health care services should include reproductive decision-making counselling services.