Stepwise emergence of azole, echinocandin and amphotericin B multidrug resistance in vivo in Candida albicans orchestrated by multiple genetic alterations.

OBJECTIVES: The objective of this study was to characterize the underlying molecular mechanisms in consecutive clinical Candida albicans isolates from a single patient displaying stepwise-acquired multidrug resistance. METHODS: Nine clinical isolates (P-1 to P-9) were susceptibility tested by EUCAST EDef 7.2 and Etest. P-4, P-5, P-7, P-8 and P-9 were available for further studies. Relatedness was evaluated by MLST. Additional genes were analysed by sequencing (including FKS1, ERG11, ERG2 and TAC1) and gene expression by quantitative PCR (CDR1, CDR2 and ERG11). UV-spectrophotometry and GC-MS were used for sterol analyses. In vivo virulence was determined in the insect model Galleria mellonella and evaluated by log-rank Mantel-Cox tests. RESULTS: P-1 + P-2 were susceptible, P-3 + P-4 fluconazole resistant, P-5 pan-azole resistant, P-6 + P-7 pan-azole and echinocandin resistant and P-8 + P-9 MDR. MLST supported genetic relatedness among clinical isolates. P-4 harboured four changes in Erg11 (E266D, G307S, G450E and V488I), increased expression of ERG11 and CDR2 and a change in Tac1 (R688Q). P-5, P-7, P-8 and P-9 had an additional change in Erg11 (A61E), increased expression of CDR1, CDR2 and ERG11 (except for P-7) and a different amino acid change in Tac1 (R673L). Echinocandin-resistant isolates harboured the Fks1 S645P alteration. Polyene-resistant P-8 + P-9 lacked ergosterol and harboured a frameshift mutation in ERG2 (F105SfsX23). Virulence was attenuated (but equivalent) in the clinical isolates, but higher than in the azole- and echinocandin-resistant unrelated control strain. CONCLUSIONS: C. albicans demonstrates a diverse capacity to adapt to antifungal exposure. Potentially novel resistance-inducing mutations in TAC1, ERG11 and ERG2 require independent validation.

Screening of mental health and substance users in frequent users of a general Swiss emergency department.

BACKGROUND: The objectives of this study were to determine the proportions of psychiatric and substance use disorders suffered by emergency departments' (EDs') frequent users compared to the mainstream ED population, to evaluate how effectively these disorders were diagnosed in both groups of patients by ED physicians, and to determine if these disorders were predictive of a frequent use of ED services. METHODS: This study is a cross-sectional study with concurrent and retrospective data collection. Between November 2009 and June 2010, patients' mental health and substance use disorders were identified prospectively in face-to-face research interviews using a screening questionnaire (i.e. researcher screening). These data were compared to the data obtained from a retrospective medical chart review performed in August 2011, searching for mental health and substance use disorders diagnosed by ED physicians and recorded in the patients' ED medical files (i.e. ED physician diagnosis). The sample consisted of 399 eligible adult patients (≥18 years old) admitted to the urban, general ED of a University Hospital. Among them, 389 patients completed the researcher screening. Two hundred and twenty frequent users defined by >4 ED visits in the previous twelve months were included and compared to 169 patients with ≤4 ED visits in the same period (control group). RESULTS: Researcher screening showed that ED frequent users were more likely than members of the control group to have an anxiety, depressive disorder, post-traumatic stress disorder (PTSD), or suffer from alcohol, illicit drug abuse/addiction. Reviewing the ED physician diagnosis, we found that the proportions of mental health and substance use disorders diagnosed by ED physicians were low both among ED frequent users and in the control group. Using multiple logistic regression analyses to predict frequent ED use, we found that ED patients who screened positive for psychiatric disorders only and those who screened positive for both psychiatric and substance use disorders were more likely to be ED frequent users compared to ED patients with no disorder. CONCLUSIONS: This study found high proportions of screened mental health and/or substance use disorders in ED frequent users, but it showed low rates of detection of such disorders in day-to-day ED activities which can be a cause for concern. Active screening for these disorders in this population, followed by an intervention and/or a referral for treatment by a case-management team may constitute a relevant intervention for integration into a general ED setting.

Single Heartstring aortotomy for multiple off-pump venous bypass grafts.

Off-pump coronary bypass grafting may decrease the rate of stroke, due to minimal aortic manipulation. For venous grafts, clampless hemostasis when performing the proximal anastomosis can be achieved using the Heartstring device. We describe a technique using a single device to suture two veins to one aortotomy. This technique requires less space and could be advantageous in very short, small, and calcified aortas. In to our experience, this technique is rapid, simple, easy to reproduce, and cost-saving.

A systematic review of ultrasound-guided methods for brachial plexus blockade.

We systematically reviewed 25 randomised controlled trials of ultrasound-guided brachial plexus blockade that recruited 1948 participants: either one approach vs another (axillary, infraclavicular or supraclavicular); or one injection vs multiple injections. There were no differences in the rates of successful blockade with approach, relative risk (95% CI): axillary vs infraclavicular, 1.0 (1.0-1.1), p = 0.97; axillary vs supraclavicular, 1.0 (1.0-1.1), p = 0.68; and infraclavicular vs supraclavicular, 1.0 (1.0-1.1), p = 0.32. There was no difference in the rate of successful blockade with the number of injections, relative risk (95% CI) 1.0 (1.0-1.0), p = 0.69, for one vs multiple injections. The rate of procedural paraesthesia was less with one injection than multiple injections, relative risk (95% CI) 0.6 (0.4-0.9), p = 0.004.

How to report multiple outcome metrics in virtual reality simulation

Background Virtual reality (VR) simulation is increasingly used in surgical disciplines. Since VR simulators measure multiple outcomes, standardized reporting is needed. Methods We present an algorithm for combining multiple VR outcomes into dimension summary measures, which are then integrated into a meaningful total score. We reanalyzed the data of two VR studies applying the algorithm. Results The proposed algorithm was successfully applied to both VR studies. Conclusions The algorithm contributes to standardized and transparent reporting in VR-related research.

Development and validation of a visual grading scale for assessing image quality of AP pelvis radiographic images.

OBJECTIVE: The aim of this article was to apply psychometric theory to develop and validate a visual grading scale for assessing the visual perception of digital image quality anteroposterior (AP) pelvis. METHODS: Psychometric theory was used to guide scale development. Seven phantom and seven cadaver images of visually and objectively predetermined quality were used to help assess scale reliability and validity. 151 volunteers scored phantom images, and 184 volunteers scored cadaver images. Factor analysis and Cronbach's alpha were used to assess scale validity and reliability. RESULTS: A 24-item scale was produced. Aggregated mean volunteer scores for each image correlated with the rank order of the visually and objectively predetermined image qualities. Scale items had good interitem correlation (≥0.2) and high factor loadings (≥0.3). Cronbach's alpha (reliability) revealed that the scale has acceptable levels of internal reliability for both phantom and cadaver images (α = 0.8 and 0.9, respectively). Factor analysis suggested that the scale is multidimensional (assessing multiple quality themes). CONCLUSION: This study represents the first full development and validation of a visual image quality scale using psychometric theory. It is likely that this scale will have clinical, training and research applications. ADVANCES IN KNOWLEDGE: This article presents data to create and validate visual grading scales for radiographic examinations. The visual grading scale, for AP pelvis examinations, can act as a validated tool for future research, teaching and clinical evaluations of image quality.

Statistical Methods for Conservation and Alignment Quality in Proteins

Construction of multiple sequence alignments is a fundamental task in Bioinformatics. Multiple sequence alignments are used as a prerequisite in many Bioinformatics methods, and subsequently the quality of such methods can be critically dependent on the quality of the alignment. However, automatic construction of a multiple sequence alignment for a set of remotely related sequences does not always provide biologically relevant alignments.Therefore, there is a need for an objective approach for evaluating the quality of automatically aligned sequences. The profile hidden Markov model is a powerful approach in comparative genomics. In the profile hidden Markov model, the symbol probabilities are estimated at each conserved alignment position. This can increase the dimension of parameter space and cause an overfitting problem. These two research problems are both related to conservation. We have developed statistical measures for quantifying the conservation of multiple sequence alignments. Two types of methods are considered, those identifying conserved residues in an alignment position, and those calculating positional conservation scores. The positional conservation score was exploited in a statistical prediction model for assessing the quality of multiple sequence alignments. The residue conservation score was used as part of the emission probability estimation method proposed for profile hidden Markov models. The results of the predicted alignment quality score highly correlated with the correct alignment quality scores, indicating that our method is reliable for assessing the quality of any multiple sequence alignment. The comparison of the emission probability estimation method with the maximum likelihood method showed that the number of estimated parameters in the model was dramatically decreased, while the same level of accuracy was maintained. To conclude, we have shown that conservation can be successfully used in the statistical model for alignment quality assessment and in the estimation of emission probabilities in the profile hidden Markov models.

Supervised regionalization methods: A survey

This paper reviews almost four decades of contributions on the subject of supervised regionalization methods. These methods aggregate a set of areas into a predefined number of spatially contiguous regions while optimizing certain aggregation criteria. The authors present a taxonomic scheme that classifies a wide range of regionalization methods into eight groups, based on the strategy applied for satisfying the spatial contiguity constraint. The paper concludes by providing a qualitative comparison of these groups in terms of a set of certain characteristics, and by suggesting future lines of research for extending and improving these methods.

Supervised regionalization methods: A survey

This paper reviews almost four decades of contributions on the subject of supervised regionalization methods. These methods aggregate a set of areas into a predefined number of spatially contiguous regions while optimizing certain aggregation criteria. The authors present a taxonomic scheme that classifies a wide range of regionalization methods into eight groups, based on the strategy applied for satisfying the spatial contiguity constraint. The paper concludes by providing a qualitative comparison of these groups in terms of a set of certain characteristics, and by suggesting future lines of research for extending and improving these methods.

The use of mixed methods research in the behavioral sciences field

Mixed methods research involves the combined use of quantitative and qualitative methods in the same research study, and it is becoming increasingly important in several scientific areas. The aim of this paper is to review and compare through a mixed methods multiple-case study the application of this methodology in three reputable behavioural science journals: the Journal of Organizational Behavior, Addictive Behaviors and Psicothema. A quantitative analysis was carried out to review all the papers published in these journals during the period 2003-2008 and classify them into two blocks: theoretical and empirical, with the latter being further subdivided into three subtypes (quantitative, qualitative and mixed). A qualitative analysis determined the main characteristics of the mixed methods studies identified, in order to describe in more detail the ways in which the two methods are combined based on their purpose, priority, implementation and research design. From the journals selected, a total of 1.958 articles were analysed, the majority of which corresponded to empirical studies, with only a small number referring to research that used mixed methods. Nonetheless, mixed methods research does appear in all the behavioural science journals studied within the period selected, showing a range of designs, where the sequential equal weight mixed methods research design seems to stand out.

The use of mixed methods research in interdisciplinary educational journals

Mixed methods research is becoming increasingly important in several scientific areas. The analysis of prevalence rates is a new line of research that has emerged in mixed methods research, and this methodological approach has only been applied carefully in a handful of journals. The purpose of this article was to analyse the prevalence of mixed methods research in interdisciplinary educational journals. Moreover, the main characteristics of the mixed methods articles identified were examined. This study used a mixed methods approach to analyse these aspects. Specifically, a partially mixed sequential equal status multiple-case study design was applied with a development mixed methods purpose. Three educational journals in different disciplines were reviewed from 2005 to 2010 (Academy of Management Learning and Education, Educational Psychology Review, Journal of the Learning Sciences). The findings show differences among the journals in the prevalence rates and characteristics of the mixed methods studies

Novel Regression Methods For Spectral Data

Singular Value Decomposition (SVD), Principal Component Analysis (PCA) and Multiple Linear Regression (MLR) are some of the mathematical pre- liminaries that are discussed prior to explaining PLS and PCR models. Both PLS and PCR are applied to real spectral data and their di erences and similarities are discussed in this thesis. The challenge lies in establishing the optimum number of components to be included in either of the models but this has been overcome by using various diagnostic tools suggested in this thesis. Correspondence analysis (CA) and PLS were applied to ecological data. The idea of CA was to correlate the macrophytes species and lakes. The di erences between PLS model for ecological data and PLS for spectral data are noted and explained in this thesis. i

SOCIAL MEDIA IN INTERNATIONAL BRAND COMMUNICATION OF SMES - A multiple case study of small Finnish design-intensive companies

Social media is a rather new phenomenon which has revolutionised the world of online communication. However, academic research on how companies can benefit from social media is lacking. The research objective of this thesis was to examine the use of social media in international brand communication of small Finnish design-intensive companies. Therefore, this research contributes also to the research gap in SME branding. The focus was on communication targeted at consumers. The research was carried out as a mixed methods research employing the questionnaire and multiple case study methods. The questionnaire was used to gather preliminary information on Finnish design-intensive companies and to provide an eligible list of companies for deeper examination. Then, four case companies were studied in more depth. The empirical evidence of the case companies was mainly gathered through theme interviews. The results of the questionnaire shed light on the internationalisation of small Finnish designintensive companies. On average, the companies had internationalised rather quickly after they had been founded. However, the share of exports was rather low in most of the companies. The results revealed also that social media was already used widely in the exporting companies and the use can be expected to grow in future. The findings of the multiple case study suggest that branding activities in small Finnish designintensive companies are constrained by limited resources and skills. In addition, the branding activities are strongly guided by the vision and values of the entrepreneur(s) rather than extensive marketing research. The brand structure was simple in all case companies and they aimed at having a standardised brand image across markets. However, all case companies had faced a need for some adaptation of their international brand communication. Internationally important brand communication channels were international fairs, the internet, word-of-mouth and social media. Social media offered a cost-effective brand communication channel for the case companies. It was used for various purposes, such as creating brand awareness and affecting how the brand is perceived. The entrepreneurs found the use of social media to be rather easy and the case companies had not faced any major challenges. However, the companies had recognised that communication in social media requires consistency and planning. The planning was rather informal and stayed on a general level. Overall, the utilisation of social media in the case companies was limited by a lack of resources. It seemed to affect especially the follow-up of brand communication in social media which stayed rather superficial.

Do induced twin pregnancies influence the obstetric and neonatal results of multiple births born before 32 weeks? Comparison to spontaneous gestation

PURPOSE: To compare obstetric outcomes of induced preterm twin births (under 32 weeks gestation) with those spontaneously conceived. METHODS: Prospective study of twin pregnancies (25 induced and 157 spontaneously conceived) developed over a period of 16 years in a tertiary obstetric center. Demographic factors, obstetric complications, gestational age at delivery, mode of delivery, birth weight and immediate newborn outcome were compared. RESULTS: The analysis of obstetrical complications concerning urinary or other infections, hypertensive disorders of pregnancy, gestational diabetes, fetal malformations, intrauterine fetal death, intrauterine growth restriction and intrauterine discordant growth reveal no significant statistical differences between the two groups. First trimester bleeding was higher in the induced group (24 versus 8.3%, p=0.029). The cesarean delivery rate was 52.2% in spontaneous gestations and 64% in induced gestations. Gestational age at delivery, birth weight, Apgar scores at first and fifth minutes, admissions to Neonatal Intensive Care Unit and puerperal complications show no statistically significant differences between the two groups. These results were independent of chorionicity and induction method. CONCLUSION: The mode of conception did not influence obstetric and neonatal outcomes. Although induced pregnancies have higher risk of first trimester bleeding, significant differences were not observed regarding other obstetric and puerperal complications and neonatal results.