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  • 2011  (17)
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  • 2011  (17)
  • 1
    Language: English
    In: Pediatrics, February 2011, Vol.127(2), pp.e336-44
    Description: We assessed differences in chlamydia screening rates according to race/ethnicity, insurance status, age, and previous sexually transmitted infection (STI) or pregnancy. A retrospective cohort study was performed using electronic medical record and billing data for women 14 to 25 years of age in 2002-2007, assessing differences in the odds of a chlamydia test being performed at that visit. Adjusted odds of a chlamydia test being performed were lower among women 14 to 15 years of age (odds ratio: 0.83 [95% confidence interval: 0.70-1.00]) and 20 to 25 years of age (20-21 years, odds ratio: 0.78 [95% confidence interval: 0.70-0.89]; 22-23 years, odds ratio: 0.76 [95% confidence interval: 0.67-0.87]; 24-25 years, odds ratio: 0.64 [95% confidence interval: 0.57-0.73]), compared with women 18 to 19 years of age. Black women had 3 times increased odds (odds ratio: 2.96 [95% confidence interval: 2.66-3.28]) and Hispanic women nearly 13 times increased odds (odds ratio: 12.89 [95% confidence interval: 10.85-15.30]) of testing, compared with white women. Women with public (odds ratio: 1.74 [95% confidence interval: 1.58-1.91]) and public pending (odds ratio: 6.85 [95% confidence interval: 5.13-9.15]) insurance had increased odds of testing, compared with women with private insurance. After first STI diagnosis, differences according to race/ethnicity persisted but were smaller; after first pregnancy, differences persisted. Despite recommendations to screen all sexually active young women for chlamydia, providers screened women differently according to age, race/ethnicity, and insurance status, although differences were reduced after first STI or pregnancy.
    Keywords: Chlamydia Infections -- Diagnosis ; Health Personnel -- Standards ; Mass Screening -- Methods
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 2
    Language: English
    In: BMC Microbiology, Sept 22, 2011, Vol.11, p.208
    Description: Background Haemophilus ducreyi, the causative agent of the sexually transmitted disease chancroid, contains a flp (fimbria like protein) operon that encodes proteins predicted to contribute to adherence and pathogenesis. H. ducreyi mutants that lack expression of Flp1 and Flp2 or TadA, which has homology to NTPases of type IV secretion systems, have decreased abilities to attach to and form microcolonies on human foreskin fibroblasts (HFF). A tadA mutant is attenuated in its ability to cause disease in human volunteers and in the temperature dependent rabbit model, but a flp1flp2 mutant is virulent in rabbits. Whether a flp deletion mutant would cause disease in humans is not clear. Results We constructed 35000HP[DELTA]flp1-3, a deletion mutant that lacks expression of all three Flp proteins but has an intact tad secretion system. 35000HP[DELTA]flp1-3 was impaired in its ability to form microcolonies and to attach to HFF in vitro when compared to its parent (35000HP). Complementation of the mutant with flp1-3 in trans restored the parental phenotype. To test whether expression of Flp1-3 was necessary for virulence in humans, ten healthy adult volunteers were experimentally infected with a fixed dose of 35000HP (ranging from 54 to 67 CFU) on one arm and three doses of 35000HP[DELTA]flp1-3 (ranging from 63 to 961 CFU) on the other arm. The overall papule formation rate for the parent was 80% (95% confidence interval, CI, 55.2%-99.9%) and for the mutant was 70.0% (95% CI, 50.5%-89.5%) (P = 0.52). Mutant papules were significantly smaller (mean, 11.2 mm.sup.2.sup.) than were parent papules (21.8 mm.sup.2.sup.) 24 h after inoculation (P = 0.018). The overall pustule formation rates were 46.7% (95% CI 23.7-69.7%) at 30 parent sites and 6.7% (95% CI, 0.1-19.1%) at 30 mutant sites (P = 0.001). Conclusion These data suggest that production and secretion of the Flp proteins contributes to microcolony formation and attachment to HFF cells in vitro. Expression of flp1-3 is also necessary for H. ducreyi to initiate disease and progress to pustule formation in humans. Future studies will focus on how Flp proteins contribute to microcolony formation and attachment in vivo.
    Keywords: Hemophilus Infections -- Genetic Aspects ; Hemophilus Infections -- Health Aspects ; Hemophilus Infections -- Research
    ISSN: 1471-2180
    Source: Cengage Learning, Inc.
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  • 3
    Language: English
    In: BMC Microbiology, Sept 22, 2011, Vol.11, p.208
    Description: Background Haemophilus ducreyi, the causative agent of the sexually transmitted disease chancroid, contains a flp (fimbria like protein) operon that encodes proteins predicted to contribute to adherence and pathogenesis. H. ducreyi mutants that lack expression of Flp1 and Flp2 or TadA, which has homology to NTPases of type IV secretion systems, have decreased abilities to attach to and form microcolonies on human foreskin fibroblasts (HFF). A tadA mutant is attenuated in its ability to cause disease in human volunteers and in the temperature dependent rabbit model, but a flp1flp2 mutant is virulent in rabbits. Whether a flp deletion mutant would cause disease in humans is not clear. Results We constructed 35000HP[DELTA]flp1-3, a deletion mutant that lacks expression of all three Flp proteins but has an intact tad secretion system. 35000HP[DELTA]flp1-3 was impaired in its ability to form microcolonies and to attach to HFF in vitro when compared to its parent (35000HP). Complementation of the mutant with flp1-3 in trans restored the parental phenotype. To test whether expression of Flp1-3 was necessary for virulence in humans, ten healthy adult volunteers were experimentally infected with a fixed dose of 35000HP (ranging from 54 to 67 CFU) on one arm and three doses of 35000HP[DELTA]flp1-3 (ranging from 63 to 961 CFU) on the other arm. The overall papule formation rate for the parent was 80% (95% confidence interval, CI, 55.2%-99.9%) and for the mutant was 70.0% (95% CI, 50.5%-89.5%) (P = 0.52). Mutant papules were significantly smaller (mean, 11.2 mm.sup.2.sup.) than were parent papules (21.8 mm.sup.2.sup.) 24 h after inoculation (P = 0.018). The overall pustule formation rates were 46.7% (95% CI 23.7-69.7%) at 30 parent sites and 6.7% (95% CI, 0.1-19.1%) at 30 mutant sites (P = 0.001). Conclusion These data suggest that production and secretion of the Flp proteins contributes to microcolony formation and attachment to HFF cells in vitro. Expression of flp1-3 is also necessary for H. ducreyi to initiate disease and progress to pustule formation in humans. Future studies will focus on how Flp proteins contribute to microcolony formation and attachment in vivo.
    Keywords: Hemophilus Infections -- Genetic Aspects ; Hemophilus Infections -- Health Aspects ; Hemophilus Infections -- Research
    ISSN: 1471-2180
    Source: Cengage Learning, Inc.
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  • 4
    Language: English
    In: The Journal of infectious diseases, 15 June 2011, Vol.203(12), pp.1859-65
    Description: Haemophilus ducreyi 35000HP contains a homolog of the CpxRA 2-component signal transduction system, which controls the cell envelope stress response system in other gram-negative bacteria and regulates some important H. ducreyi virulence factors. A H. ducreyi cpxR mutant was compared with its parent for virulence in the human challenge model of experimental chancroid. The pustule formation rate in 5 volunteers was 33% (95% confidence interval [CI], 1.3%-65.3%) at 15 parent sites and 40% (95% CI, 18.1%-61.9%) at 15 mutant sites (P = .35). Thus, the cpxR mutant was not attenuated for virulence. Inactivation of the H. ducreyi cpxR gene did not reduce the ability of this mutant to express certain proven virulence factors, including the DsrA serum resistance protein and the LspA2 protein, which inhibits phagocytosis. These results expand our understanding of the involvement of the CpxRA system in regulating virulence expression in H. ducreyi.
    Keywords: Bacterial Proteins -- Genetics ; Chancroid -- Microbiology ; Haemophilus Ducreyi -- Genetics
    ISSN: 00221899
    E-ISSN: 1537-6613
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  • 5
    Language: English
    In: Infection and immunity, August 2011, Vol.79(8), pp.3338-47
    Description: Haemophilus ducreyi causes chancroid, a genital ulcer disease. In human inoculation experiments, most volunteers fail to clear the bacteria despite the infiltration of innate and adaptive immune cells to the infected sites. The immunosuppressive protein indoleamine 2,3-dioxygenase (IDO) is a rate-limiting enzyme in the L-tryptophan-kynurenine metabolic pathway. Tryptophan depletion and tryptophan metabolites contribute to pathogen persistence by inhibiting T cell proliferation, inducing T cell apoptosis, and promoting the expansion of FOXP3(+) regulatory T (Treg) cells. We previously found that FOXP3(+) Treg cells are enriched in experimental lesions and that H. ducreyi induced IDO transcription in dendritic cells (DC) derived from blood of infected volunteers who developed pustules. Here, we showed that enzymatically active IDO was induced in DC by H. ducreyi. Neutralizing antibodies against interferon alpha/beta receptor 2 chain (IFNAR2) and tumor necrosis factor alpha (TNF-α) inhibited IDO induction. Inhibitors of the mitogen-activated protein kinase (MAPK) p38 and nuclear factor-κB (NF-κB) also inhibited IDO expression. Neither bacterial contact with nor uptake by DC was required for IDO activation. H. ducreyi culture supernatant and H. ducreyi lipooligosaccharides (LOS) induced IDO expression, which required type I interferons, TNF-α, and the three MAPK (p38, c-Jun N-terminal kinase, and extracellular signal regulated kinase) and NF-κB pathways. In addition, LOS-induced IFN-β activated the JAK-STAT pathway. Blocking the LOS/Toll-like receptor 4 (TLR4) signaling pathway greatly reduced H. ducreyi-induced IDO production. These findings indicate that H. ducreyi-induced IDO expression in DC is largely mediated by LOS via type I interferon- and TNF-α-dependent mechanisms and the MAPK, NF-κB, and JAK-STAT pathways.
    Keywords: Immune Tolerance ; Dendritic Cells -- Immunology ; Haemophilus Ducreyi -- Immunology ; Indoleamine-Pyrrole 2,3,-Dioxygenase -- Biosynthesis ; Interferon Type I -- Metabolism ; Lipopolysaccharides -- Immunology ; Tumor Necrosis Factor-Alpha -- Metabolism
    ISSN: 00199567
    E-ISSN: 1098-5522
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  • 6
    In: Journal of the Royal Statistical Society: Series A (Statistics in Society), October 2011, Vol.174(4), pp.975-989
    Description: Bacterium causes genital chlamydia infection. Yet little is known about the efficiency of transmission of this organism. Ethical constraint against exposing healthy subjects to infected partners precludes the possibility of quantifying the risk of transmission through controlled experiments. This research proposes an alternative strategy that relies on observational data. Specifically, we present a stochastic model that treats longitudinally observed states of infection in a group of young women as a Markov process. The model proposed explicitly accommodates the parameters of transmission, including per‐encounter sexually transmitted infection acquisition risks, with and without condom protection, and the probability of antibiotic treatment failure. The male‐to‐female transmission probability of is then estimated by combining the per‐encounter disease acquisition risk and the organism's prevalence in the male partner population. The model proposed is fitted in a Bayesian computational framework.
    Keywords: Bacterial Infection ; Binary Outcome ; Longitudinal Study ; Markov Chain Monte Carlo Methods ; Markov Model ; Observational Data ; Transmission Probability
    ISSN: 0964-1998
    E-ISSN: 1467-985X
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  • 7
    In: BMC Microbiology, 2011, Vol.11(1), p.208
    Description: Background Haemophilus ducreyi, the causative agent of the sexually transmitted disease chancroid, contains a flp (fimbria like protein) operon that encodes proteins predicted to contribute to adherence and pathogenesis. H. ducreyi mutants that lack expression of Flp1 and Flp2 or TadA, which has homology to NTPases of type IV secretion systems, have decreased abilities to attach to and form microcolonies on human foreskin fibroblasts (HFF). A tadA mutant is attenuated in its ability to cause disease in human volunteers and in the temperature dependent rabbit model, but a flp1flp2 mutant is virulent in rabbits. Whether a flp deletion mutant would cause disease in humans is not clear. Results We constructed 35000HPΔflp1-3, a deletion mutant that lacks expression of all three Flp proteins but has an intact tad secretion system. 35000HPΔflp1-3 was impaired in its ability to form microcolonies and to attach to HFF in vitro when compared to its parent (35000HP). Complementation of the mutant with flp1-3 in trans restored the parental phenotype. To test whether expression of Flp1-3 was necessary for virulence in humans, ten healthy adult volunteers were experimentally infected with a fixed dose of 35000HP (ranging from 54 to 67 CFU) on one arm and three doses of 35000HPΔflp1-3 (ranging from 63 to 961 CFU) on the other arm. The overall papule formation rate for the parent was 80% (95% confidence interval, CI, 55.2%-99.9%) and for the mutant was 70.0% (95% CI, 50.5%-89.5%) (P = 0.52). Mutant papules were significantly smaller (mean, 11.2 mm2) than were parent papules (21.8 mm2) 24 h after inoculation (P = 0.018). The overall pustule formation rates were 46.7% (95% CI 23.7-69.7%) at 30 parent sites and 6.7% (95% CI, 0.1-19.1%) at 30 mutant sites (P = 0.001). Conclusion These data suggest that production and secretion of the Flp proteins contributes to microcolony formation and attachment to HFF cells in vitro. Expression of flp1-3 is also necessary for H. ducreyi to initiate disease and progress to pustule formation in humans. Future studies will focus on how Flp proteins contribute to microcolony formation and attachment in vivo.
    Keywords: Adult–Genetics ; Bacterial Adhesion–Metabolism ; Bacterial Proteins–Microbiology ; Bacterial Proteins–Genetics ; Chancroid–Pathogenicity ; Female–Physiology ; Gene Expression Regulation, Bacterial–Physiology ; Haemophilus Ducreyi–Physiology ; Haemophilus Ducreyi–Physiology ; Haemophilus Ducreyi–Physiology ; Human Experimentation–Physiology ; Humans–Physiology ; Male–Physiology ; Middle Aged–Physiology ; Operon–Physiology ; Sequence Deletion–Physiology ; Virulence–Physiology ; Bacteria ; Microbiology ; Pathogenesis ; Volunteers ; Manuscripts ; Colleges & Universities ; Standard Deviation ; Experiments ; Immunization ; Confidence Intervals ; Public Health ; Health Services ; Bacterial Proteins ; Flp Protein, Bacteria;
    ISSN: 1471-2180
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  • 8
    Language: English
    In: The Journal of the American Dental Association, September 2011, Vol.142(9), pp.1065-1071
    Description: In this article, the authors present evidence-based clinical recommendations regarding the use of nonfluoride caries-preventive agents. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. The panel addressed several questions regarding the efficacy of nonfluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries. A panel of experts convened by the ADA Council on Scientific Affairs, in collaboration with ADA Division of Science staff, conducted a MEDLINE search to identify all randomized and nonrandomized clinical studies regarding the use of nonfluoride caries-preventive agents. The panel reviewed evidence from 50 randomized controlled trials and 15 nonrandomized studies to assess the efficacy of various nonfluoride caries-preventive agents. The panel concluded that certain non-fluoride agents may provide some benefit as adjunctive therapies in children and adults at higher risk of developing caries. These recommendations are presented as a resource for dentists to consider in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. (The full report can be accessed at “ ”.)
    Keywords: Caries ; Xylitol ; Chlorhexidine ; Acidulated Phosphate Fluoride ; Evidence-Based Dentistry ; Clinical Recommendations ; ADA: American Dental Association ; Csa: Council on Scientific Affairs ; Nidcr: National Institute of Dental and Craniofacial Research ; Rct: Randomized Controlled Trial ; Dentistry
    ISSN: 0002-8177
    E-ISSN: 1943-4723
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  • 9
    Language: English
    In: The Journal of the American Dental Association, 09/2011, Vol.142(9), pp.1065-1071
    Description: BackgroundIn this article, the authors present evidence-based clinical recommendations regarding the use of nonfluoride caries-preventive agents. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. The panel addressed several questions regarding the efficacy of nonfluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries. Types of Studies ReviewedA panel of experts convened by the ADA Council on Scientific Affairs, in collaboration with ADA Division of Science staff, conducted a MEDLINE search to identify all randomized and nonrandomized clinical studies regarding the use of nonfluoride caries-preventive agents. ResultsThe panel reviewed evidence from 50 randomized controlled trials and 15 nonrandomized studies to assess the efficacy of various nonfluoride caries-preventive agents. Clinical ImplicationsThe panel concluded that certain non-fluoride agents may provide some benefit as adjunctive therapies in children and adults at higher risk of developing caries. These recommendations are presented as a resource for dentists to consider in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. (The full report can be accessed at “http://ebd.ada.org/ClinicalRecommendations.aspx”.)
    Keywords: Caries ; Xylitol ; Chlorhexidine ; Acidulated Phosphate Fluoride ; Evidence-Based Dentistry ; Clinical Recommendations ; ADA: American Dental Association ; Csa: Council on Scientific Affairs ; Nidcr: National Institute of Dental and Craniofacial Research ; Rct: Randomized Controlled Trial;
    ISSN: 00028177
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  • 10
    Article
    Article
    Language: English
    In: Journal of Product Innovation Management, May, 2011, Vol.28(3), p.381(3)
    Description: To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1540-5885.2011.00806.x Byline: Tim Brown (1), Barry Katz (1) Abstract: Over the course of a century of professional practice, designers have mastered a set of skills that can be productively applied to a wider range of problems than has commonly been supposed. These include complex social problems, issues of organizational management, and strategic innovation. Conversely, non-designers-those in leadership positions in companies, governmental and non-governmental organizations, professionals in a broad range of services and industries-can benefit from learning how to think like designers. We offer some large-scale and more finely grained ideas about how this might happen. Author Affiliation: (1)global consultancy IDEO Article note: Address correspondence to: Tim Brown, IDEO, 100 Forest Street, Palo Alto, CA 94301.
    Keywords: Nongovernmental Organizations
    ISSN: 0737-6782
    E-ISSN: 15405885
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