Main Street West Research Articles

Research and policy implications of a recently published controlled study in previously untreated haemophilia patients at high risk of inhibitor development

HaemophiliaVolume 23, Issue 3 p. 350-352 Letter to the Editor Research and policy implications of a recently published controlled study in previously untreated haemophilia patients at high risk of inhibitor development A. Iorio, Corresponding Author A. Iorio iorioa@mcmaster.ca orcid.org/0000-0002-3331-8766 Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Alfonso Iorio, Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, Canada, L8S 4K1. Tel.: +1 905 525 9140; fax: +1 905 577 8478; e-mails: iorioa@mcmaster.caSearch for more papers by this author A. Iorio, Corresponding Author A. Iorio iorioa@mcmaster.ca orcid.org/0000-0002-3331-8766 Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Alfonso Iorio, Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, Canada, L8S 4K1. Tel.: +1 905 525 9140; fax: +1 905 577 8478; e-mails: iorioa@mcmaster.caSearch for more papers by this author First published: 20 February 2017 https://doi.org/10.1111/hae.13176Citations: 14Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume23, Issue3May 2017Pages 350-352 RelatedInformation

Editorial Announcement

first_page settings Order Article Reprints Font Type: Arial Georgia Verdana Font Size: Aa Aa Aa Line Spacing:    Column Width:    Background: Open AccessEditorial Editorial Announcement by Kerry Patterson Founding Editor-in-Chief of Econometrics, Department of Economics, the University of Reading, Whiteknights, PO Box 217, READING, Berkshire, RG6 6AH, UK (Retired) Econometrics 2016, 4(4), 40; https://doi.org/10.3390/econometrics4040040 Received: 8 October 2016 / Revised: 8 October 2016 / Accepted: 9 October 2016 / Published: 10 October 2016 Download Download PDF Download PDF with Cover Download XML Download Epub Versions Notes I am pleased to announce that, following my retirement on the 30th September 2016, Marc Paolella will become Editor-in-Chief (EiC) of Econometrics. Marc will be supported by three Deputy EiCs: In Choi, Steve Cook and Jeffrey S. Racine. I am very fortunate and grateful that such distinguished econometricians have agreed to lead the direction of development for Econometrics. May I offer them my deep-felt thanks and best wishes for the continued success of the journal.My own time as EiC has been immensely pleasurable and rewarding. It has seen Econometrics develop into a leading open-access journal attracting articles of the highest quality.I would like to thank the staff at Econometrics and the publishers MDPI for their practical support; in particular, I am grateful to Alistair Freeland, the Managing Editor for my appointment, and especially to Lu Liao, the Assistant Editor of Econometrics, whose boundless and unstinting support have made my role so enjoyable.I would also like to thank my colleagues worldwide for their unfailing support in enabling Econometrics to become a leading journal. The quality of the articles that have been published was recognised this year by the inauguration of an award for the best article and, from next year, an award for the best article by a young researcher. The members of the Editorial Board also deserve special recognition for supporting Econometrics in its initial and subsequent stages of development. I am pleased to report that the Editorial Board continues to grow, with recognized experts in the field, and reflects the increasing range and reach of econometrics (https://www.mdpi.com/journal/econometrics/editors).Econometrics has published a number of very successful Special Issues that focus on recent developments in a particular field, and I would like to thank the Guest Editors of these Special Issues for their support. In the area of Special Issues, a recent development of note is the commission of a series of Special Issues under the general heading of “Celebrated Econometricians”, the first three of which will be dedicated to the work and influence of David Hendry, Soren Johansen and Katarina Juselius, and Peter Phillips. This series will be overseen by the EiC and two specially appointed Series Editors, Professor Christopher Gilbert (SAIS Bologna Center, Johns Hopkins University, https://sites.google.com/site/christopherlesliegilbert/home) and Professor Duo Qin (Department of Economics, SOAS, University of London, https://www.soas.ac.uk/staff/staff60855.php). For more details on this exciting project see (https://www.mdpi.com/2225-1146/4/3/35).Editorial StructureEiC:Professor Marc PaolellaDepartment of Banking and Finance, University of Zurich, Zurich, SwitzerlandWebsite: http://www.bf.uzh.ch/cms/en/paolella.marc.htmlDeputy EiC:Professor In ChoiDepartment of Economics, Sogang University, 35 Baekbeom-ro, Mapo-gu Seoul, 121-742 KoreaWebsite: http://inchoi.sogang.ac.kr/Professor Steve CookDepartment of Economics, Swansea University, SA2 8PP, Wales, UKWebsite: http://www.swansea.ac.uk/staff/som/academic-staff/s.cook/Professor Jeffrey S. RacineDepartment of Economics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4M4, CanadaWebsite: http://www.economics.mcmaster.ca/people/racinej © 2016 by the author; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/). Share and Cite MDPI and ACS Style Patterson, K. Editorial Announcement. Econometrics 2016, 4, 40. https://doi.org/10.3390/econometrics4040040 AMA Style Patterson K. Editorial Announcement. Econometrics. 2016; 4(4):40. https://doi.org/10.3390/econometrics4040040 Chicago/Turabian Style Patterson, Kerry. 2016. "Editorial Announcement" Econometrics 4, no. 4: 40. https://doi.org/10.3390/econometrics4040040 Find Other Styles Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here. Article Metrics No No Article Access Statistics For more information on the journal statistics, click here. Multiple requests from the same IP address are counted as one view.

Copresentation of relative and absolute effects is essential to promote optimal interpretability of treatment effects

Copresentation of relative and absolute effects is essential to promote optimal interpretability of treatment effects Jason W. Busse*, Gordon H. Guyatt The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, MDCL 2101, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1 Department of Anesthesia, Faculty of Health Sciences, 2V9, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1 Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1

Canadian uniqueness and theoretical-methodological pluralism in sociology.

Canadian Review of Sociology/Revue canadienne de sociologieVolume 51, Issue 4 p. 402-408 ON THE DISCIPLINE Canadian Uniqueness and Theoretical-Methodological Pluralism in Sociology Neil McLaughlin, Corresponding Author Neil McLaughlin McMaster UniversityNeil McLaughlin, Department of Sociology, Room 626, Kenneth Taylor Hall 1280 Main Street West, McMaster University, Hamilton, ON, L8S 4M4 Canada. E-mail: nmclaugh@mcmaster.caSearch for more papers by this author Neil McLaughlin, Corresponding Author Neil McLaughlin McMaster UniversityNeil McLaughlin, Department of Sociology, Room 626, Kenneth Taylor Hall 1280 Main Street West, McMaster University, Hamilton, ON, L8S 4M4 Canada. E-mail: nmclaugh@mcmaster.caSearch for more papers by this author First published: 20 November 2014 https://doi.org/10.1111/cars.12055Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume51, Issue4November 2014Pages 402-408 RelatedInformation

When I say … reliability.

Medical EducationVolume 48, Issue 10 p. 946-947 When I Say… When I say … reliability Geoff Norman, Corresponding Author Geoff Norman Hamilton, Ontario, CanadaCorrespondence: Geoff Norman, MDCL-3519, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. Tel: 00 1 905 525 9140 (ext. 22119); E-mail: [email protected]Search for more papers by this author Geoff Norman, Corresponding Author Geoff Norman Hamilton, Ontario, CanadaCorrespondence: Geoff Norman, MDCL-3519, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. Tel: 00 1 905 525 9140 (ext. 22119); E-mail: [email protected]Search for more papers by this author First published: 09 September 2014 https://doi.org/10.1111/medu.12511Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume48, Issue10October 2014Pages 946-947 RelatedInformation

Pyroclastic edifices record vigorous lava fountains during the emplacement of a flood basalt flow field, Roza Member, Columbia River Basalt Province, USA

Research Article| July 01, 2014 Pyroclastic edifices record vigorous lava fountains during the emplacement of a flood basalt flow field, Roza Member, Columbia River Basalt Province, USA Richard J. Brown; Richard J. Brown 1Volcano Dynamics Group, Department of Environment, Earth and Ecosystems, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK †Current address: Department of Earth Sciences, Durham University, Science Labs, Durham, DH1 3LE, UK; e-mail: richard.brown3@durham.ac.uk. Search for other works by this author on: GSW Google Scholar S. Blake; S. Blake 1Volcano Dynamics Group, Department of Environment, Earth and Ecosystems, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK Search for other works by this author on: GSW Google Scholar T. Thordarson; T. Thordarson 2School of Geosciences, Grant Institute, The King’s Buildings, University of Edinburgh, West Mains Road, Edinburgh, EH9 3JW, UK §Current address: Faculty of Earth Sciences, University of Iceland, Askja, Sturlugata 7, 101 Reykjavik, Iceland. Search for other works by this author on: GSW Google Scholar S. Self S. Self 1Volcano Dynamics Group, Department of Environment, Earth and Ecosystems, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK Search for other works by this author on: GSW Google Scholar GSA Bulletin (2014) 126 (7-8): 875–891. https://doi.org/10.1130/B30857.1 Article history received: 22 Jan 2013 rev-recd: 03 Dec 2013 accepted: 31 Dec 2013 first online: 08 Mar 2017 Cite View This Citation Add to Citation Manager Share Icon Share MailTo Twitter LinkedIn Tools Icon Tools Get Permissions Search Site Citation Richard J. Brown, S. Blake, T. Thordarson, S. Self; Pyroclastic edifices record vigorous lava fountains during the emplacement of a flood basalt flow field, Roza Member, Columbia River Basalt Province, USA. GSA Bulletin 2014;; 126 (7-8): 875–891. doi: https://doi.org/10.1130/B30857.1 Download citation file: Ris (Zotero) Refmanager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentBy SocietyGSA Bulletin Search Advanced Search Abstract The 1300 km3 tholeiitic lava flow field of the 14.98 Ma Roza Member of the Columbia River Basalt Province has the best-preserved vent system of any known continental flood basalt. Detailed geological mapping and logging of the exposed pyroclastic rocks along the >180-km-long vent system enable the reconstruction of pyroclastic edifices (partial cones) built around vents. The pyroclastic cones differ from those constructed during typical basaltic effusive eruptions and are characterized by low to moderate slope angles (<20°), have minimum heights up to ∼160 m, and are composed of dominantly coarse-grained, moderately to densely agglutinated and welded spatter and scoria that extend up to 750 m away from the vent. Thick, well-sorted fall deposits composed of moderately to highly vesicular scoria lapilli extend away from some vents and exhibit some characteristics comparable to the proximal deposits of violent Strombolian or subplinian eruptions. The recorded volcanic activity does not fit with common eruption styles of basaltic magmas, and the evidence indicates that the Roza eruption was punctuated by eruptive activity of unusually high intensity that was characterized by vigorous lava fountains. The extensive agglutinated deposits accumulated around the vents as a result of fallout from high (>1 km) fountains enhanced by fallout from the lower parts of convective plumes that rose above the fountains. You do not have access to this content, please speak to your institutional administrator if you feel you should have access.

Nasal ventilation is not continuous positive airway pressure with a rate but mechanical ventilation without a tube

1.Paediatrics, JSS Medical College, Mysore, India2.Neonatal and Perinatal Medicine, McMaster University Children Hospital, McMaster University, Hamilton, ON, Canada3.Neonatology, McMaster Children Hospital, Hamilton, ON, CanadaCorrespondenceSrinivasa Murthy Doreswamy, 1001, Main streetwest, Apt no 1004 Hamilton, ON L8S 1A9, Canada.Tel: +011 9059212622 |Email: drdsrinivasa@gmail.comReceived9 January 2014; accepted 27 January 2014DOI:10.1111/apa.12579

Plate tephra: Preserved bubble walls from large slug bursts during violent Strombolian eruptions

Research Article| January 01, 2014 Plate tephra: Preserved bubble walls from large slug bursts during violent Strombolian eruptions Dawn C.S. Ruth; Dawn C.S. Ruth * 1Department of Geology, 411 Cooke Hall, State University of New York University at Buffalo, Buffalo, New York 14260, USA *E-mail: dcs34@buffalo.edu. Search for other works by this author on: GSW Google Scholar Eliza S. Calder Eliza S. Calder 1Department of Geology, 411 Cooke Hall, State University of New York University at Buffalo, Buffalo, New York 14260, USA2School of Geosciences, Grant Institute, University of Edinburgh, The King’s Buildings, West Mains Road, Edinburgh EH9 3JW, UK Search for other works by this author on: GSW Google Scholar Geology (2014) 42 (1): 11–14. https://doi.org/10.1130/G34859.1 Article history received: 20 Jun 2013 rev-recd: 09 Sep 2013 accepted: 10 Sep 2013 first online: 09 Mar 2017 Cite View This Citation Add to Citation Manager Share Icon Share MailTo Twitter LinkedIn Tools Icon Tools Get Permissions Search Site Citation Dawn C.S. Ruth, Eliza S. Calder; Plate tephra: Preserved bubble walls from large slug bursts during violent Strombolian eruptions. Geology 2014;; 42 (1): 11–14. doi: https://doi.org/10.1130/G34859.1 Download citation file: Ris (Zotero) Refmanager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentBy SocietyGeology Search Advanced Search Abstract We describe unusual “plate tephra” particles that provide key information about rarely observed processes that occur during volcanic eruptions. The tephra formed during the 2008–2009 eruption of Llaima volcano, Chile, and dispersed as far as 9 km from the vent. The plates are angular clasts of vesicular basaltic andesite ranging in size from 1 to 14 cm and in thickness from 2 to 5 mm. External features such as ridges, varying degrees of curvature, and adhered material are present. Internal textures include strong crystal alignment and deformed enclaves. We propose that the plates are wall fragments formed during the rupture of large gas slugs associated with unsteady fire fountaining during the violent Strombolian phase of the eruption. The presence of plate tephra may be a diagnostic feature of highly unsteady activity where slug rupture is concurrent with the formation of a sustained eruption column. You do not have access to this content, please speak to your institutional administrator if you feel you should have access.

Canadian Association of Gastroenterology position statement regarding the use of thiopurines for the treatment of inflammatory bowel disease.

Canadian Association of Gastroenterology position statement regarding the use of thiopurines for the treatment of inflammatory bowel disease.

Fever in the returning traveller: A forgotten culprit.

Department of Internal Medicine, McMaster University, Hamilton, Ontario Correspondence: Dr Karim Ladak, Department of Internal Medicine, McMaster University, 1280 Main Street West, HSC-3W10, Hamilton, Ontario L8S 4K1. Telephone 905-962-2786, fax 905-529-0066, e-mail karim.ladak@medportal.ca CASE PRESENTATION A 74-year-old woman presented to the emergency department after blood cultures drawn by her family physician four days previously grew Gram-negative bacilli. She had recently returned from a three-month trip to Afghanistan to visit friends and relatives, and admitted to “eating like a local” while there. During the final two weeks of her stay in Afghanistan, she experienced fevers, chills, malaise, night sweats, myalgias and diffuse abdominal pain. She was admitted to hospital there and received two weeks of an unspecified intravenous antibiotic without clinical amelioration. On returning to Canada, her symptoms persisted for a third week and, despite multiple clinical assessments, no diagnosis was established. While originally born in Afghanistan, the patient had lived in Canada for nearly two decades. She had not taken many dietary precautions during her trip, and admitted to consuming both cow’s and goat’s milk. Furthermore, she denied any exposure to animals or slaughterhouses. On examination, her temperature was 38.9°C. Her vital signs were otherwise within normal limits. She had mild abdominal tenderness, but no hepatosplenomegaly or lymphadenopathy. Preliminary laboratory investigations demonstrated an elevated C-reactive protein (CRP) level (13.4 mg/L; normal <5 mg/L) and a mild transaminitis. A complete blood count, glucose, electrolytes and creatinine levels were normal. Chest and abdominal x-rays were normal. Based on her clinical presentation and Gram-negative bacilli bacteremia, she was treated for presumed typhoid. On hospital day 3 her cultures speciated something unexpected...

Evolving Wonder-RNAs in a Test Tube

RNA is a captivating polymer: it is chemically simple yet functionally diverse. RNA has been sought out by Mother Nature to take on many important biological functions, from genetic information encoding and transmission, to enzymatic catalysis and molecular recognition, to regulation of gene expression. Along the way, Nature has produced so many interesting RNA species, and, perhaps out of necessity, given them different sizes. At one end of the spectrum are microRNAs made of merely *22 nucleotides, and at the other end is the human 28S ribosomal RNA composed of 5,070 nucleotides! Yet, most functional RNA molecules, including many ribozymes and riboswitches, are middle-ofthe-roaders having 50–200 nucleotides. As far as the complexity of the structure and function is concerned, the size of the RNA does matter. The most fitting example is the ribosome, which is designed to execute an essential and demanding chemical transformation in a highly organized manner. Nature has adequately dealt with this challenge by creating one of most spectacular macromolecular assemblies in cells. Among several dozen macromolecules used to construct the ribosome are two super-sized RNAs that contain a few thousand nucleotides. One of Nature’s most intriguing but unsolved mysteries is the evolution process behind the selection of such long functional RNA molecules. It has been postulated that the modern size of ribosomal RNAs is a consequence of amalgamation of smaller fragments (Clark 1987; Gray and Schnare 1996) and sequence comparison studies have suggested that some ribosomal RNA domains are indeed older than others (Gray and Schnare 1996; Bokov and Steinberg 2009). Evidently, Nature has found a way to patiently build a complex function through progressive, domain-by-domain construction of ‘‘wonder-RNAs’’. A distinct trait of Homo sapiens is to learn and apply. Based on the principle of Darwinian evolution, in vitro selection technique was devised in 1990 (Ellington and Szostak 1990; Tuerk and Gold 1990), and has since been used to create numerous functional RNA (or single-stranded DNA) molecules. Key to the success of each in vitro selection experiment is the simultaneous exploration of a vast sequence space covered by a random library containing as many as 10 RNA siblings. Although many fascinating functional nucleic acids have been derived by this approach, large and complex wonder-RNAs are few and far between (Bartel and Szostak 1993). This may simply be an inevitable outcome of two inherent drawbacks associated with the random library approach: the inefficient sequence space coverage and the tyranny of simple structural motifs. A standard DNA synthesis produces *0.1 mg of DNA (*10 molecules), just enough to cover the entire sequence space of a 25-nucleotide sequence (4 & 10). When the random domain increases to 50 nucleotides (still smaller than a tRNA), the sequence space rises to *10 (4 & 10), translating to *35,000 t of DNA! Thus, the sequence space coverage for a long RNA is categorically infinitesimal. Even if we assume there are complex RNAs in such a library, the chance of finding them is further diminished due to the overabundance of simple structural motifs in the library (Schlosser and Li 2005). Computational analysis has shown that random libraries are primarily populated with simple structural motifs like hairpin loops and three-way junctions and have extremely few more intricate structural motifs often found in large biological RNAs (Gevertz et al. 2005). Y. Li (&) Department of Biochemistry and Biomedical Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada e-mail: liying@mcmaster.ca

Necrotizing Fasciitis in an Immunocompromised Elderly Woman

1Department of Medicine; 2Institute for Infectious Diseases Research, Faculty of Health Sciences, McMaster University, Hamilton, Ontario Correspondence: Dr Jennie Johnstone, Department of Medicine, McMaster University, 3200 MDCL, 1280 Main Street West, Hamilton, Ontario L8S 4L8. Telephone 905-525-9140 ext 22726, fax 905-389-5822, e-mail johnsj48@mcmaster.ca Case Presentation An 85-year-old woman presented to hospital with a rapidly progressing erythema of the lower left leg. The patient was well until several hours before admission when she noted a small area of painful erythema on her left shin that progressed over 2 h to involve the entire leg below the knee. There had been no erythema noted earlier that day when her daughter bathed her. Her medical history was significant for hypertension, congestive heart failure, remote left total knee arthroplasty and a recent diagnosis of temporal arteritis for which 40 mg of prednisone daily was perscribed. She had no recent travel history and no sick contacts. On presentation, the patient appeared well, was not in distress and was hemodynamically stable with a heart rate of 80 beats/min, blood pressure of 120/60 mmHg and a temperature of 36.7°C. Her physical examination was remarkable for erythema over the anterior lower left leg, extending around the calf. There were no bullae. Although the leg was tender to palpation, the pain was not out of proportion with the area of erythema. There was no crepitus, and no ulcers or ports of entry were apparent. No regional lymphadenopathy was present. Examination of the left knee found no warmth, effusion or erythema, and there was complete and pain-free range of motion. The remainder of her physical examination was unremarkable. Initial investigations revealed a hemoglobin level of 146 g/L, a leukocyte count of 6.5×109/L, a platelet count of 146×109/L and a creatinine level of 51 μmol/L. Venous Doppler ultrasound of the left leg showed no evidence of deep vein thrombosis. Blood cultures were obtained before the patient was started on empirical intravenous antibiotic therapy with cefazolin (1 g every 8 h) and clindamycin (600 mg every 8 h). After 24 h of therapy, the erythema of the leg improved; however, severe foot pain developed in the absence of any erythema. She remained hemodynamically stable with a blood pressure of 140/80 mmHg and a heart rate of 80 beats/min and remained afebrile with a temperature of 36.5°C but had a notable drop in her leukocyte count to 1.8 ×109/L. Her creatine kinase level (26 U/L) was normal (normal <150 U/L). Due to the confusing clinical picture and in light of her immunocompromised status, antibiotic coverage was broadened by discontinuing cefazolin and starting piperacillin/tazobactam (4.5 g every 8 h). Approximately 36 h after admission, she acutely deteriorated, developing fever (37.9°C), hypotension (80/60 mmHg), a decreased level of consciousness, and worsened edema and erythema of the left leg extending above the knee with multiple small foci of necrosis. She required transfer to the intensive care unit for inotropic support. Vancomycin was added to the piperacillin/tazobactam and clindamycin, intravenous immunoglobulin was given, and an urgent orthopedic surgery consultation was obtained. A fascial biopsy was performed, which was sent for frozen section and culture. The biopsy was consistent with necrotizing fasciitis (NF) and the patient was taken to the operating room for urgent debridement, where an above-knee amputation was performed. Postoperatively, the patient experienced ongoing hypotension and a new area of erythema over the upper left thigh extending to the abdomen. The piperacillin/tazobactam was discontinued and meropenem was added. The next day, there was growth in the tissue culture from the fascial biopsy. What was the causative organism?

Closure of a Percutaneous Endoscopic Gastrostomy-Associated Nonhealing Gastrocutaneous Fistula Using Endoscopic Hemoclips

1Department of Medicine, McMaster University, Hamilton, Ontario; 2Department of Medicine, University of Calgary, Calgary, Alberta; 3Division of Gastroenterology, McMaster University, Hamilton, Ontario; 4Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA Correspondence: Dr Frances Tse, Division of Gastroenterology, McMaster University, Room 2F53, 1200 Main Street West, Hamilton, Ontario L8N 3Z5. Telephone 905-521-2100 ext 76733, fax 905-523-6048, e-mail tsef@mcmaster.ca Received for publication April 21, 2013. Accepted May 12, 2013 Case presentation A 53-year-old man admitted for stem cell transplantation in the context of acute myeloid leukemia was referred for gastric content leakage from a persistent gastrocutaneous fistula. A percutaneous endoscopic gastrostomy (PEG) tube had been placed for four months due to suboptimal nutrition. The PEG tube was subsequently removed due to improvement in caloric intake and nutritional status. Unfortunately, drainage of gastric contents (approximately 250 mL/day) from the gastrocutaneous fistula after removal of the PEG tube persisted. This led to peristomal skin maceration and breakdown resulting in local cutaneous bleeding from the PEG tube site. Despite conservative management with bowel rest, proton pump inhibitor therapy, wound care and parenteral nutrition, drainage and bleeding from the gastrocutaneous fistula site persisted. The remainder of his medical history was noncontributory. Physical examination using subjective global assessment revealed a hemodynamically stable man with adequate nutritional status, without any examination or laboratory contraindications to endoscopy. Informed consent was obtained to proceed with an attempt to close the gastrocutaneous fistula via endoscopic hemoclips before considering surgical closure. During endoscopy, the opening of the fistula was identified in the antrum (Figure 1). Single-modality therapy was used and three hemoclips were placed in an attempt to close the fistula site (Figure 2). A stoma bag was placed over the pre-existing fistula site; no air leakage was observed at the time of endoscopy. The fistula tract closed within 24 h after the procedure with no further leakage noted. The patient was closely followed over the ensuing week. Daily clinical assessments were conducted and no evidence of gastric content was noted at the previous fistula site. The patient was kept nil per os for three days and proton pump inhibitor therapy was continued. His diet was then advanced. The lack of gastric output from the fistula tract postendoclip placement, even after the initiation of oral feeds, confirmed the successful outcome of the procedure (Figure 3).

Levofloxacin-Based Three-Antibiotic Regimen for H. pylori Eradication

1 Department of Medicine, Division of Gastroenterology, Health Sciences Center, McMaster University, Hamilton, Ontario, Canada Correspondence: Grigorios I. Leontiadis, MD, PhD, Department of Medicine, Division of Gastroenterology, Health Sciences Center, McMaster University, 1280 Main Street West, Suite 4W8B, Hamilton, Ontario L8S 4K1, Canada. E-mail: [email protected] This letter underwent AJG editorial review.

Emulsion Reactors: A New Technique for the Preparation of Molecular Imaging Probes

There is an ongoing global effort to prepare targeted molecular imaging (MI) agents for positron emission tomography (PET) and single photon emission computed tomography (SPECT) by labeling small molecules, peptides, and antibodies with radionuclides. More recently, the library of available vectors has expanded to include naturally occurring and genetically engineered proteins, such as affibodies, antibody fragments, hormones, and growth factors. Although modern MI agents offer the opportunity to image and interrogate specific biochemical pathways, they also present unique challenges with respect to labeling the parent targeting vectors with medical isotopes. In many cases, conventional labeling methods fail to produce the desired products in high yield because of the complex structures of derivatized vectors and (in the case of biological agents) because of sensitivities to elevated reaction temperatures and non-physiological pH. Furthermore, production of the parent ligands is often non-trivial, resulting in their limited availability and high cost. These challenges have created the need for a new generation of high yielding and chemoselective labeling methods for both traditional and emerging classes of vectors. In response to these challenges, new radiolabeling strategies have been developed that include solid-phase and fluorous-phase radiolabeling, more reactive prosthetic groups and radiometal chelating His-tag analogues. Microfluidics has also been used increasingly for radiochemical applications because it allows for reactions to be run by using small quantities of precursor in which the unique reaction environment can improve yields and reduce labeling times. Here we report a new strategy that utilizes an emulsion-based labeling platform that requires no specialized equipment, provides a biocompatible reaction environment and that affords a significant increase in radiochemical yields. Aqueous dispersed systems, heterogeneous interfaces, and micelles have been found to accelerate organic reactions and catalyze molecular transformations, therefore, it was postulated that these reaction environments could similarly enhance radiolabeling reactions while providing a biocompatible reaction media. The utility of the emulsion platform was initially explored by using a chelate-derivatized peptide 1 (Scheme 1) that binds to the urokinase plasminogen activator receptor (uPAR)—a protein that is associated with aggressive forms of cancer. The peptide was modified with a tridentate amino acid-derived chelate (SAACII) that binds the technetium tricarbonyl ([Tc(CO)3] ) core. This is an attractive system for evaluating the emulsion platform since technetium is the most widely used radionuclide in diagnostic medicine and the tricarbonyl core typically requires a large excess of the ligand to achieve reasonable conversion yields in less than one half-life. A series of different emulsions were prepared in which the amount and type of surfactant and oil, and the volume ratio between the aqueous and oil phase, were varied. The labeling yields were evaluated as a function of ligand concentration and reaction conditions, and results were compared directly to conventional solution phase labeling reactions run in parallel. The initial emulsions investigated were prepared by varying the amount of the non-ionic surfactant sorbitan mono-oleate (Span-80) in isooctane from 0–5 wt% (0–8.02 10 2 molL ). The reaction mixture contained 1 (10 nmol), 37–55 MBq of [Tc(CO)3 ACHTUNGTRENNUNG(OH2)3]+ (an amount that enabled imaging and biodistribution studies to be completed), the aqueous phase (0.1 mL), and isooctane (1.0 mL). The reactions were conducted at ambient temperature and monitored for 60 min. Emulsification was performed by using a 35 kHz sonication bath with the conventional aqueous reaction placed in the sonicator beside the emulsion reactor so that the process for the two methods was identical (except for the addition of the isooctane) to account for any effects from sonication. All of the labeling reactions that were conducted in the emulsion system outperformed the corresponding conventional labeling, which had a radiochemical yield of less than 5%. The highest radiochemical yield (98%) was achieved when no surfactant was added to the system. [a] Dr. R. W. Simms, D. M. Weaver, M. Blacker, Dr. K. A. Stephenson, Prof. Dr. J. F. Valliant Centre for Probe Development and Commercialization Burke Science Building, Room B231, McMaster University 1280 Main Street West, Hamilton, Ontario L8S 4K1 (Canada) Fax: (+1)905-522-2509 E-mail : valliant@mcmaster.ca [b] Dr. D. H. Kim, Dr. C. Sundararajan, Prof. Dr. J. F. Valliant Department of Chemistry and Chemical Biology McMaster University, 1280 Main Street West Hamilton, Ontario L8S 4L8 (Canada) Supporting information for this article is available on the WWW under http://dx.doi.org/10.1002/chem.201200049.

Hydrogen Sulfide: A Rescue Molecule for Mucosal Defence and Repair

In the past decade, hydrogen sulfide (H2S) has taken on something of a new identity. Long recognized as an industrial pollutant and environmental toxin, H2S is now known to be produced throughout the body and to regulate important functions in most organs and tissues [1–3]. In the digestive system, H2S exerts potent anti-inflammatory actions, regulates blood flow and smooth muscle tone, modulates epithelial secretion and promotes healing of ulcers [4, 5]. Indeed, many of the actions of H2S overlap with those of nitric oxide (NO), another gaseous mediator recognized mainly as a pollutant and toxin before its physiological importance was elucidated [1–4]. H2S also bears some similarity to NO with respect to its synthetic pathways in mammals. Like NO, H2S is synthesized from an amino acid (L-cysteine), and this can occur via three (at least) enzyme pathways. Inhibitors of these pathways are available for use in experimental settings, but they are imperfect, lacking specificity for the target enzymes. A number of H2S donors are available for assessing the effects of this mediator in experimental settings, including some derived from natural products, such as garlic [3, 5]. Like NO, H2S is an important mediator of gastric mucosal defence (Table 1) [5]. Inhibition of endogenous H2S synthesis increases the susceptibility of the mucosa to damage induced by nonsteroidal anti-inflammatory drugs (NSAIDs), for example [6, 7]. On the other hand, exogenous H2S donors can increase the resistance of the mucosa to injury [5–7]. Moreover, H2S synthesis is markedly up-regulated after mucosal injury occurs, and it contributes significantly to promoting the healing of the injured tissue [8, 9]. H2S donors can accelerate ulcer healing in experimental models [8, 9]. There is emerging evidence that H2S plays an important role in promoting resolution of inflammation, in part by up-regulating cyclooxygenase-2 expression [9]. In the current issue of this journal, Mard et al. [10] report that administration of H2S just prior to an episode of ischemia–reperfusion can dose-dependently protect the stomach of the rat from damage. Protection could similarly be afforded through administration of L-cysteine, the precursor for H2S synthesis. Further evidence that H2S played a pivotal role in the maintenance of mucosal integrity during ischemia–reperfusion was the observation that suppression of endogenous H2S synthesis, with propargylglycine, resulted in a significant exacerbation of gastric injury. The authors suggest that it is the suppression of mRNA expression and plasma levels of pro-inflammatory cytokines that accounts for the reduction of gastric damage when the rats were pre-treated with an H2S donor or L-cysteine. One cannot exclude the possibility that the reduced cytokine expression/production occurred, at least in part, as a consequence of the reduced gastric injury, though H2S has been shown to reduce pro-inflammatory cytokine expression/synthesis in other in vivo models, including colitis [9, 11, 12]. The reduced gastric injury observed in the study of Mard et al. [10] may have been attributable to effects of H2S on any of a number of components of mucosal defence, including bicarbonate secretion [13] and mucosal blood flow [6] (see summary in Table 1). A number of recent studies suggest that the ability of H2S to maintain mitochondrial function in the face of challenges such as ischemia may underlie some of the beneficial effects of this J. L. Wallace (&) Farncombe Family Digestive Health Research Institute, McMaster University, 1280 Main Street West, HSC-3N4, Hamilton, ON L8S 4K1, Canada e-mail: jwalla@mcmaster.ca

Weighing new prescriptions for change

Medical EducationVolume 45, Issue 12 p. 1167-1168 commentaries Weighing new prescriptions for change Cathy Risdon, Cathy Risdon Hamilton, Ontario, CanadaSearch for more papers by this author Cathy Risdon, Cathy Risdon Hamilton, Ontario, CanadaSearch for more papers by this author First published: 29 November 2011 https://doi.org/10.1111/j.1365-2923.2011.04164.x Cathy Risdon, Department of Family Medicine, McMaster University, 690 Main Street West, Hamilton, Ontario L9H 6W5, Canada. Tel: 00 1 905 628 2247; Fax: 00 1 905 521 5010; E-mail: risdonc@mcmaster.ca Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume45, Issue12December 2011Pages 1167-1168 RelatedInformation

RStudio: A Platform‐Independent IDE for R and Sweave

Journal of Applied EconometricsVolume 27, Issue 1 p. 167-172 Software Review RStudio: A Platform-Independent IDE for R and Sweave Jeffrey S. Racine, Corresponding Author Jeffrey S. Racine Department of Economics, McMaster University, Hamilton, Ontario, CanadaJeffrey S. Racine, Department of Economics, Kenneth Taylor Hall, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4M4. E-mail: [email protected]Search for more papers by this author Jeffrey S. Racine, Corresponding Author Jeffrey S. Racine Department of Economics, McMaster University, Hamilton, Ontario, CanadaJeffrey S. Racine, Department of Economics, Kenneth Taylor Hall, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4M4. E-mail: [email protected]Search for more papers by this author First published: 26 October 2011 https://doi.org/10.1002/jae.1278Citations: 67Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume27, Issue1January/February 2012Pages 167-172 RelatedInformation

Ectomorphic body habitus, microcephaly, developmental delay with characteristic facial phenotype

Department of Pathology and Molecular Medicine and Department of Pediatrics, McMaster University, Hamilton, Canada Correspondence to Dr Małgorzata J.M. Nowaczyk, MD, Departments of Pathology and Molecular Medicine and Department of Pediatrics, McMaster University, McMaster University Medical Centre, 1200 Main Street West, Room 3N16, Hamilton, Ontario L8S 4J9, Canada Tel: +1905 521 5085; fax: +1905 521 2651; e-mail: [email protected] Received December 17, 2010 Accepted June 9, 2011

Echo-Guided Pericardiocentesis

HomeCirculationVol. 123, No. 4Echo-Guided Pericardiocentesis Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessResearch ArticlePDF/EPUBEcho-Guided PericardiocentesisLet the Bubbles Show the Way Craig D. Ainsworth, MD, FRCPC and Omid Salehian, MSc, MD, FRCPC, FACC, FAHA Craig D. AinsworthCraig D. Ainsworth From the Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Search for more papers by this author and Omid SalehianOmid Salehian From the Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Search for more papers by this author Originally published1 Feb 2011https://doi.org/10.1161/CIRCULATIONAHA.110.005512Circulation. 2011;123:e210–e211A 75-year-old man with coronary artery disease, atrial fibrillation, sick sinus syndrome with permanent pacemaker, hypertension, dyslipidemia, and previous exertional dyspnea related to moderately severe mitral regurgitation from myxomatous degeneration and bileaflet prolapse presented with progressively worsening dyspnea several weeks after undergoing successful mitral and tricuspid valve repair with insertion of annuloplasty rings in addition to 2-vessel coronary artery bypass surgery. On presentation to the hospital he was found to have dyspnea at rest, hypotension, and jugular venous distension. A transthoracic echocardiogram demonstrated normal left ventricular function, no significant valvular stenosis, or regurgitation and a moderate sized pericardial effusion measuring 1.4 cm anteriorly and 2.7 cm posteriorly (Figure A through C). Significant inferior vena cava dilatation was noted, but no convincing chamber collapse to suggest overt cardiac tamponade. His symptoms persisted with no alternate cause discovered; therefore, therapeutic pericardiocentesis was requested. The location and distribution of pericardial fluid was reestablished, and a lateral apical approach provided the best window to access the effusion. Under echocardiographic guidance, a sheathed needle was inserted into the pericardial space with aspiration of sanguineous fluid. Agitated saline bubbles confirmed that the needle tip was in the pericardial space (Figure D and online-only Data Supplement Movie I). The needle was removed and the sheath advanced. Prior to dilatation, repeat injection of agitated saline revealed bubbles in the right ventricle; therefore, the procedure was stopped (Figure E and online-only Data Supplement Movie II). A subsequent attempt was performed using the same technique, and this resulted in entry of the catheter sheath into the left ventricle (Figure F and online-only Data Supplement Movie III). The procedure was abandoned, and serial echocardiograms showed no worsening of the pericardial effusion.Download figureDownload PowerPointFigure. Transthoracic echocardiogram images obtained before and during attempted pericardiocentesis. (A and B) apical 4-chamber views detailing size and location of pericardial effusion. (C) subcostal view showing posterior fluid collection. (D) agitated saline contrast injected through needle inserted in apical area seen entering pericardial space as imaged from subcostal window. (E and F) subcostal views depicting agitated saline entering right and left ventricular cavities respectively.DiscussionEchocardiography-guided pericardiocentesis has been performed since the late 1970s, when it was first performed at the Mayo Clinic in Rochester, Minnesota. Echocardiographic guidance for placement of a sheathed catheter into pericardial effusions has supplanted the previously performed blind subxiphoid approach as the preferred procedure for the diagnosis and management of most large or hemodynamically significant pericardial effusions. The blind technique used for years prior to the introduction of echocardiography was associated with exceedingly high rates of morbidity and mortality.1 The echocardiography-guided technique involves indentifying the location and distribution of pericardial fluid and entering with a needle at a point on the chest wall where the largest fluid accumulation is closest to the skin while avoiding vital structures.2 Once the sheathed needle is inserted into the pericardial space, only the sheath is advanced, and the steel needle is removed. Sheath position is routinely verified by instillation of agitated saline through the sheath and imaging from another window. In large, symptomatic, or hemodynamically significant pericardial effusions, this technique is associated with near perfect procedural success rates and low incidence of minor complications (3.5%) or major adverse events requiring intervention (1.2%).2 Our attempted pericardiocentesis initially revealed saline bubbles in the pericardial space but subsequently showed bubbles entering the right and left ventricular cavities. No intervention was required after these inadvertent entries into cardiac chambers. Ultimately, the procedure was abandoned and further attempts were not performed. Although not attempted in our case, real-time echocardiography-guided pericardiocentesis with a probe-mounted needle has been studied and appears to be very safe, and may be useful for smaller or difficult-to-access effusions.3 The authors of this study argue that constant visualization of the needle during insertion reduces the likelihood of perforating cardiac chambers.This case highlights the importance of administering agitated saline after attempted needle insertion into the pericardial space as to help avoid inadvertently dilating into a ventricular cavity or other undesired space.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/123/4/e210/DC1.Correspondence to Omid Salehian, MD, Division of Cardiology, Department of Medicine, McMaster University, 1200 Main Street West, Room 3U8, Hamilton, Ontario, Canada, L8N 3Z5. E-mail [email protected]ca