bluuebunny/crossref_metadata_2025 huggingface dataset:
Landscape context influences chytrid fungus distribution in an endangered European amphibian
Authors: Scheele B. C. , Driscoll D. A. , Fischer J. , Fletcher A. W. , Hanspach J. , Vörös J. , Hartel T.
Published: March 2015

Wildlife disease is an emerging threat to biodiversity. The amphibian chytrid fungus Batrachochytrium dendrobatidis (Bd), which causes the disease chytridiomycosis, has been documented in over 500 amphibian species globally. Understanding conditions under which amphibians are vulnerable to Bd is important for evaluating species risk and developing surveillance strategies. Here, we investigate the spatial distribution of Bd infection in the ephemeral pond‐breeding yellow‐bellied toad Bombina variegata, a species of high conservation concern in the European Union. We sampled 550 toads from 60 ponds in a traditional agricultural landscape in Southern Transylvania, Romania. Overall, Bd prevalence was low in B. variegata, but infected toads were widely dispersed through the landscape and were found in a quarter of all sampled ephemeral ponds. At the pond level, increased Bd occurrence was associated with short distances to perennial water sources and high forest cover. These findings suggest that perennial water sources may act as source habitat for Bd, with amphibian movements resulting in Bd spillover into ephemeral ponds. Increased Bd occurrence in ponds surrounded by high levels of forest cover is likely related to cooler and wetter conditions that are more favourable for Bd. Throughout the study landscape, patchy environmental suitability for Bd appears to restrict the pathogen to a subset of B. variegata habitat. Ephemeral ponds in open landscapes, without nearby perennial habitat, likely provide an environmental refuge from Bd, where the risk of infection is low. From a conservation perspective, these findings highlight the importance of maintaining ephemeral ponds in open landscapes, but these are currently threatened by land‐use change.
Dental demographics and metrics of oral diseases in the ageing Australian population
Authors: Hopcraft MS
Published: March 2015

One of the biggest challenges currently facing the dental profession in Australia is the provision of quality and timely dental care to the elderly. Adults aged 65+ years are an exponentially growing section of the community with rapidly changing dental needs, thanks in part to improvements in oral health over the past 60 years that have resulted in a dramatically decreased rate of edentulism and subsequently an increased number of teeth present. This is a challenge not only for the public dental services, but also public health policy makers, private dental practitioners, professional organizations and dental education providers. It is an issue that crosses a range of dental care providers, not only dentists but also dental prosthetists and dental hygienists, whose role in the provision of dental services has been slowly growing in Australia. Furthermore, with evidence of links between oral and systemic health, this issue has significant impacts for the broader health system.
Periodontal considerations in older individuals
Authors: Darby I
Published: March 2015

In the next few years there will be a great increase in the percentage of the population aged over 65. Not only will they have more teeth than previous generations, but also a large number of implants. The increase in age is accompanied by an increase in the prevalence and incidence of periodontal diseases. In addition, there is a decrease in manual dexterity and an increase in co‐morbidity and medications affecting the oral cavity. Dental care in aged care facilities can be poor and access to dental professionals difficult. This article discusses these issues.
Oral medicine and the ageing population
Authors: Yap T , McCullough M
Published: March 2015

The oral cavity is subject to age related processes such as cellular ageing and immunosenescence. The ageing population bears an increased burden of intraoral pathology. In oral medicine, the majority of presenting patients are in their fifth to seventh decade of life. In this review, we discuss the ageing population's susceptibility to mucosal disorders and the increased prevalence of potentially malignant disorders and oral squamous cell carcinoma, as well as dermatoses including oral lichen planus and immunobullous conditions. We also address the ageing population's susceptibility to oral discomfort and explore salivary secretion, ulceration and the symptoms of oral burning. Finally, we will describe orofacial pain conditions which are more likely encountered in an older population. This update highlights clinical presentations which are more likely to be encountered in the ageing population in a general practice setting and the importance of screening both new and long‐term patients.
Relaxation and guided imagery do not reduce stress, pain and unpleasantness for 11‐ to 12‐year‐old girls during vaccinations
Authors: Nilsson Stefan , Forsner Maria , Finnström Berit , Mörelius Evalotte
Published: March 2015

Aim

Relaxation and guided imagery is a distraction technique known to reduce discomfort during paediatric medical procedures. We examined whether its use decreased the stress experienced by 11‐ to 12‐year‐old girls receiving the human papilloma virus vaccination, as well as the intensity and unpleasantness of any pain.

Methods

A randomised crossover trial was conducted with 37 girls. During the first vaccination, each girl was randomised to receive either relaxation and guided imagery or standard care. They then received the other form of care during the second vaccination. Salivary cortisol was measured before each vaccination, and 30 minutes after it was administered. The girls reported pain intensity and pain unpleasantness before and directly after each vaccination and stress after each vaccination.

Results

On a group level, relaxation and guided imagery did not decrease cortisol levels, self‐reported stress, pain intensity and pain unpleasantness. Salivary cortisol levels decreased significantly in both groups during the second vaccination.

Conclusion

Relaxation and guided imagery did not prove beneficial during the vaccination of 11‐ to 12‐year‐old girls and is not recommended as a regular nursing intervention. However, further research is needed into effective techniques to help children who experience pain unpleasantness in connection with needle procedures.
Estimating tissue iron burden: current status and future prospects
Authors: Wood John C.
Published: March 2015

Iron overload is becoming an increasing problem as haemoglobinopathy patients gain greater access to good medical care and as therapies for myelodysplastic syndromes improve. Therapeutic options for iron chelation therapy have increased and many patients now receive combination therapies. However, optimal utilization of iron chelation therapy requires knowledge not only of the total body iron burden but the relative iron distribution among the different organs. The physiological basis for extrahepatic iron deposition is presented in order to help identify patients at highest risk for cardiac and endocrine complications. This manuscript reviews the current state of the art for monitoring global iron overload status as well as its compartmentalization. Plasma markers, computerized tomography, liver biopsy, magnetic susceptibility devices and magnetic resonance imaging (MRI) techniques are all discussed but MRI has come to dominate clinical practice. The potential impact of recent pancreatic and pituitary MRI studies on clinical practice are discussed as well as other works‐in‐progress. Clinical protocols are derived from experience in haemoglobinopathies but may provide useful guiding principles for other iron overload disorders, such as myelodysplastic syndromes.
Insights into the Interaction Mechanism of Ligands with Aβ42 Based on Molecular Dynamics Simulations and Mechanics: Implications of Role of Common Binding Site in Drug Design for Alzheimer's Disease
Authors: Kundaikar Harish S. , Degani Mariam S.
Published: March 2015

Aggregation of β‐amyloid (Aβ) into oligomers and further into fibrils is hypothesized to be a key factor in pathology of Alzheimer's disease (AD). In this study, mapping and docking were used to study the binding of ligands to protofibrils. It was followed by molecular simulations to understand the differences in interactions of known therapeutic agents such as curcumin, fluorescence‐based amyloid staining agents such as thioflavin T, and diagnostic agents such as florbetapir (AV45), with Aβ protofibrils. We show that therapeutic agents bind to and distort the protofibrils, thus causing destabilization or prevention of oligomerization, in contrast to diagnostic agents which bind to but do not distort such structures. This has implications in the rational design of ligands, both for diagnostics and therapeutics of AD.
Knowledge use and learning in everyday social work practice: a study in child investigation work
Authors: Avby Gunilla , Nilsen Per , Ellström Per‐Erik
Published: March 2015

The aim of this study was to explore knowledge use and learning among social workers in everyday child investigation work. Research was undertaken in two Swedish children's services departments. The study applied an ethnographic approach. Methods for data collection included interviews, participant observations, reflective dialogues and a documentary analysis of case files. The social workers' knowledge sources were classified into research‐based, practice‐based and ordinary knowledge. The findings show that the social workers preferred practice‐based knowledge, which was primarily conveyed from colleagues and previous experience, and rarely consulted knowledge from sources found outside the practice setting. Furthermore, the findings suggest that the integration of knowledge was made possible through the social workers' engagement in both a verbal and a more cognitive (tacit) reasoning activity, processes that fostered learning at work. The social workers' learning was predominantly adaptive as they learned to handle tasks in a fairly routinized way on the basis of rules or procedures. The findings lend support to the notion that the use of different knowledge forms could potentially trigger learning in everyday social work.
Deep‐colour vat dyeing of cotton knit fabric on a modified jet dyeing machine
Authors: Wakoh Hiroshi , Furuie Mina , Inaba Daisuke , Azuma Nobuto , Nakane Koji , Ogata Nobuo , Shimizu Toru , Ishimaru Osamu
Published: March 2015

To improve the vat dyeing of cotton knit fabric with Indanthren Black RB Coll. (CI Vat Black 9), the basic parameters of dyeing, including the concentrations of chemicals, the dyeing temperature and duration, and the apparent diffusion coefficient of the dye, were obtained by test dyeing with a stoppered Erlenmeyer flask and the cellophane film roll method. A stable vat dyeing process has been developed on a modified jet dyeing machine for the first time without using nitrogen to purge oxygen. Modifications were made to improve the airtightness of the machine and the equipment in the liquor circulating system, with a water inlet and outlet for the gentle oxidation of dyed fabric, and with monitoring by means of a sensor inserted in the liquor circulating system for in situ measurements of the redox potential and the pH of the dyeing liquors. These measurements made it possible to follow to their completion the process of dyeing and the process of gentle oxidation by overflow washing with water and final oxidation. Optimal conditions with regard to the amount of reducing agent, the dyeing temperature (80 °C), and oxidising processes were established with this machine. It was found that, by using the modified machine and process conditions, dyeing proceeded stably and reproducibly (at 80 °C) to yield grade A dyed fabric. Visual inspection confirmed that faultless deep‐colour dyeing of the fabric was attained. Production has been proceeding successfully for the past 2 years. Owing to its insolubility, complete removal of the dye from the wastewater has been possible.
Myeloid sarcoma: an unusual presentation for acute tracheal stenosis
Authors: Podgaetz Eitan , Kriegsmann Mark , Dincer Erhan H. , Allan James S.
Published: March 2015

Background and Aims

Extramedullary involvement of acute myelogenous leukemia (AML) is rare and has been reported under the terms myeloid sarcoma (MS), granulocytic sarcoma, chloroma, extramedullary acute myeloid leukemia, myeloblastoma and myelosarcoma. The most common extramedullary involvement includes soft tissues and lymph nodes, but it may arise in different sites of the body. There are only very few reports about MS in the pulmonary system, and involvement of the trachea is extremely rare.

Methods

This is the first report of initial presentation of MS by severe acute tracheal stenosis.

Results

After failed tracheal dilatation, a tracheostomy was performed where tracheal tissue was submitted for pathology. Histology of the tracheal biopsy and bone marrow revealed AML. The patient was subsequently referred to our oncology service for further management.

Conclusion

Myeloid sarcoma should be part of the differential for acute tracheal stenosis.
Prognostic factors affecting survival in non‐small cell lung carcinoma patients with malignant pleural effusions
Authors: Kasapoglu Umut Sabri , Arınç Sibel , Gungor Sinem , Irmak Ilim , Guney Pinar , Aksoy Ferda , Bandak Dilek , Hazar Armagan
Published: March 2015

Background and Aims

Lung cancer is the most common cause of malignant pleural effusions (MPEs). For patients with lung cancer and MPE, median survival is only 3–4 months. The aim of this study was to evaluate lung cancer patients with MPE by clinical and laboratory findings on admission, and determine 2‐year survival rate and prognostic factors.

Methods

Between 2008 and 2011, we examined 199 cases of non‐small cell lung carcinoma with MPE. Demographic factors of patients, tumor characteristics, treatment delivered and laboratory parameters affecting prognosis were evaluated. Survival rates were estimated by Kaplan–Meier method. Significance of each prognostic factors selected by univariate analysis were confirmed using Cox regression model.

Results

The study included 139 (69.8%) male and 60 (30.2%) female patients with a median age of 64 (30–85) years. Median overall survival was 4.4 months. Adenocarcinoma was the leading cause of MPE with 80.4%. A univariate analysis showed that factors affecting mortality included gender (P < 0.001), MPE with distant metastasis (P = 0.025), lower serum albumin (P < 0.0001), lower pleural protein (P < 0.0001), increased serum lactate dehydrogenase (P = 0.003), increased serum C‐reactive protein (CRP) (P < 0.0001), increased white blood cells (P < 0.0001), histopathological type (P = 0.004) and treatment decision (P < 0.0001). A multivariate analysis revealed that patients who had high level of serum CRP (P = 0.017), lower serum albumin (P = 0.009) and lower pleural protein (P = 0.003), MPE with distant metastasis (P = 0.003) and those who were chemotherapy naive (P < 0.0001) had shorter survival.

Conclusion

High level of serum CRP, lower serum albumin and lower pleural protein, MPE with distant metastasis were most important prognostic factors for non‐small cell lung carcinoma in patients with MPEs.
Provision of structured diabetes information encourages activation amongst people with diabetes as measured by diabetes care process attainment: the WICKED Project
Authors: Gillani S. M. R. , Nevill A. , Singh B. M.
Published: March 2015

Background

People with diabetes have better outcomes if they actively participate in their care. Patient‐focused interventions can be effective in activating patients. Yet there is no known trial to evaluate the impact of the provision of individualized diabetes‐specific information on patient activation and diabetes care outcomes.

Methods

In a randomized controlled trial, all people (n = 14 559) with diabetes within the local health economy were recruited and cluster randomized into two groups with the active group mailed a structured personalized report containing information on all nine of their diabetes care processes, whereas the control group received standard care. Differences in their Failed Process Score (FPS) were compared at three months.

Results

At three months, the FPS score (1.25 ± 1.87 vs. 1.35 ± 1.97, P < 0.01) and the change in FPS score (0.48 ± 1.55 vs. 0.42 ± 1.49, P < 0.02) were significantly better in those mailed a structured personalized report. A dichotomized FPS score [good attainment (GA) vs. poorer attainment], was significantly better in those mailed (χ2 = 10.0, P < 0.05) and using a binary logistic regression analysis adjusting for all demographic factors and the baseline FPS, the relative effect of mailing compared with non‐mailing on three‐month GA category was OR 1.14 (95% CI 1.04–1.25, P < 0.01).

Conclusions

Provision of structured and individualized information to people with diabetes can positively influence the level of patient activation, promote better engagement and open the potential to improve other crucial diabetes outcomes.
Data‐driven directions for effective footwear provision for the high‐risk diabetic foot
Authors: Arts M. L. J. , de Haart M. , Waaijman R. , Dahmen R. , Berendsen H. , Nollet F. , Bus S. A.
Published: March 2015

Aims

Custom‐made footwear is used to offload the diabetic foot to prevent plantar foot ulcers. This prospective study evaluates the offloading effects of modifying custom‐made footwear and aims to provide data‐driven directions for the provision of effectively offloading footwear in clinical practice.

Methods

Eighty‐five people with diabetic neuropathy and a recently healed plantar foot ulcer, who participated in a clinical trial on footwear effectiveness, had their custom‐made footwear evaluated with in‐shoe plantar pressure measurements at three‐monthly intervals. Footwear was modified when peak pressure was ≥ 200 kPa. The effect of single and combined footwear modifications on in‐shoe peak pressure at these high‐pressure target locations was assessed.

Results

All footwear modifications significantly reduced peak pressure at the target locations compared with pre‐modification levels (range –6.7% to –24.0%, P < 0.001). The metatarsal heads were most frequently targeted. Repositioning an existing (trans‐)metatarsal pad in the shoe insole (–15.9% peak pressure relief), applying local cushioning to the insole (–15.0%) and replacing the insole top cover with Plastazote (–14.2%) were the most effective single modifications. Combining a new Plastazote top cover with a trans‐metatarsal bar (–24.0% peak pressure relief) or with local cushioning (–22.0%) were the most effective combined modifications.

Conclusions

In people with diabetic neuropathy and a recently healed plantar foot ulcer, significant offloading can be achieved at high‐risk foot regions by modifying custom‐made footwear. These results provide data‐driven directions for the design and evaluation of custom‐made footwear for high‐risk people with diabetes, and essentially mean that each shoe prescribed should incorporate those design features that effectively offload the foot.
A genetic diagnosis of maturity‐onset diabetes of the young (MODY): experiences of patients and family members
Authors: Bosma A. R. , Rigter T. , Weinreich S. S. , Cornel M. C. , Henneman L.
Published: March 2015

Aims

Genetic testing for maturity‐onset diabetes of the young (MODY) facilitates a correct diagnosis, enabling treatment optimization and allowing monitoring of asymptomatic family members. To date, the majority of people with MODY remain undiagnosed. To identify patients' needs and areas for improving care, this study explores the experiences of patients and family members who have been genetically tested for MODY.

Methods

Fourteen semi‐structured interviews with patients and the parents of patients, and symptomatic and asymptomatic family members were conducted. Atlas.ti was used for thematic analysis.

Results

Most people with MODY were initially misdiagnosed with Type 1 or Type 2 diabetes; they had been seeking for the correct diagnosis for a long time. Reasons for having a genetic test included reassurance, removing the uncertainty of developing diabetes (in asymptomatic family members) and informing relatives. Reasons against testing were the fear of genetic discrimination and not having symptoms. Often a positive genetic test result did not come as a surprise. Both patients and family members were satisfied with the decision to get tested because it enabled them to adjust their lifestyle and treatment accordingly. All participants experienced a lack of knowledge of MODY among healthcare professionals, in their social environment and in patient organizations. Additionally, problems with the reimbursement of medical expenses were reported.

Conclusions

Patients and family members are generally positive about genetic testing for MODY. More education of healthcare professionals and attention on the part of diabetes organizations is needed to increase awareness and optimize care and support for people with MODY.
Successful self‐management among non‐insulin‐treated adults with Type 2 diabetes: a self‐regulation perspective
Authors: Tanenbaum M. L. , Leventhal H. , Breland J. Y. , Yu J. , Walker E. A. , Gonzalez J. S.
Published: March 2015

Aims

To clarify the role of self‐monitoring of blood glucose (SMBG) in the self‐management of Type 2 diabetes from the patient's perspective, using in‐depth interviews with non‐insulin‐treated adults to investigate how they learned to manage their diabetes effectively and whether SMBG played a significant role in this process.

Methods

Individual interviews were conducted with 14 non‐insulin‐treated adults with Type 2 diabetes who had significantly improved their glycaemic control [64% women; 50% black; 21% Hispanic; mean age 60 years; mean HbA1c concentration 43 mmol/mol (6.1%)]. Interviews were transcribed and analysed by a coding team, applying the concept of illness coherence from the Common Sense Model of Self‐Regulation.

Results

The majority of participants relied on SMBG to evaluate their self‐management efforts. Key themes included: adopting an experimental approach; experiencing ‘a‐ha’ moments; provider‐assisted problem‐solving; using SMBG and other feedback to evaluate when their efforts were working; and normalizing diabetes‐specific behaviour changes as being healthy for everyone.

Conclusions

Our qualitative data are consistent with the argument that SMBG, if implemented appropriately with enough education and provider access, can be a powerful tool for non‐insulin‐treated adults with Type 2 diabetes to monitor their self‐management. Establishing sufficient conditions for illness coherence to develop while individuals are learning to use SMBG could increase their sense of personal control in managing a complex and demanding illness.
Changes in physical activity among adults with diabetes: a longitudinal cohort study of inactive patients with Type 2 diabetes who become physically active
Authors: Palakodeti S. , Uratsu C. S. , Schmittdiel J. A. , Grant R. W.
Published: March 2015

Aims

To identify the predictors and clinical effects among inactive patients with diabetes who become physically active, in the setting of a large integrated health system.

Methods

We studied adults with Type 2 diabetes with at least two clinic visits between December 2011 and November 2012 who reported being inactive at their first visit. The mean (±sd) interval between their first and last visit was 6.2 (±2.3) months. We analysed self‐reported moderate‐to‐vigorous physical activity data collected using a structured intake form during routine clinical care.

Results

The study cohort (N = 6853) had a mean age of 60.2 years; 51.4% were women and 53.6% were non‐white. Nearly two‐thirds (62.5%, n = 4280) reported remaining physically inactive, while 16.0% reported achieving the recommended moderate‐to‐vigorous physical activity levels (≥ 150 min/week) by the last visit of the study period. Female gender (odds ratio 0.77, 95% CI 0.67, 0.88), obesity (BMI 30–34.9 kg/m2: odds ratio 0.76, 95% CI 0.60, 0.97; BMI ≥ 35 kg/m2: odds ratio 0.55, 95% CI 0.42, 0.70), chronic kidney disease (odds ratio 0.78, 95% CI 0.65, 0.94) and depression (odds ratio 0.77, 95% CI 0.62, 0.96) were each independently associated with not achieving the recommended moderate‐to‐vigorous physical activity level, while physician referral to lifestyle education was a positive predictor (odds ratio 1.40, 95% CI 1.09, 1.85). Controlling for baseline differences, patients achieving the recommended moderate‐to‐vigorous physical activity target lost 1.0 kg more weight compared with patients remaining inactive (P < 0.001).

Conclusions

Patients with diabetes in a real‐world clinical setting lost weight after becoming physically active; however, nearly two‐thirds of patients remained inactive. Novel interventions to address physical inactivity in primary care should address barriers faced by older patients with medically complex disease.
Diagnosis and assessment of peripheral arterial disease in the diabetic foot
Authors: Brownrigg J. R. W. , Schaper N. C. , Hinchliffe R. J.
Published: March 2015

Approximately half of all patients with a diabetic foot ulcer have co‐existing peripheral arterial disease. Identifying peripheral arterial disease among patients with foot ulceration is important, given its association with failure to heal, amputation, cardiovascular events and increased risk of premature mortality. Infection, oedema and neuropathy, often present with ulceration, may adversely affect the performance of diagnostic tests that are reliable in patients without diabetes. Early recognition and expert assessment of peripheral arterial disease allows measures to be taken to reduce the risk of amputation and cardiovascular events, while determining the need for revascularization to promote ulcer healing. When peripheral arterial disease is diagnosed, the extent of perfusion deficit should be measured. Patients with a severe perfusion deficit, likely to affect ulcer healing, will require further imaging to define the anatomy of disease and indicate whether a revascularization procedure is appropriate.
Medicine‐taking experiences and associated factors: comparison between Arabic‐speaking and Caucasian English‐speaking patients with Type 2 diabetes
Authors: Alzubaidi H. , Mc Mamara K. , Chapman C. , Stevenson V. , Marriott J.
Published: March 2015

Aim

The aim of this study was to explore and compare medication‐taking experiences and associated issues in Arabic‐speaking and Caucasian English‐speaking patients with Type 2 diabetes in Australia.

Methods

Various healthcare settings in metropolitan Melbourne, Australia, were purposefully selected to obtain a diverse group of participants with Type 2 diabetes. Recruitment occurred at diabetes outpatient clinics in two tertiary referral hospitals, six primary care practices and ten community centres. Face‐to‐face semi‐structured individual interviews and group interviews were employed. All interviews were audiotaped, transcribed and coded thematically. Data collection continued until saturation was reached.

Results

In total, 100 participants were recruited into two groups: 60 were Arabic‐speaking and 40 were Caucasian English‐speaking. Both groups had similar demographic and clinical characteristics. Only 5% of the Arabic‐speaking participants had well‐controlled diabetes compared with 17.5% of the participants in the English‐speaking group. Arabic‐speaking participants actively changed medication regimens on their own without informing their healthcare professionals. Arabic‐speaking patients had more knowledge gaps about their prescribed treatments, compared with the English‐speaking group. Their use of diabetes medicines was heavily influenced by peers with diabetes and family members; conversely, they feared revealing their diagnosis within the wider Arabic community due to stigma and collective negative social labelling of diabetes. Confidence in non‐Arabic‐speaking healthcare providers was lacking.

Conclusions

Findings yielded new insights into medication‐taking practices and associated factors in Arabic‐speaking patients with diabetes. It is vital that healthcare professionals working with Arabic‐speaking patients adapt their treatment approaches to accommodate different beliefs and views about medicines.
Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry
Authors: Lerner A. G. , Bernabé‐Ortiz A. , Ticse R. , Hernandez A. , Huaylinos Y. , Pinto M. E. , Málaga G. , Checkley W. , Gilman R. H. , Miranda J. J. ,   the CRONICAS Cohort Study Group
Published: March 2015

Aim

To determine if changes in pupillary response are useful as a screening tool for diabetes and to assess whether pupillometry is associated with cardiac autonomic neuropathy.

Methods

We conducted a cross‐sectional study with participants drawn from two settings: a hospital and a community site. At the community site, individuals with newly diagnosed diabetes as well as a random sample of control individuals without diabetes, confirmed by oral glucose tolerance test, were selected. Participants underwent an LED light stimulus test and eight pupillometry variables were measured. Outcomes were diabetes, defined by oral glucose tolerance test, and cardiac autonomic dysfunction, determined by a positive readout on two of four diagnostic tests: heart rate response to the Valsalva manoeuvre; orthostatic hypotension; 30:15 ratio; and expiration‐to‐inspiration ratio. The area under the curve, best threshold, sensitivity and specificity of each pupillometry variable was calculated.

Results

Data from 384 people, 213 with diabetes, were analysed. The mean (±sd) age of the people with diabetes was 58.6 (±8.2) years and in the control subjects it was 56.1 (±8.6) years. When comparing individuals with and without diabetes, the amplitude of the pupil reaction had the highest area under the curve [0.69 (sensitivity: 78%; specificity: 55%)]. Cardiac autonomic neuropathy was present in 51 of the 138 people evaluated (37.0%; 95% CI 28.8–45.1). To diagnose cardiac autonomic neuropathy, two pupillometry variables had the highest area under the curve: baseline pupil radius [area under the curve: 0.71 (sensitivity: 51%; specificity: 84%)], and amplitude of the pupil reaction [area under the curve: 0.70 (sensitivity: 82%; specificity: 55%)].

Conclusions

Pupillometry is an inexpensive technique to screen for diabetes and cardiac autonomic neuropathy, but it does not have sufficient accuracy for clinical use as a screening tool.
The role of serum methylglyoxal on diabetic peripheral and cardiovascular autonomic neuropathy: the ADDITION Denmark study
Authors: Hansen C. S. , Jensen T. M. , Jensen J. S. , Nawroth P. , Fleming T. , Witte D. R. , Lauritzen T. , Sandbæk A. , Charles M. , Fleischer J. , Vistisen D. , Jørgensen M. E.
Published: March 2015

Aims

Cardiovascular autonomic neuropathy and diabetic peripheral neuropathy are common diabetic complications and independent predictors of cardiovascular disease. The glucose metabolite methylglyoxal has been suggested to play a causal role in the pathogeneses of diabetic peripheral neuropathy and possibly diabetic cardiovascular autonomic neuropathy. The aim of this study was to investigate the cross‐sectional association between serum methylglyoxal and diabetic peripheral neuropathy and cardiovascular autonomic neuropathy in a subset of patients in the ADDITION‐Denmark study with short‐term screen‐detected Type 2 diabetes (duration ~ 5.8 years).

Methods

The patients were well controlled with regard to HbA1c, lipids and blood pressure. Cardiovascular autonomic neuropathy was assessed by measures of resting heart rate variability and cardiovascular autonomic reflex tests. Diabetic peripheral neuropathy was assessed by vibration detection threshold (n = 319), 10 g monofilament (n = 543) and the Michigan Neuropathy Screening Instrument questionnaire (n = 966). Painful diabetic neuropathy was assessed using the Brief Pain Inventory short form (n = 882).

Results

No associations between methylglyoxal and cardiovascular autonomic reflex tests or any measures of diabetic peripheral neuropathy or painful diabetic neuropathy were observed. However, a positive association between methylglyoxal and several heart rate variability indices was observed, although these associations were not statistically significant when corrected for multiple testing.

Conclusion

Serum methylglyoxal is not associated with cardiovascular autonomic neuropathy, diabetic peripheral neuropathy or painful diabetic neuropathy in this cohort of well‐treated patients with short‐term diabetes.
Successful surgical management of abdominal abscessation secondary to Strongylus edentatus migration
Authors: Bell R. P. , Reed S. K. , Messer N. T.
Published: March 2015

This report describes the successful surgical management of abdominal abscessation secondary to Strongylus edentatus migration. Abdominal abscesses are a relatively common source of recurrent fever in the horse and are primarily managed with long‐term antimicrobial administration. However, identification of the definitive cause, extent of the abscesses and successful resolution in this case were not possible without an exploratory celiotomy to facilitate surgical resection.
Polymerase chain reaction‐based national surveillance programme to determine the distribution and prevalence of Taylorella equigenitalis in South African horses
Authors: May C. E. , Guthrie A. J. , Keys B. , Joone C. , Monyai M. , Schulman M. L.
Published: March 2015

Reasons for performing study

The response to the first outbreak of contagious equine metritis in South Africa included pioneering a web‐based platform to coordinate key aspects of a national, real‐time polymerase chain reaction (qPCR)‐based stallion screening programme to determine the distribution and prevalence of Taylorella equigenitalis in stallions and exposed mares.

Objectives

To define the hypothesised pre‐existing status of T. equigenitalis in the South African equine population and progression of the epidemiological investigation via the implementation of a molecular diagnostic‐based surveillance programme.

Study design

Retrospective case series.

Methods

Screening for T. equigenitalis was via a qPCR assay on genital swabs obtained from predilection sites in stallions and mares with subsequent confirmation using bacterial culture according to prescribed methods.

Results

The initial outbreak investigation identified 4 horses including the index stallion and mare. Traceback of in‐contact horses identified 26 horses, including a subpopulation focus at the South African Lipizzaner Centre where 24/33 resident stallions tested positive for T. equigenitalis on qPCR. The national screening programme identified an additional 9 stallions. A total of 39 horses (36 stallions and 3 mares) tested positive for T. equigenitalis by qPCR and T. equigenitalis was isolated from 23 of these stallions and 2 of these mares. In addition to the index property, an artificial breeding centre where the index case was first identified, an additional 12 properties with infected horses were identified in 3/9 provinces. Horses on 11 of these 12 properties were directly linked to the index property. Two incidents of T. equigenitalis transmission associated with artificial insemination were recorded.

Conclusions

T. equigenitalis was present in a subpopulation focus within the South African horse population prior to the outbreak identification in April 2011. Horizontal fomite‐associated spread was the most probable route of transmission between stallions. The targeted surveillance of stallions and exposed mares using a qPCR‐based screening programme expedited investigation of the distribution and prevalence of T. equigenitalis infection in South African horses. The application of qPCR provided a sensitive and practical screening test for identification of T. equigenitalis‐positive animals as part of an emergency response to the first identified cases of T. equigenitalis infection in South African horses.
Comparison of the management and in‐hospital outcomes of acute coronary syndrome patients in Australia and New Zealand: results from the binational SNAPSHOT acute coronary syndrome 2012 audit
Authors: Ellis C. , Hammett C. , Ranasinghe I. , French J. , Briffa T. , Devlin G. , Elliott J. , Lefkovitz J. , Aliprandi‐Costa B. , Astley C. , Redfern J. , Howell T. , Carr B. , Lintern K. , Bloomer S. , Farshid A. , Matsis P. , Hamer A. , Williams M. , Troughton R. , Horsfall M. , Hyun K. , Gamble G. , White H. , Brieger D. , Chew D. ,   Bi‐National Acute Coronary Syndromes (ACS) ‘SNAPSHOT’ Audit Group
Published: March 2015

Background/Aims

We aimed to assess differences in patient management, and outcomes, of Australian and New Zealand patients admitted with a suspected or confirmed acute coronary syndrome (ACS).

Methods

We used comprehensive data from the binational Australia and New Zealand ACS ‘SNAPSHOT‘ audit, acquired on individual patients admitted between 00.00 h on 14 May 2012 to 24.00 h on 27 May 2012.

Results

There were 4387 patient admissions, 3381 (77%) in Australia and 1006 (23%) in New Zealand; Australian patients were slightly younger (67 vs 69 years, P = 0.0044). Of the 2356 patients with confirmed ACS, Australian patients were at a lower cardiovascular risk with a lower median Global Registry Acute Coronary Events score (147 vs 154 P = 0.0008), but as likely to receive an invasive coronary angiogram (58% vs 54%, P = 0.082), or revascularisation with percutaneous coronary intervention (32% vs 31%, P = 0.92) or coronary artery bypass graft surgery (7.0% vs 5.6%, P = 0.32). Of the 1937 non‐segment elevation myocardial infarction/unstable angina pectoris (NSTEMI/UAP) patients, Australian patients had a shorter time to angiography (46 h vs 67 h, P < 0.0001). However, at discharge, Australian NSTEMI/UAP survivors were less likely to receive aspirin (84% vs 89%, P = 0.0079, a second anti‐platelet agent (57% vs 63%, P = 0.050) or a beta blocker (67% vs 77%, P = 0.0002). In‐hospital death rates were not different (2.7% vs 3.2%, P = 0.55) between Australia and New Zealand.

Conclusions

Overall more similarities were seen, than differences, in the management of suspected or confirmed ACS patients between Australia and New Zealand. However, in several management areas, both countries could improve the service delivery to this high‐risk patient group.
Effect of Zirconium on the Structure and Congruent Crystallization of a Supercooled Calcium Aluminosilicate Melt
Authors: Strukelj Eozen , Comte Monique , Roskosz Mathieu , Richet Pascal
Published: March 2015

The influence of zirconium as a nucleating agent on the congruent crystallization and relevant physical properties of a supercooled calcium aluminosilicate melt of a composition close to CaAl2SiO6 has been investigated up to 6 mol% ZrO2. Zirconium marginally affects rheological and structural properties, decreasing the viscosity of the Zr‐free melt by no more than 0.25 log unit and, as observed by Raman spectroscopy, not changing significantly the polymerization state of the material. Whereas the Zr‐free melt crystallizes congruently and heterogeneously from the sample surface to yield yoshiokaite, a stuffed derivative of the nepheline structure, addition of zirconia promotes instead bulk crystallization of tetragonal ZrO2 and then of yoshiokaite. The latter process takes place in two stages: dissolved Zr first promotes homogeneous precipitation of zirconia before yoshiokaite crystallizes congruently from a Zr‐depleted volume of melt around zirconia precipitates. This process makes zirconium, and probably other poorly soluble oxides, valuable to control congruent crystallization in silicate glass‐ceramics. From the recorded thermograms, an enthalpy of crystallization of 40 and 46 kJ/mol has been determined at 1060 and 1140 K, respectively, for CaAl2SiO6 yoshiokaite, a very low value that is likely due to the extensive atomic disorder of crystals precipitating at high degrees of supercooling.
Long‐term history and synchrony of mountain pine beetle outbreaks in lodgepole pine forests
Authors: Jarvis Daniel S. , Kulakowski Dominik
Published: March 2015

Aim

A subcontinental‐scale outbreak of mountain pine beetle (MPB; Dendroctonus ponderosae) has affected millions of hectares of forest in the western USA and Canada over the past 15 years. Little research has examined the long‐term and broad‐scale history of MPB outbreaks, which is necessary to provide a baseline for comparing current and future outbreak extents. We examine the long‐term history of MPB outbreaks in western Colorado, and analyse the synchrony of previous outbreaks across western North America.

Location

Western Colorado for tree‐ring analysis; western North America for comparative analysis.

Methods

We used dendroecological methods to reconstruct the history of MPB outbreaks since the 1700s in lodgepole pine (Pinus contorta) forests in Colorado. We then combined these new records with previously published data on MPB outbreaks to examine the historical synchrony of outbreaks across western North America.

Results

The tree‐ring record indicated that multiple cross‐site MPB outbreaks occurred in Colorado lodgepole pine forests, initiating c. 1760s, 1780s, 1820s–1830s, 1860s, 1910s, 1960s and 1980s. Comparative analysis indicated that these outbreak dates coincide with documented and reconstructed MPB outbreaks in British Columbia, Colorado, Idaho, Montana, Wyoming and Utah.

Main conclusions

Several subcontinental‐scale MPB outbreaks have occurred in lodgepole pine forests over the past three centuries. Although the current study does not address the intensity of past outbreaks, it does indicate that previous outbreaks appear to have been highly synchronous across western North America. The subcontinental, rather than purely local, nature of these outbreaks is important for putting recent and future outbreaks of MPB into a broader ecological context. This study presents the longest tree‐ring reconstruction of MPB outbreaks in the southern Rocky Mountains available to date, as well as the first subcontinental long‐term comparative analysis of MPB outbreaks in western North America.
Clinical and anthropological perspectives on chemical relaxing of afro‐textured hair
Authors: Aryiku S.A. , Salam A. , Dadzie O.E. , Jablonski N.G.
Published: March 2015

The culturally engrained practice of ‘relaxing’ afro‐textured hair has been linked with hair and scalp disorders. Herein, we discuss the evolution of human hair types, focusing in particular on afro‐textured hair. We explore the biological features of this hair type, and discuss the different methods employed to straighten afro‐textured hair, focusing in particular on chemical straightening. We also examine clinical, anthropological, and psychological issues associated with this latter practice. Examples of common scalp pathologies associated with chronic hair relaxing, such as alopecia, hair breakage, caustic burns and irritant contact dermatitis, are also highlighted. The data presented herein should enable clinicians to engage in culturally appropriate discussions with their patients about issues of appearance and conformity.
Short‐ and long‐term efficacy and mechanism of action of tumescent suction curettage for axillary hyperhidrosis
Authors: Feldmeyer L. , Bogdan I. , Moser A. , Specker R. , Kamarashev J. , French L.E. , Läuchli S.
Published: March 2015

Background

Axillary hyperhidrosis is a common and distressing problem interfering with the life of affected individuals. Currently, local surgery is the treatment of choice once conservative treatment has failed.

Objectives

To evaluate the clinical efficacy and safety of tumescent suction curettage (TSC) in treating axillary hyperhidrosis and to correlate it with histological markers.

Methods

Thirty patients (17 females and 13 males, average age 29.9 years) underwent TSC. After tumescent anaesthesia, a suction cannula was inserted in the axilla on each side through two tiny incisions and subcutaneous tissue was removed by suction. We evaluated the clinical efficacy and complications, and in a subset of patients performed biopsies before surgery, as well as 1 month and 1 year after the operation.

Results

In comparison with preoperative values, the sweat rate was diminished by 85% after 1 month, 71% after 6 months, 77% after 12 months and 61% after 24 months. The reduced efficacy with time was histologically correlated with an increase in the innervation, whereas the number of sweat glands continued to diminish. The majority of patients were satisfied with the operation but the satisfaction diminished with time. Patients with the highest preoperative sweat rates were the most satisfied after the intervention.

Conclusion

TSC is an effective and safe treatment for axillary hyperhidrosis. The long‐term recurrence may be due to reinnervation.
Melatonin regulates the rhythmic migration of neutrophils in live zebrafish
Authors: Ren Da‐long , Li Ya‐juan , Hu Bing‐bing , Wang Han , Hu Bing
Published: March 2015

The circadian clock plays a vital role in physiology and behavior such as the sleep–wake cycle and blood pressure and hormone levels. Immune responses also display circadian rhythmicity and particularly pineal melatonin contributes to immunological processes. Little attention, however, is given to mechanisms underlying rhythmic neutrophil responses to the injury. Here, we used a transgenic Tg(lyz:EGFP) zebrafish tail fin transection model to investigate whether the recruitment of neutrophils toward the injured site is regulated by the circadian clock. We found that migrating neutrophils display robust rhythmicity, peaking at darkness. Melatonin positively regulates rhythmic neutrophil migration, as evidenced that treatment with melatonin at low dosage can significantly enhance neutrophil recruitment toward the injured site, which is attenuated by luzindole treatment and in pinealectomized fish. Furthermore, using a transgenic zebrafish eyeball model, we observed that melatonin enhances secretion of two cytokines, TNF‐α and IL‐8, both of which markedly enhance neutrophil migration. Taken together, these results highlight a positive role of melatonin in rhythmic neutrophil migration and help obtain a better understanding of circadian regulation in immunology.
Where we are with point‐of‐care testing
Authors: Johannessen A.
Published: March 2015

Viral hepatitis claims one million lives each year. Scaling up treatment for hepatitis B and C in resource‐limited settings is not possible without access to reliable diagnostic tools. This article gives an overview of current technologies and the pipeline for easy‐to‐use assays for serological and virological analyses, which can be performed at the site of patient care (‘point‐of‐care assays’). Furthermore, the utility of dried blood spots for hepatitis B and C viral load testing is discussed. In addition to simple and reliable diagnostics, there is a need for a sustainable funding scheme and generic production of antiviral drugs to reduce the burden of viral hepatitis worldwide.