bluuebunny/crossref_metadata_2025 huggingface dataset:
The Household Risk Perception instrument and the Self‐Efficacy in Environmental Risk Reduction instrument: psychometric testing using principal component analysis
Authors: Oneal Gail , Odom‐Maryon Tamara , Postma Julie , Hill Wade , Butterfield Patricia
Published: January 2013

Aim

To report the psychometric testing of the Household Risk Perception and Self‐Efficacy in Environmental Risk Reduction instruments using principal components analysis.

Background

There are limited instruments available to test household risk perception and self‐efficacy related to environmental health behaviours. The Household Risk Perception instrument was developed to measure personal perceptions of household environmental health risks. The Self‐Efficacy in Environmental Risk Reduction instrument was designed to measure caregivers' confidence in taking steps to reduce household risks.

Design

An exploratory analysis of previous data was undertaken.

Method

Baseline data from 235 caregivers enrolled in a randomized clinical trial testing a healthy housing intervention were collected between 2006–2009. Principal components analysis was used to determine principal components from measured responses to each instrument.

Results

Components were explored and compared to constructs used to design the original instruments. A five‐component structure showed the simplest solution and explained 65% of variance in the Household Risk Perception analysis. Cronbach's alpha values indicated satisfactory internal consistency for four of five identified components. Risk perception varied according to available sensory input of the specific risk. A four‐component structure explained 64% of the variance in the Self‐Efficacy in Environmental Risk Reduction analysis. Cronbach's alpha values were satisfactory. Items mapped to steps in an action‐oriented process vs. agent‐specific actions. Results from both analyses suggest that environmental tobacco smoke is perceived differently than other household risks.

Conclusion

Previously, both instruments relied on item reliability and content validity testing. This study provides a basis for further instrument revision and theoretical testing.
Mosaic of verbal abuse experienced by nurses in their everyday work
Authors: Jackson Debra , Hutchinson Marie , Luck Lauretta , Wilkes Lesley
Published: January 2013

Aims

To report observational data collected as part of a multi‐phased study examining violence in the health sector. The findings presented detail the nature of verbal abuse experienced by nurses during their everyday interactions with patient, their families, or companions.

Background

Nurses have unacceptably high levels of exposure to violence, which commonly includes verbal abuse. However, relatively little is known about the nature of verbal abuse against nurses.

Design

Observational design.

Methods

During 2010, 1150 hours of observation resulted in data on 220 patients displaying cues for physical violence and 210 qualitative observational notes. These observational notes constitute the data for this paper and reveal the nature of verbal abuse experienced by nurses in their everyday work.

Results

A mosaic of abuse was revealed through three major categories: a discourse of gendered verbal abuse that was largely: sexual; insults, ridicule, and unreasonable demands; and hostility, threats, and menacing language.

Conclusions

For the nurses observed in this study, everyday nursing practice occurred in a backdrop of verbal abuse and hostility, which had a strong theme of gendered and sexualized overtones. We recommend that interventions that target verbal abuse should address the gendered and sexualized nature of the abuse experienced by nurses.
Adapting to living with a mechanical aortic heart valve: a phenomenographic study
Authors: Oterhals Kjersti , Fridlund Bengt , Nordrehaug Jan Erik , Haaverstad Rune , Norekvål Tone M.
Published: January 2013

Aim

To describe how patients adapt to living with a mechanical aortic heart valve.

Background

Aortic valve replacement with a mechanical prosthesis is preferred for patients with life expectancy of more than 10 years as they are more durable than bioprosthetic valves. Mechanical valves have some disadvantages, such as higher risk of thrombosis and embolism, increased risk of bleeding related to lifelong oral anticoagulation treatment and noise from the valve.

Design

An explorative design with a phenomenographic approach was employed.

Methods

An explorative design with a phenomenographic approach was applied. Interviews were conducted over 4 months during 2010–2011 with 20 strategically sampled patients, aged 24–74 years having undergone aortic valve replacement with mechanical prosthesis during the last 10 years.

Findings

Patients adapted to living with a mechanical aortic heart valve in four ways: ‘The competent patient’ wanted to stay in control of his/her life. ‘The adjusted patient’ considered the implications of having a mechanical aortic valve as part of his/her daily life. ‘The unaware patient’ was not aware of warfarin–diet–medication interactions. ‘The worried patient’ was bothered with the oral anticoagulation and annoyed by the sound of the valve. Patients moved between the different ways of adapting.

Conclusions

The oral anticoagulation therapy was considered the most troublesome consequence, but also the sound of the valve was difficult to accept. Patient counselling and adequate follow‐up can make patients with mechanical aortic heart valves more confident and competent to manage their own health. We recommend that patients should participate in a rehabilitation programme following cardiac surgery.
Mortality and Clostridium difficile infection in an Australian setting
Authors: Mitchell Brett G. , Gardner Anne , Hiller Janet E.
Published: January 2013

Aim

To quantify the risk of death associated with Clostridium difficile infection, in an Australian tertiary hospital.

Background

Two reviews examining Clostridium difficile infection and mortality indicate that Clostridium difficile infection is associated with increased mortality in hospitalized patients. Studies investigating the mortality of Clostridium difficile infection in settings outside of Europe and North America are required, so that the epidemiology of Clostridium difficile infection in these regions can be understood and appropriate prevention strategies made.

Design

An observational non‐concurrent cohort study design was used.

Methods

Data from all persons who had (exposed) and a matched sample of persons who did not have Clostridium difficile infection, for the calendar years 2007–2010, were analysed. The risk of dying within 30, 60, 90 and 180 days was compared using the two groups. Kaplan–Meier survival analysis and conditional logistic regression models were applied to the data to examine time to death and mortality risk adjusted for comorbidities using the Charlson Comorbidity Index.

Results

One hundred and fifty‐eight cases of infection were identified. A statistically significant difference in all‐cause mortality was identified between exposed and non‐exposed groups at 60 and 180 days. In a conditional regression model, mortality in the exposed group was significantly higher at 180 days.

Conclusion

In this Australian study, Clostridium difficile infection was associated with increased mortality. In doing so, it highlights the need for nurses to immediately instigate contact precautions for persons suspected of having Clostridium difficile infection and to facilitate a timely faecal collection for testing. Our findings support ongoing surveillance of Clostridium difficile infection and associated prevention and control activities.
Practitioner Review: Current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents
Authors: Cortese Samuele , Holtmann Martin , Banaschewski Tobias , Buitelaar Jan , Coghill David , Danckaerts Marina , Dittmann Ralf W. , Graham John , Taylor Eric , Sergeant Joseph ,   on behalf of the European ADHD Guidelines Group
Published: January 2013

Background:  Medication is an important element of therapeutic strategies for ADHD. While medications for ADHD are generally well‐tolerated, there are common, although less severe, as well as rare but severe adverse events AEs during treatment with ADHD drugs. The aim of this review is to provide evidence‐ and expert‐based guidance concerning the management of (AEs) with medications for ADHD.

Methods:  For ease of use by practitioners and clinicians, the article is organized in a simple question and answer format regarding the prevalence and management of the most common AEs. Answers were based on empirical evidence from studies (preferably meta‐analyses or systematic reviews) retrieved in PubMed, Ovid, EMBASE and Web of Knowledge through 30 June 2012. When no empirical evidence was available, expert consensus of the members of the European ADHD Guidelines Group is provided. The evidence‐level of the management recommendations was based on the SIGN grading system.

Results:  The review covers monitoring and management strategies of loss of appetite and growth delay, cardiovascular risks, sleep disturbance, tics, substance misuse/abuse, seizures, suicidal thoughts/behaviours and psychotic symptoms.

Conclusion:  Most AEs during treatment with drugs for ADHD are manageable and most of the times it is not necessary to stop medication, so that patients with ADHD may continue to benefit from the effectiveness of pharmacological treatment.
Daylight‐mediated photodynamic therapy of basal cell carcinomas – an explorative study
Authors: Wiegell S.R. , Skødt V. , Wulf H.C.
Published: January 2013

Background

Studies have shown that daylight‐photodynamic therapy (PDT) is an effective treatment of actinic keratoses, nearly pain free and more convenient for both the clinics and patients. Treatment of basal cell carcinomas (BCCs) is another main indication for PDT.

Objectives

The aim of this open, uncontrolled, prospective explorative study was to evaluate the efficacy of daylight‐PDT for BCCs.

Methods

Twenty‐one patients with a total of 32 BCCs located in the face, scalp, chest, back and lower leg received one cycle of daylight‐methyl aminolevulinate (MAL)‐PDT, consisting of two treatments 1 week apart. After sunscreen application and lesion preparation, MAL was applied and patients exposed themselves to daylight for 2½ h. Daylight exposure was monitored with a wrist‐borne dosimeter.

Results

At 3‐month follow‐up, complete response was seen in 30 lesions (94%) and in 19 patients (90%). At 12‐month follow‐up, six lesions had recurred resulting in a total recurrence rate of 21% (6/29) as one lesion was lost to follow‐up. Twelve months after daylight‐PDT, 74% (23/31) of the treated lesions showed complete response. During each treatment, the mean effective light dose was 10.8 J/cm2 during an average of 152 min of daylight exposure. Treatment was pain free with good or excellent cosmesis.

Conclusions

In conclusion, daylight‐PDT proved to be as effective as conventional PDT in the treatment of BCCs in this explorative clinical study. Daylight‐PDT was pain free and more convenient for both clinicians and patients. The cosmetic outcome was good or excellent. Larger studies need to confirm the findings of this study.
Complete filaggrin deficiency in ichthyosis vulgaris is associated with only moderate changes in epidermal permeability barrier function profile
Authors: Perusquía‐Ortiz A.M. , Oji V. , Sauerland M.C. , Tarinski T. , Zaraeva I. , Seller N. , Metze D. , Aufenvenne K. , Hausser I. , Traupe H.
Published: January 2013

Background

Ichthyosis vulgaris (IV) is caused by loss‐of‐function mutations in the profilaggrin (FLG) gene. Filaggrin drives complex interrelated functions, with strategic roles in establishing structural and chemical barrier function, hydration of the skin and maintaining epidermal homeostasis. Data on the effect of FLG mutations on epidermal barrier function in IV are very scarce.

Objectives

A primary aim of this study was to determine in vivo characteristics of epidermal permeability barrier function such as transepidermal water loss (TEWL), skin hydration and skin surface pH in homozygous or compound heterozygous (FLG−/−) and heterozygous (FLG+/−) subjects with IV.

Methods

We evaluated a cohort of 15 patients with IV, analysed epidermal ultrastructure and investigated epidermal barrier function by measurement of TEWL, skin surface pH and skin hydration. Mutations were screened by restriction enzyme analysis and/or complete sequencing. Ten patients were homozygous or compound heterozygous (FLG−/−), while five patients were heterozygous (FLG+/−). Twenty healthy individuals served as controls.

Results

In FLG−/− subjects, a moderate increase of TEWL from 5.41 ± 0.32–7.54 ± 0.90 g/m2h (P < 0.03) and a moderate decrease of skin hydration from 29.20 ± 1.96 to 20.17 ± 3.60 (P < 0.05) in comparison with the control group were observed. Changes in skin surface pH were not significant. FLG+/− subjects did not suffer from significant changes in all variables.

Conclusions

A complete, but not a partial deficiency is associated with moderate changes in TEWL and skin hydration, revealing surprisingly only a mild disturbance of the epidermal permeability barrier function.
Functional significance of Micraspis discolor (F.) (Coccinellidae: Coleoptera) in rice ecosystem
Authors: Shanker C. , Mohan M. , Sampathkumar M. , Lydia Ch. , Katti G.
Published: January 2013

Coccinellids are key predators that are conserved and augmented in agricultural ecosystems, to achieve biological control of pests. Actual quantification of field predation has not been attempted for many of the beneficial coccinellids. Numerous reports show coccinellids as opportunistic, feeding on a variety of food material in addition to their preferred prey. Micraspis discolor is the most abundant species of coccinellid in rice ecosystems and touted as a biocontrol option for brown planthopper (BPH), Nilaparvata lugens (Stal), a key pest of rice. However, it has been reported as both entomophagous and phytophagous. Native polyacrylamide gel electrophoresis (PAGE) was used to separate esterases from whole‐body homogenates of Micraspis and its prey viz., green leafhopper (GLH) Nephotettix virescens (Distant), BPH N. lugens, whitebacked planthopper (WBPH) Sogatella furcifera (Horvath), aphid Rhopalosiphum padi L., thrips, Haplothrips sp., and pollen. Field‐collected beetles showed a range of bands, some corresponding with pollen and GLH, while others were different from prey offered, indicating a wider range of prey spectrum than envisaged. Feeding preference studies confirmed a preference for pollen and GLH in no‐choice (H = 20.724; P = 0.001) and multiple‐choice tests (H = 20.52; P < 0.001) and a significant preference for pollen over all insects offered in the paired‐choice test (t = 5.099; P = 0.007). The abundance of adult M. discolor in rice at flowering phase does not correspond to prey abundance in the field but rather reflects an inclination to pollen feeding more than entomophagy.
Tissue distribution of infectious pancreatic necrosis virus serotype Sp in naturally infected cultured rainbow trout, Oncorhynchus mykiss (Walbaum): an immunohistochemical and nested‐PCR study
Authors: Ahmadi N , Oryan A , Akhlaghi M , Hosseini A
Published: January 2013

This study investigates the occurrence and distribution pattern of infectious pancreatic necrosis virus (IPNV) within the pancreas, liver, kidney and spleen of naturally infected cultured rainbow trout, Oncorhynchus mykiss (Walbaum), using immunohistochemistry (IHC). A nested PCR was also employed to confirm the presence of the virus in the pooled tissues of the specimens. All the examined tissues except spleen were immunohistochemically positive for IPNV, but staining intensity and distribution pattern varied. The kidney tubules had the most intense and widespread staining by IHC, indicating a specific tissue tropism at least for this particular serotype. The nucleotide sequence had the greatest identity with the Sp serotype confirming the presence of the nucleic acid of IPNV in the pooled tissues. Based on the present findings, it could be concluded that the absence of lesions consistent with infectious pancreatic necrosis (IPN) disease in the H&E‐stained sections cannot rule out the presence of the IPNV, and the use of an alternative rapid confirmatory method such as IHC with formalin‐fixed, paraffin‐embedded tissue sections is helpful for the final diagnosis of IPN in rainbow trout.
Current and Emerging Technology Approaches in Genomics
Authors: Conley Yvette P. , Biesecker Leslie G. , Gonsalves Stephen , Merkle Carrie J. , Kirk Maggie , Aouizerat Bradley E.
Published: January 2013

Purpose: To introduce current and emerging approaches that are being utilized in the field of genomics so the reader can conceptually evaluate the literature and appreciate how these approaches are advancing our understanding of health‐related issues.

Organizing Construct: Each approach is described and includes information related to how it is advancing research, its potential clinical utility, exemplars of current uses, challenges related to technologies used for these approaches, and when appropriate information related to understanding the evidence base for clinical utilization of each approach is provided. Web‐based resources are included for the reader who would like more in‐depth information and to provide opportunity to stay up to date with these approaches and their utility.

Conclusions: The chosen approaches—genome sequencing, genome‐wide association studies, epigenomics, and gene expression—are extremely valuable approaches for collecting research data to help us better understand the pathophysiology of a variety of health‐related conditions, but they are also gaining in utility for clinical assessment and testing purposes.

Clinical Relevance: Our increased understanding of the molecular underpinnings of disease will assist with better development of screening tests, diagnostic tests, tests that allow us to prognosticate, tests that allow for individualized treatments, and tests to facilitate post‐treatment surveillance.
An Update of Childhood Genetic Disorders
Authors: Prows Cynthia A. , Hopkin Robert J. , Barnoy Sivia , Van Riper Marcia
Published: January 2013

Purpose: Thousands of single gene, mitochondrial, and chromosomal disorders have been described in children. The purpose of this article is twofold. The first is to increase nurses’ awareness of new developments in genetic disorders that are commonly seen in practice and taught in schools of nursing. The second is to illustrate important genetic concepts of relevance to nurses who care for infants, children, or adolescents.

Organizing Construct: This article is organized into four sections: one that describes new developments in a well‐known disorder, a second that discusses the process and potential outcomes of diagnosing a very rare disorder, and the third and fourth sections that describe select conditions caused by single gene mutations.

Methods: Clinical expertise was paired with literature review to present evidence‐based current information. Implications for nursing practice are highlighted throughout the article. Citations of publicly available evidence‐based online resources are used so nurses can continue to use these in their practices.

Findings: Diagnosis and treatment strategies for children with genetic disorders are rapidly changing. While it is impossible to stay current in all disorders, resources are available to help nurses provide evidence‐based care to children with genetic disorders.

Clinical Relevance: Nurses have an important role in the early identification of children with genetic disorders and in facilitating their access to appropriate services and resources. Nurses can also help families understand why genetic testing may be necessary and assure families are informed throughout the process.
Health promotion in mental health care: perceptions from patients and mental health nurses
Authors: Verhaeghe Nick , De Maeseneer Jan , Maes Lea , Van Heeringen Cornelis , Annemans Lieven
Published: January 2013

Aims and objectives

To gain insight into the factors influencing the integration of physical activity and healthy eating into the daily care of individuals with mental disorders (MD) living in sheltered housing and to increase the understanding of the relationships between and complexities of these factors.

Background

Growing attention is given to the implementation of health promotion activities in mental health care. By improving the understanding of perceptions of patients and mental health nurses, health promotion programmes targeting physical activity and healthy eating can be developed that better meet the patients' needs.

Design

A descriptive qualitative study.

Methods

Based on a purposive sampling strategy, three focus groups including 17 mental health nurses and individual interviews with 15 patients were conducted.

Results

Although physical and mental health benefits of physical activity and healthy eating were identified, several barriers to integrate healthy lifestyles into the daily life of patients were reported. Important barriers identified by the patients consisted of lack of energy and motivation as a result of the MD, side effects of psychotropic drug use, and hospitalisation. Lack of time and personal views and attitudes towards health promotion were reported by the mental health nurses as important elements influencing the way in which they integrate health promotion in the care provided. Support from the mental health nurse was considered important by the patients in changing their unhealthy lifestyle behaviour.

Conclusions

The results of the study provide insight into important factors influencing the integration of health promotion activities targeting physical activity and healthy eating in individuals with MD living in sheltered housing.

Relevance to clinical practice

The information derived from this study is useful and relevant in the design and implementation of health promotion interventions targeting physical activity and healthy eating in people with MD living in sheltered housing.
Leak around endotracheal tubes in ventilated newborns: An observational study
Authors: Brinsmead Tammy Lee , Inglis Garry Donald Trevor , Ware Robert S
Published: January 2013

Aim

The study aims to determine the incidence and magnitude of leak around endotracheal tubes (ETTs) in ventilated babies in our unit, and to identify any relationship between weight, gestation, head position or ETT tip position, and the amount of leak.

Methods

Ventilated infants in the neonatal unit of the Royal Brisbane and Women's Hospital were observed. Data were collected on ETT size, ventilator settings, body position, head position and amount of leak. Also recorded were weight, post‐menstrual age and radiological position of the ETT tip.

Results

Two hundred ninety‐six sets of data were collected from 60 infants. At the time of recruitment, infants had a median (interquartile range) post‐menstrual age of 32+3 (28+4–36+3) years. Minimal leak (defined as <10% measured leak) and a small leak (10–25% leak) were observed on 162 occasions (55%) and 77 occasions (26%), respectively. A large leak of more than 25% was observed on 57 (19%) occasions. The odds of having a large leak with the head turned to the right, or midline, was greater than with the head turned to the left (odds ratio = 2.0; 95% confidence interval: 1.0 to 4.1 and 6.8; 1.4 to 31.5, respectively). Infants lying prone were more likely than those lying supine to have a leak >25% (odds ratio = 2.1; 95% confidence interval: 1.1 to 3.8). There was no association between leak and distance from carina, or weight.

Conclusions

Few babies in our unit had a large leak around the ETT, and many had minimal leak. A leak was less likely when a baby's head was turned to the left. Further study is required to clarify the reasons for this. Weight and post‐menstrual age were not associated with the extent of leak.
Market Games in Successive Oligopolies
Authors: GABSZEWICZ JEAN , LAUSSEL DIDIER , VAN YPERSELE TANGUY , ZANAJ SKERDILAJDA
Published: January 2013

This paper introduces a new approach to successive oligopolies. We draw on market games à la Shapley–Shubik to examine how successive oligopolies operate between downstream and upstream markets when the input price is determined by the action of all firms, downstream and upstream both. This approach differs from the classical one as it allows us to consider downstream firms that exercise market power both in both downstream and upstream markets. We perform a comparison of the market outcome with each scenarios as well as a welfare analysis.
The Role of Income Effects in Early Retirement
Authors: CONDE‐RUIZ JOSÉ IGNACIO , GALASSO VINCENZO , PROFETA PAOLA
Published: January 2013

We provide a long‐term perspective on the individual retirement behavior and on the future of retirement by emphasizing the role of (negative) income effects. We consider a political economic theoretical framework, with actuarially “fair” and “unfair” early retirement schemes, and derive a political equilibrium with positive social security contribution rates and early retirement. A reduction in the wages in youth, consistent with the recent labor market trends since the massive introduction of temporary jobs, induces workers to postpone retirement, and—in the “unfair” system—leads to lower contribution rates. A reduction in the growth rate of the economy has opposite effects on the retirement decisions, leading—in the “unfair” system—to more early retirement. Aging induces a negative income effect, but has also an opposite political effect on social security contributions and retirement decisions. For an actuarially “fair” social security system, we provide conditions for the political effect to dominate; in an “unfair” scheme, numerical simulations confirm a slight predominance of the political effect, as contribution rates increase. These results may shed some light on the future of early retirement in aging societies.
A Simple Supermodular Mechanism that Implements Lindahl Allocations
Authors: VAN ESSEN MATTHEW J.
Published: January 2013

This paper introduces a new incentive‐compatible mechanism which, for general preference environments, implements Lindahl allocations as Nash equilibria. We provide an example that having a mechanism induce a supermodular game is not typically sufficient to guarantee dynamic stability of equilibrium. However, for the new mechanism, inducing a supermodular game guarantees that the best reply mapping is a contraction. Thus, this new mechanism provides a connection between the desirable welfare properties of Lindahl allocations and the theoretical/convergence properties of games whose best reply mappings are a contraction.
Fusarium Species Isolated from Common Weeds in Eggplant Fields and Symptomless Hosts of Fusarium oxysporum f. sp. melongenae in Turkey
Authors: Altinok Hacer Handan
Published: January 2013

Thirteen species of weed plants were collected between May and September in 2010 and 2011 from eggplant fields representing 11 distinct locations covering a wide geographical area of Turkey. Weeds are potential hosts of many plant pathogens and may not exhibit disease symptoms when colonized. Fusarium spp. were isolated from five monocotyledonous species and eight dicotyledonous species. A total of 212 isolates recovered from weeds were assigned to eight Fusarium species on the basis of morphological characteristics. F. oxysporum was the most frequently isolated species (29.7%), followed by F. solani (19.8%), F. graminearum (13.7%), F. verticillioides (12.7%), F.equiseti (9.9%), F. avenacearum (8.0%), F. proliferatum (3.8%) and F. subglutinans (2.4%). The F. oxysporum isolates from different weed hosts were characterized by means of pathogenicity and vegetative compatibility grouping (VCG) tests. Among these, 29 isolates were found to be pathogenic to eggplant cv. Kemer and re‐isolated as Fusarium oxysporum Schlecht. f. sp. melongenae (Fomg) as evidenced. These isolates from weed hosts were assigned to VCG 0320. This study is the first report of Fomg isolated from weeds in eggplant fields in Turkey. None of the weed species tested showed symptoms of wilting in pot experiments, and F. oxysporum was isolated with greater frequency from all inoculated weeds. The results of this study indicate that several weed plants may serve as alternative sources of inoculum for Fomg, during the growing season.
A brief 20‐item dental/medical health literacy screen (REALMD‐20)
Authors: Gironda Melanie , Der‐Martirosian Claudia , Messadi Diana , Holtzman Jennifer , Atchison Kathryn
Published: January 2013

Objectives

Few health literacy instruments are available to clinicians to help understand the implications of patient difficulty understanding health information. Those that do exist are lengthy and would not be conducive to use in a busy clinical setting. Long‐term dental and medical outcomes may improve if health care providers can identify individuals with low health literacy levels who may benefit from tailored communication, yet few instruments are available for clinical use. The purpose of this study is to introduce a brief 20‐item screener for limited dental/medical health literacy among adult dental patients.

Methods

Two‐hundred adult patients seeking treatment at a dental clinic in a large medical complex completed a health literacy screening instrument and survey. Steps in the development of the 20‐item instrument are described. Comparison of the 20‐item dental/medical instrument with other health literacy measures are calculated using mean health literacy scores, tests of reliability and readability, and correlation coefficients.

Results

Scores on the brief 20‐item measure varied significantly by race, education level, language use, needing help with medical/health materials forms. Those with lower dental/medical health literacy, as measured by the REALMD‐20 were less likely to receive regular follow‐up care than those with higher literacy.

Conclusions

The REALMD‐20 is a quick screening instrument that can be used by clinicians to detect limited dental/medical health literacy among adult patients seeking treatment in dental/medical clinic settings.
Shortages of systemic antibiotics in the USA: how long can we wait?
Authors: Balkhi Bander , Araujo-Lama Lita , Seoane-Vazquez Enrique , Rodriguez-Monguio Rosa , Szeinbach Sheryl L , Fox Erin R
Published: January 2013

Objectives

Drug shortages have risen steadily in the USA. Systemic antibiotics are most frequently in short supply raising concerns about public health safety and patient care. We sought to assess the prevalence and characteristics of systemic antibiotics in short supply as reported by federal agencies and private healthcare providers in the USA on 1 June 2011.

Methods

Data derived from the US Food and Drug Administration, American Society of Health-System Pharmacists and the Brigham and Women's Hospital. The units of analysis were active ingredient(s) and route of administration.

Key findings

Overall, 18 antibiotic active ingredients, with 20 routes of administration, were in short supply on 1 June 2011. The prevalence varied from 5.7% reported by the Food and Drug Administration and Brigham and Women's Hospital to 28.3% reported by the American Society of Health-System Pharmacists. Injectable antibiotics had the highest (28.3%) level of shortage. Shortages occurred because of problems with manufacturing (35.0%) and raw materials (15%.0), and for unknown reasons (45.0%). The average duration of the shortages was 591.7 ± 304.9 days.

Conclusions

Over one-fifth of the systemic antibiotics (one-quarter of the injectables) marketed in the USA were reported to be in short supply on 1 June 2011. One-half of the shortages were attributed to problems with manufacturing and raw materials although reasons for shortages are often unknown.
Changes in use of antidiabetic medications following price regulations in China (1999–2009)
Authors: Lu Christine Y , Ross-Degnan Dennis , Stephens Peter , Liu Bao , Wagner Anita K
Published: January 2013

Background and Objectives

Pharmaceutical expenditures are a major burden in China, partly because of pharmaceutical sales covering hospital operating costs, so a series of reductions in maximum retail prices of specific products, including antidiabetic medications, have been implemented. This is the first large-scale, longitudinal study evaluating effects of two rounds of price regulations on use of antidiabetic medications.

Methods

We used quarterly purchasing data collected by IMS Health from more than 1000 hospitals in China (1999–2009). We used interrupted time-series analysis to assess changes in the population-adjusted market volume of insulin and oral hypoglycaemic products and in the percentage market share of price-regulated products following price regulations implemented in December 2001 and December 2006.

Results

After the 2001 price regulation, there was a significant increase in market volume trend of insulin products (0.06 standard units/1000 population/quarter; 95% confidence interval: 0.04–0.08); utilisation of oral hypoglycaemic products remained stable. After the 2006 price regulation, there were significant increases in the market volume trend of both insulin products (0.18 standard units/1000 population/quarter; 0.12–0.23) and oral hypoglycaemic products (10.31 standard units/1000 population/quarter; 5.65–14.98). Market share of price-regulated insulin and oral hypoglycaemic products did not change significantly after either price regulation.

Conclusion

Our results indicate that lowering the retail prices of specific products was associated with increases in total per capita utilisation of antidiabetic medications without shifts in use between non- and price-regulated products. Broad volume increases suggest access to antidiabetic medications by additional people, increased use by those with prior access, or both.
Manipulation of ruminal fermentation and methane production by supplementation of rain tree pod meal containing tannins and saponins in growing dairy steers
Authors: Anantasook N. , Wanapat M. , Cherdthong A.
Published: January 2013

Four rumen‐fistulated dairy steers were used in a 2 × 2 factorial arrangement in a 4 × 4 Latin square design. The main factors were two roughage‐to‐concentrate ratios (R:C, 60:40 and 40:60) and two supplementation levels of rain tree pod meal (RPM) [0 or unsupplemented and 60 g/kg of total dry matter (DM) intake]. Chopped 30 g/kg of urea‐treated rice straw was used as a roughage source. All animals received dietary according to respective R:C ratios at 25 g/kg body weight. The RPM contained condensed tannins and crude saponins at 84 and 143 g/kg of DM respectively. It was found that total volatile fatty acids (VFAs) and propionate concentrations were increased (p < 0.01), while acetate concentration, acetate‐to‐propionate ratio, CH4 production and protozoal numbers were decreased (p < 0.01) when steers were supplemented with RPM and 600 g/kg of concentrate. Allantoin excretion was found different by both R:C ratio and supplementation of RPM, with the highest value at R:C of 40:60 with 60 g/kg RPM (123.6 mmol/day) (p < 0.05). Allantoin absorption and microbial crude protein were increased (p < 0.05) with an increasing concentrate ratio. Moreover, efficiency of microbial protein synthesis was increased (p < 0.05) by feeding a higher ratio of concentrate (R:C 40:60) and supplementation of RPM. Based on this study, it is suggested that supplementation of RPM was beneficial for dairy cows fed on high roughage ratio, which could improved rumen fermentation by reducing fermentation gas loss, thus improving VFA profiles and thus enhancing efficiency of microbial protein synthesis.
High‐altitude hypoxia and periodic breathing during sleep: gender‐related differences
Authors: Lombardi Carolina , Meriggi Paolo , Agostoni Piergiuseppe , Faini Andrea , Bilo Grzegorz , Revera Miriam , Caldara Gianluca , Di Rienzo Marco , Castiglioni Paolo , Maurizio Bussotti , Gregorini Francesca , Mancia Giuseppe , Parati Gianfranco ,   The Highcare Investigators
Published: January 2013

High‐altitude exposure is characterized by the appearance of periodic breathing during sleep. Only limited evidence is available, however, on the presence of gender‐related differences in this breathing pattern. In 37 healthy subjects, 23 male and 14 female, we performed nocturnal cardio‐respiratory monitoring in the following conditions: (1) sea level; (2) first/second night at an altitude of 3400 m; (3) first/second night at an altitude of 5400 m and after a 10 day sojourn at 5400 m. At sea level, a normal breathing pattern was observed in all subjects throughout the night. At 3400 m the apnea–hypopnea index was 40.3 ± 33.0 in males (central apneas 77.6%, central hypopneas 22.4%) and 2.4 ± 2.8 in females (central apneas 58.2%, central hypopneas 41.8%; P < 0.01). During the first recording at 5400 m, the apnea–hypopnea index was 87.5 ± 35.7 in males (central apneas 60.0%, central hypopneas 40.0%) and 41.1 ± 44.0 in females (central apneas 73.2%, central hypopneas 26.8%; P < 0.01), again with a higher frequency of central events in males as seen at lower altitude. Similar results were observed after 10 days. With increasing altitude, there was also a progressive reduction in respiratory cycle length during central apneas in males (26.9 ± 3.4 s at 3400 m and 22.6 ± 3.7 s at 5400 m). Females, who displayed a significant number of central apneas only at the highest reached altitude, were characterized by longer cycle length than males at similar altitude (30.1 ± 5.8 s at 5400 m). In conclusion, at high altitude, nocturnal periodic breathing affects males more than females. Females started to present a significant number of central sleep apneas only at the highest reached altitude. After 10 days at 5400 m gender differences in the apnea–hypopnea index similar to those observed after acute exposure were still observed, accompanied by differences in respiratory cycle length.
Sustained virologic response after therapy with the HCV protease inhibitor narlaprevir in combination with peginterferon and ribavirin is durable through long‐term follow‐up
Authors: Hotho D. M. , de Bruijne J. , Spaan M. , Treitel M. A. , Boonstra A. , de Knegt R. J. , Janssen H. L. A. , Reesink H. W.
Published: January 2013

Achievement of a sustained virologic response (SVR) after peginterferon (PEG‐IFN) and ribavirin (RBV) treatment is considered to be a marker for the cure of chronic hepatitis C virus (HCV) infection. Long‐term follow‐up of patients with SVR after treatment with a direct acting antiviral has not yet been described. We used a randomized placebo‐controlled, double‐blind, two‐period phase 1b trial that was conducted in 40 HCV genotype 1 (treatment‐naïve and treatment‐experienced)‐infected patients. Nineteen patients achieved SVR after treatment with the HCV protease inhibitor narlaprevir followed by PEG‐IFN/RBV. In these patients, HCV‐RNA tests were scheduled at 3, 6, 12 and 24 months after end of treatment. Patients were followed for a median of 27 months (range 15–32) after end of treatment with a median number of follow‐up visits of 4 (range 3–8). All patients remained HCV‐RNA negative over time. SVR achieved following narlaprevir and PEG‐IFN/RBV‐therapy was durable up to 32 months after the end of treatment.
Coupling ordination techniques and GAM to spatially predict vegetation assemblages along a climatic gradient in an ENSO‐affected region of extremely high climate variability
Authors: Muenchow Jannes , Feilhauer Hannes , Bräuning Achim , Rodríguez Eric F. , Bayer Fabian , Rodríguez Rodolfo A. , von Wehrden Henrik
Published: January 2013

Questions

El Niño Southern Oscillation (ENSO) is a strong driver of climatic and ecosystem variability in coastal NW Peru. La Niña amplifies the already dry local conditions, and led to depleted ecosystems in 2011. However, the 2012 La Niña event triggered rainfall far above the average. (1) Did plant species diversity, primary productivity and vegetation assemblages change along a climatic gradient between two climatologically different La Niña years; (2) Is there a difference in explanatory power of environmental predictors between the 2 yr; and (iii) is it possible to predict the observed vegetation patterns spatially?

Location

Transect along a climatic gradient in the Sechura Desert of Piura, NW Peru (corresponds to the terrestrial part of the El Niño region 1 + 2) – a region of extremely high climatic variability.

Methods

We visited 50 30 m × 30 m randomly sampled plots in 2011 and 2012. A Procrustes analysis of two non‐metric multidimensional scaling (NMDS) ordinations provided information on the temporal change of species assemblages. Variation partitioning revealed the differences in explanatory power of the predictors. We employed a generalized additive model (GAM) to fit the scores of the first ordination axis with a floristic gradient map as a result.

Results

Generally, higher rainfall resulted in a positive feedback when considering biodiversity, productivity and vegetation assemblages. The floristic gradient map resulting from the GAM displayed the spatial distribution of the three main assemblages along the climatic gradient. Edaphic variables added no independent portion to the explanation of the vegetation assemblages, but explained in conjunction with topography and NDVI a considerable amount of the variance.

Conclusions

Strong Atlantic easterly winds crossing the Andes can boost plant growth even during a La Niña situation. This underscores the need for a deeper understanding of ENSO‐related climate variability of ENSO. Combining vegetation maps with accurate predictions of such climatic anomalies would aid the effective execution of conservation and recovery strategies. Additionally, coupling an unconstrained ordination with a GAM appears to be a promising tool for vegetation mapping, especially in the presence of a non‐linear gradient.
Coexistence between the southern river otter and the alien invasive North American mink in marine habitats of southern Chile
Authors: Medina‐Vogel G. , Barros M. , Organ J. F. , Bonesi L.
Published: January 2013

The interaction between native and introduced predators can be an important determinant of the success of introduced species and of the magnitude of their effects. In Europe, it has been shown that the American mink Neovison vison can be affected by native competitors; however, such evidence has not been found in South America. We studied the southern river otter Lontra provocax and the American mink at five marine sites, where they coexisted, and at one freshwater site, where only mink were present, in southern Chile. We used the signs of both species to study their habitat use and diet, and radio tracking to study their activity patterns. The results indicated that otters and minks tended to use different habitats in marine environments, the otter favouring littoral areas that are rocky and steep while the mink favours areas of gravel with a gently sloping intertidal zone. These differences were also reflected in their diets. At one of the coastal sites where the diet of the two species was similar, the activity pattern of minks was mostly diurnal, which is unusual. While differential habitat use may be the way through which the American mink is able to coexist with the southern river otter in coastal habitats of southern Chile, it is possible that otters are having an effect on individual minks by affecting their activity patterns, although more observations are needed to confirm this hypothesis.
Clinal variation in colony breeding structure and level of inbreeding in the subterranean termitesReticulitermes flavipesandR. grassei
Authors: Vargo Edward L. , Leniaud Laurianne , Swoboda Lois E. , Diamond Sarah E. , Weiser Michael D. , Miller Dini M. , Bagnères Anne‐Geneviève
Published: January 2013

Social insects exhibit remarkable variation in their colony breeding structures, both within and among species. Ecological factors are believed to be important in shaping reproductive traits of social insect colonies, yet there is little information linking specific environmental variables with differences in breeding structure. Subterranean termites (Rhinotermitidae) show exceptional variation in colony breeding structure, differing in the number of reproductives and degree of inbreeding; colonies can be simple families headed by a single pair of monogamous reproductives (king and queen) or they can be extended families headed by multiple inbreeding neotenic reproductives (wingless individuals). Using microsatellite markers, we characterized colony breeding structure and levels of inbreeding in populations over large parts of the range of the subterranean termitesReticulitermes flavipesin theUSAandR. grasseiin Europe. Combining these new data with previous results on populations of both species, we found that latitude had a strong effect on the proportion of extended‐family colonies inR. flavipesand on levels of inbreeding in both species. We examined the effect of several environmental variables that vary latitudinally; while the degree of inbreeding was greatest in cool, moist habitats in both species, seasonality affected the species differently. Inbreeding inR. flavipeswas most strongly associated with climatic variables (mean annual temperature and seasonality), whereas nonclimatic variables, including the availability of wood substrate and soil composition, were important predictors of inbreeding inR. grassei. These results are the first showing that termite breeding structure is shaped by local environmental factors and that species can vary in their responses to these factors.
Molecular patterns of introgression in a classic hybrid zone between theAustralian tree frogs,Litoria ewingiiandL. paraewingi: evidence of a tension zone
Authors: Smith Katie L. , Hale Joshua M. , Kearney Michael R. , Austin Jeremy J. , Melville Jane
Published: January 2013

Hybrid zones provide a rare opportunity to explore the processes involved in reproductive isolation and speciation. The southern hybrid zone between the southeastern Australian tree frogsLitoria ewingiiandL. paraewingihas been comprehensively studied over the last 40 years, primarily using reproductive compatibility experiments and male advertisement calls. We used mitochondrialDNA(mtDNA) and eight nuclear microsatellite markers to characterize this hybrid zone along a historically studied transect and to test various dispersal‐dependent and dispersal‐independent hybrid zone models. The species are genetically distinct and the level of hybridization within the contact zone is low, with the majority of admixed individuals representing later‐generation hybrids. Based on previous experimental genetic compatibility studies, we predicted that hybrids withL. paraewingimtDNAwould be more frequent than hybrids withL. ewingiimtDNA. Surprisingly, a greater proportion of the identified hybrids hadL. ewingiimtDNA. Geographical cline analyses showed a sharp transition in allele frequencies across the transect, and both the mtDNAand microsatellite data showed concordant cline centres, but were best supported by a model that allowed width to vary. Overall, theL. ewingii–L. paraewingihybrid zone is best characterized as a tension zone, due to the narrow cline width, concordant genetic clines and low levels of hybridization.