bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the Wells and Revised Geneva Scores for the diagnosis of pulmonary embolism: an Australian experience
Authors: Wong D. D. , Ramaseshan G. , Mendelson R. M.
Published: February 2010

Background/Aims: Clinical prediction rules form an integral component of guidelines on the diagnostic approach to pulmonary embolism (PE). The Wells Score is commonly used but is subjective, while the newer Revised Geneva Score is based entirely on objective variables. The aim of this study was to compare the diagnostic accuracy of the Wells and Revised Geneva Scores for the diagnosis of PE.

Methods: Patients presenting to the emergency department with clinically suspected PE and referred for CT pulmonary angiogram or ventilation/perfusion scintigraphy were evaluated. The Wells and Revised Geneva Scores were calculated on the same cohort of patients and dichotomized into low and intermediate/high probability groups. The sensitivities and specificities were compared using McNemar's test. Overall accuracy was determined using receiver operator characteristic curve analysis.

Results: A total of 98 consecutive patients was included. The overall prevalence of PE was 15.3%. The frequency of PE in the low, intermediate and high probability groups was similar for both clinical prediction rules. Compared with the Revised Geneva Score, the Wells Score showed a lower sensitivity with borderline significance (46.7% vs 80.0%, P= 0.06) and a significantly higher specificity (67.5% vs 47.0%, P= 0.002). The overall accuracy of both rules was similar (P= 0.617).

Conclusion: Using the accepted guidelines in which a high pretest probability leads to further imaging and a low probability leads to a D‐dimer blood test, use of the more specific Wells Score could safely reduce the number of unnecessary scans. This would need to be confirmed with larger, prospective trials.
Medication compliance in ischaemic stroke patients
Authors: Johnson C. , Lane H. , Barber P. A. , Charleston A.
Published: February 2010

Aim: This study aimed to assess the degree of patient compliance with medications prescribed at hospital discharge following ischaemic stroke, and concordance between self‐reported medication use and general practitioner (GP) records.

Methods: The Auckland City Hospital Stroke database was used to identify consecutive patients with ischaemic stroke over a three‐month period. Participants were contacted and invited to participate in a telephone questionnaire that asked about current medications. GPs were also asked to list the medications their patients were taking.

Results: Fifty‐one patients were approached to participate of whom 48 consented to be interviewed at 6 weeks and 47 at 6 months. At 6 weeks, 36 of 38 (95%) were compliant with aspirin, 12 of 13 (92%) dipyridamole, 8 of 9 (88%) warfarin, 36 of 41 (88%) statins, 33 of 38 (87%) antihypertensive medications, and 7 of 7 (100%) diabetes medications. At 6 months, 97% were compliant with aspirin, 100% dipyridamole, 100% warfarin, 94% statins, 91% antihypertensive medications, and 100% diabetes medications. Natural or herbal remedy use was reported by 10 of 48 (21%) at 6 weeks and 11 of 47 (23%) at 6 months. Blister packs were used by 8 of 48 (17%) at 6 weeks and 5 of 47 (11%) at 6 months.

Conclusion: Adherence to secondary stroke prevention medication was between 87% and 100% at 6 weeks with similar findings at 6 months after discharge. We speculate that these high compliance rates may be due to one‐on‐one stroke nurse counselling and the use of stroke information packs, which include information about the importance of adherence to secondary prevention medication.
Assessing PaCO2 in acute respiratory disease: accuracy of a transcutaneous carbon dioxide device
Authors: Perrin K. , Wijesinghe M. , Weatherall M. , Beasley R.
Published: February 2010

Background: Pulse oximetry non‐invasively assesses the arterial oxygen saturation of patients with acute respiratory disease; however, measurement of the arterial partial pressure of carbon dioxide (PaCO2) requires an arterial blood gas. The transcutaneous partial pressure of carbon dioxide (PtCO2) has been used in other settings with variable accuracy. We investigated the accuracy of a PtCO2 device in the assessment of PaCO2 in patients with asthma and suspected pneumonia attending the emergency department.

Methods: Patients with severe asthma (FEV1 < 50% predicted) or suspected pneumonia (fever, cough and respiratory rate >18/min) were enrolled. Subjects were excluded if they had a history of chronic obstructive pulmonary disease or other conditions associated with respiratory failure. Arterial blood gases were taken at the discretion of the investigator according to clinical need, and paired with a simultaneous reading from the PtCO2 probe.

Results: Twenty‐five patients were studied with one set of data excluded because of poor PtCO2 signal quality. The remaining 24 paired samples comprised 12 asthma and 12 pneumonia patients. The range of PaCO2 was 19–64 mmHg with a median of 36.5 mmHg. Bland–Altman analysis showed a mean (SD) PaCO2– PtCO2 difference of −0.13 (1.9) mmHg with limits of agreement of plus or minus 3.8 mmHg (−3.9 to +3.7).

Conclusion: A PtCO2 device was accurate in the assessment of PaCO2 in patients with acute severe asthma and suspected pneumonia when compared with an arterial blood gas. These bedside monitors have the potential to improve patient care by non‐invasively monitoring patients with acute respiratory disease at risk of hypercapnia.
Temperature controls on aquatic bacterial production and community dynamics in arctic lakes and streams
Authors: Adams Heather E. , Crump Byron C. , Kling George W.
Published: February 2010

The impact of temperature on bacterial activity and community composition was investigated in arctic lakes and streams in northern Alaska. Aquatic bacterial communities incubated at different temperatures had different rates of production, as measured by 14C‐leucine uptake, indicating that populations within the communities had different temperature optima. Samples from Toolik Lake inlet and outlet were collected at water temperatures of 14.2°C and 15.9°C, respectively, and subsamples incubated at temperatures ranging from 6°C to 20°C. After 5 days, productivity rates varied from 0.5 to ∼13.7 µg C l−1 day−1 and two distinct activity optima appeared at 12°C and 20°C. At these optima, activity was 2‐ to 11‐fold higher than at other incubation temperatures. The presence of two temperature optima indicates psychrophilic and psychrotolerant bacteria dominate under different conditions. Community fingerprinting via denaturant gradient gel electrophoresis (DGGE) of 16S rRNA genes showed strong shifts in the composition of communities driven more by temperature than by differences in dissolved organic matter source; e.g. four and seven unique operational taxonomic units (OTUs) were found only at 2°C and 25°C, respectively, and not found at other incubation temperatures after 5 days. The impact of temperature on bacteria is complex, influencing both bacterial productivity and community composition. Path analysis of measurements of 24 streams and lakes sampled across a catchment 12 times in 4 years indicates variable timing and strength of correlation between temperature and bacterial production, possibly due to bacterial community differences between sites. As indicated by both field and laboratory experiments, shifts in dominant community members can occur on ecologically relevant time scales (days), and have important implications for understanding the relationship of bacterial diversity and function.
Microbial diversity and biogeochemistry of the Guaymas Basin deep‐sea hydrothermal plume
Authors: Dick Gregory J. , Tebo Bradley M.
Published: February 2010

Hydrothermal plumes are hot spots of microbial biogeochemistry in the deep ocean, yet little is known about the diversity or ecology of microorganisms inhabiting plumes. Recent biogeochemical evidence shows that Mn(II) oxidation in the Guaymas Basin (GB) hydrothermal plume is microbially mediated and suggests that the plume microbial community is distinct from deep‐sea communities. Here we use a molecular approach to compare microbial diversity in the GB plume and in background deep seawater communities, and cultivation to identify Mn(II)‐oxidizing bacteria from plumes and sediments. Despite dramatic differences in Mn(II) oxidation rates between plumes and background seawater, microbial diversity and membership were remarkably similar. All bacterial clone libraries were dominated by Gammaproteobacteria and archaeal clone libraries were dominated by Crenarchaeota. Two lineages, both phylogenetically related to methanotrophs and/or methylotrophs, were consistently over‐represented in the plume. Eight Mn(II)‐oxidizing bacteria were isolated, but none of these or previously identified Mn(II) oxidizers were abundant in clone libraries. Taken together with Mn(II) oxidation rates measured in laboratory cultures and in the field, these results suggest that Mn(II) oxidation in the GB hydrothermal plume is mediated by genome‐level dynamics (gene content and/or expression) of microorganisms that are indigenous and abundant in the deep sea but have yet to be unidentified as Mn(II) oxidizers.
Persistence of bacterial and archaeal communities in sea ice through an Arctic winter
Authors: Collins R. Eric , Rocap Gabrielle , Deming Jody W.
Published: February 2010

The structure of bacterial communities in first‐year spring and summer sea ice differs from that in source seawaters, suggesting selection during ice formation in autumn or taxon‐specific mortality in the ice during winter. We tested these hypotheses by weekly sampling (January–March 2004) of first‐year winter sea ice (Franklin Bay, Western Arctic) that experienced temperatures from −9°C to −26°C, generating community fingerprints and clone libraries for Bacteria and Archaea. Despite severe conditions and significant decreases in microbial abundance, no significant changes in richness or community structure were detected in the ice. Communities of Bacteria and Archaea in the ice, as in under‐ice seawater, were dominated by SAR11 clade Alphaproteobacteria and Marine Group I Crenarchaeota, neither of which is known from later season sea ice. The bacterial ice library contained clones of Gammaproteobacteria from oligotrophic seawater clades (e.g. OM60, OM182) but no clones from gammaproteobacterial genera commonly detected in later season sea ice by similar methods (e.g. Colwellia, Psychrobacter). The only common sea ice bacterial genus detected in winter ice was Polaribacter. Overall, selection during ice formation and mortality during winter appear to play minor roles in the process of microbial succession that leads to distinctive spring and summer sea ice communities.
Aqueous films limit bacterial cell motility and colony expansion on partially saturated rough surfaces
Authors: Wang Gang , Or Dani
Published: February 2010

Bacterial motility is a key mechanism for survival in a patchy environment and is important for ecosystem biodiversity maintenance. Quantitative description of bacterial motility in soils is hindered by inherent heterogeneity, pore‐space complexity and dynamics of microhydrological conditions. Unsaturated conditions result in fragmented aquatic habitats often too small to support full bacterial immersion thereby forcing strong interactions with mineral and air interfaces that significantly restrict motility. A new hybrid model was developed to study hydration effects on bacterial motility. Simulation results using literature parameter values illustrate sensitivity of colony expansion rates to hydration conditions and are in general agreement with measured values. Under matric potentials greater than −0.5 kPa (wet), bacterial colonies grew fast at colony expansion rates exceeding 421 ± 94 µm h−1; rates dropped significantly to 31 ± 10 µm h−1 at −2 kPa; as expected, no significant colony expansion was observed at −5 kPa because of the dominance of capillary pinning forces in the submicrometric water film. Quantification of hydration‐related constraints on bacterial motion provides insights into optimal conditions for bacterial dispersion and spatial ranges of resource accessibility important for bioremediation and biogeochemical cycles. Results define surprisingly narrow range of hydration conditions where motility confers ecological advantage on natural surfaces.
Biosynthesis of uronamide sugars inPseudomonas aeruginosaO6 andEscherichia coliO121 O antigens
Authors: King Jerry D. , Vinogradov Evgeny , Tran Vanessa , Lam Joseph S.
Published: February 2010

The major component of the outer leaflet of the outer membrane of Gram‐negative bacteria is lipopolysaccharide (LPS). The outermost domain of LPS is a polysaccharide called O antigen.Pseudomonas aeruginosaestablishes biofilms on wet surfaces in a wide range of habitats and mutations in O‐antigen biosynthesis genes affect bacterial adhesion and the structure of these biofilms. TheP. aeruginosaO6 O antigen contains a 2‐acetamido‐2‐deoxy‐d‐galacturonamide (d‐GalNAcAN) residue. O‐antigen biosynthesis in this serotype requires thewbpSgene, which encodes a protein with conserved domains of the glutamine‐dependent amidotransferase family. Replacement of conserved amino acids in the N‐terminal glutaminase conserved domain of WbpS inhibited O‐antigen biosynthesis under restricted‐ammonia conditions, but not in rich media; suggesting that this domain functions to provide ammonia for O‐antigen biosynthesis under restricted‐ammonia conditions, by hydrolysis of glutamine.Escherichia coliO121 also produces ad‐GalNAcAN‐containing O antigen, and possesses a homologue ofwbpScalledwbqG. AnE. coliO121wbqGmutant was cross‐complemented by providingwbpS in trans, and vice versa, showing that these two genes are functionally interchangeable. TheE. coliO121wbqGmutant O antigen contains 2‐acetamido‐2‐deoxy‐d‐galacturonate (d‐GalNAcA), instead ofd‐GalNAcAN, demonstrating thatwbqGis specifically required for biosynthesis of the carboxamide in this sugar.
Visual cues as a surrogate for tactile feedback during robotic‐assisted laparoscopic prostatectomy: posterolateral margin rates in 1340 consecutive patients
Authors: Tewari Ashutosh K. , Patel Nishant D. , Leung Robert A. , Yadav Rajiv , Vaughan E. Darracott , El‐Douaihy Youssef , Tu Jiangling J. , Amin Muhul B. , Akhtar Mohammed , Burns Mark , Kreaden Usha , Rubin Mark A. , Takenaka Atsushi , Shevchuk Maria M.
Published: February 2010

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To analyse consecutive cases of robotic‐assisted laparoscopic prostatectomy (RALP), present the incidence of nerve‐sparing‐related positive surgical margins (SM+), include visual cues that might assist in smoothly changing to the robotic platform, and discuss the scientific rationale for ‘intersensory integration’ which might explain the ‘reverse Braille’ phenomenon, i.e. the ability to feel when vision is greatly enhanced, as the lack of tactile feedback during RALP is often cited as a disadvantage of robotic surgery, interfering with a surgeon’s ability to make intraoperative oncological decisions.

PATIENTS AND METHODS

Data from 1340 consecutive patients undergoing RALP from one institution were analysed and trends for positive posterolateral SM+ (PLSM+) were correlated with oncological variables before and after RALP. A sample of patient slides were reviewed by a extramural pathologist. Multivariate regression modelling was used to compare the projected rates of PLSM+ vs the actual rate, given the effect of a conscious effort to use visual cues. Finally, video recordings of the procedure were systematically reviewed and correlated with anatomical and histopathological images in an integrated session involving the surgeon and the pathology team.

RESULTS

The incidence of PLSM+ was 2.1%, which gradually declined to 1.0% in the last 100 patients. The reduction in PLSM+ occurred despite an increased rate of high‐risk tumours operated on during this period. Forecasting analysis showed that the actual PLSM+ rate declined by half in the most recent 1000 patients, due to an integrated effort involving the use of visual cues during surgery. The following visual cues were considered important; appreciation of periprostatic (lateral prostatic) fascial compartments; colour and texture of the tissue; periprostatic veins as a landmark for athermal dissection; signs of inflammation; and a freely separating bloodless plane showing loose shiny areolar tissue.

CONCLUSION

Adapting to the robotic platform is easy and there is no compromise of the oncological safety of this procedure. Experienced surgeons can use visual cues to assist during nerve‐sparing RALP and achieve low PLSM+ rates.
TAXES, GROWTH AND THE CURRENT ACCOUNT TICK‐CURVE EFFECT
Authors: DAY CREINA , DAY GARTH
Published: February 2010

This paper examines the dynamic and long run effects of a shift from income taxes to consumption taxes in a growing small open economy. We introduce a government sector that maintains a balanced budget and expenditure at a constant proportion of domestic income to a small open economy Swan‐Solow model. Our framework provides a previously unidentified dynamic effect that is robust to endogenising the savings rate. Lowering the income tax rate promotes economic growth and has a tick‐curve effect on the current account balance, characterised by instantaneous deterioration, a period of recovery and gradual convergence to an improved position in the long run.
A WELFARE COST OF THE LOST DECADE IN JAPAN
Authors: MIYAKOSHI TATSUYOSHI
Published: February 2010

This paper measures the welfare cost of the Japanese economy in a ‘lost decade’ from 1990 to 2002, by using panels of different consumer groups. The paper finds that the costs for consumers in the lower and middle income quintiles and in urban districts are much higher, while there exists a benefit for consumers in rural districts. We suggest that such cost disparities express the business slump related to districts and income quintile group with high costs. Also, there exist consumers feeling this stagnation to be low‐cost and the seriousness of stagnation is not recognised unanimously.
ESTIMATING THE RELATIONSHIP BETWEEN IMMIGRANT AND NATIVE WORKERS IN AUSTRALIA: A PRODUCTION THEORY APPROACH
Authors: PARASNIS JAAI
Published: February 2010

The impact of immigration on labour markets depends, among other factors, on the substitutability or complementarity between immigrants and natives. This relationship is examined by treating migrant and native labour, along with capital, as inputs in production process. Estimated price elasticities of substitution between immigrants and native labour suggest that in Australian context, an increase in the wage rate of one group of workers leads to an increased demand for the other. The estimated elasticities of substitution between immigrant and native workers and the complementary relationship between immigrants and capital provide an insight into the complex effects of immigration.
UNCERTAINTY AND CONSUMPTION: NEW EVIDENCE IN OECD COUNTRIES
Authors: Menegatti Mario
Published: February 2010

This work analyses the empirical evidence about precautionary saving in OECD countries in the period 1955–2000. Unlike the previous literature, we perform the test using a measure of uncertainty allowing for heterogeneity in stochastic processes which generate data for each country and selecting for each economy the autoregressive moving average process which best describes the series. The results obtained support the main conclusion of precautionary saving theory, showing that a greater degree of uncertainty increases saving. A less clear conclusion is obtained with reference to the effect of uncertainty on consumption growth, which does not seem to be strongly supported by the data.
THE EFFECT OF GOVERNMENT POLICY ON TOBACCO ADVERTISING STRATEGIES
Authors: Elliott Caroline , Wei Yingqi , Lenton Pamela
Published: February 2010

This paper contributes to the very limited literature examining the factors determining tobacco companies' advertising strategies. The paper explores whether firms in the UK tobacco market significantly changed their advertising expenditure in the face of proposed changes to the UK and European Commission tobacco advertising legislation. The results suggest that changes in legislation have little impact on firms' advertising strategies for existing brands, but that legislative changes impact upon product launch dates. Our results also offer some information on the nature of firm interdependencies in the UK tobacco industry.
A NEW MULTIPLICATIVE DECOMPOSITION FOR THE FOSTER–GREER–THORBECKE POVERTY INDICES
Authors: Aristondo Oihana , De La Vega Casilda Lasso , Urrutia Ana
Published: February 2010

This paper shows that Foster–Greer–Thorbecke poverty indices can be written as the product of components summarizing the incidence, intensity and inequality dimensions of poverty and provides an empirical illustration of the decomposition using Spanish household budget surveys data.
Earnings Management, Asset Restructuring, and the Threat of Exchange Delisting in an Earnings‐based Regulatory Regime
Authors: Cheng Peng , Aerts Walter , Jorissen Ann
Published: February 2010

Manuscript Type: Empirical

Research Question/Issue: This study examines the effect of an earnings‐based listing regulation on corporate financial reporting management. In 2001, China revised its listing standards requiring compulsory stock suspension for firms reporting three‐year consecutive losses. Suspended stocks are further delisted if they continue to report losses in the year of stock suspension.

Research Findings/Insights: Our results show that firms approaching the delisting procedure use more earnings management, although the effect is minor. Meanwhile, we observe that delisting risk induces extensive performance‐enhancing asset restructuring activities. For firms turning losses into profits, our evidence suggests a negative relationship between earnings management and asset restructuring.

Theoretical/Academic Implications: This study extends the earnings management literature by suggesting that earnings management to avoid losses is likely to increase with the severity of the losses and decline with asset restructuring activities. In addition, this research adds to the literature on the economic consequences of the delisting process.

Practitioner/Policy Implications: The study provides evidence that an earnings‐based delisting regulation is a double‐edged sword which leads to either earnings management or performance‐enhancing asset restructuring activities. By pointing out the earnings management and restructuring effects of the Chinese delisting regime, we may inform policy makers of the economic consequences of an earnings‐based regime. This adds to prior evidence on the effects of market‐based delisting thresholds. In addition, the study highlights that the earnings‐based delisting regulation does not create a level playing field, since state‐controlled firms are at an advantage to use more government‐led asset restructurings through state‐owned shareholders in order to avoid delisting.
Exploring the Contextual Determinants of Individual Attitudes toward Immigrants and Criminal Activity and their Spillover Policy Implications
Authors: Percival Garrick L. , Currin‐Percival Mary
Published: February 2010

Immigrants are routinely tied to a range of social problems in the policy making process in the US political system. Little is known however about the extent to which citizens hold attitudes that connect immigrants to particular social problems and whether these attitudes spill over to influence citizens’ preferences toward specific public policy alternatives that might appear to be largely independent of immigrants and immigration. Investigating the nexus between immigration and crime, we ask how Anglo whites’ contextual environments influence their propensity to link immigrants to a salient social pathology like crime. Results show that whites living in states where immigrant populations have increased most dramatically and in states with lower socioeconomic characteristics are more likely to associate immigration with increased criminal activity. Whites’ attitudes toward immigration‐induced crime has important spillover implications to the larger public policy making process as whites who view immigrants as a cause of criminal activity are more likely to support tougher criminal sentencing and the death penalty.
Financial Market Crises and Natural Resource Production
Authors: BROWN JAMES R. , LAX LAUREN C. , PETERSEN BRUCE C.
Published: February 2010

During a financial crisis, the loss of access to world capital markets may force heavily indebted countries to accelerate their production of exhaustible resources. Few studies consider the impact that financial crises have on real behavior, and no existing studies appear to consider the impact a crisis might have on resource production. We find that four major state‐owned enterprises in Brazil, Chile and Mexico substantially expanded their production and world market share of copper, iron ore and oil during the 1980s' international financial crisis. There was also a very large expansion, followed by a sharp contraction, of production of tin in Brazil and silver in Mexico. In contrast, Indonesia – a major resource producer who did not succumb to the 1980s' financial crisis – did not accelerate production during the 1980s' crisis, and resource production in the United States sharply contracted during this period. Our study provides new insights into why the prices of natural resources are so volatile and highlights a previously unexplored reason for financial contagion: one country's efforts to service its debt can drive down resource prices and revenues to other indebted resource producers.
An Overview of the Crisis: Causes, Consequences, and Solutions*
Authors: ALLEN FRANKLIN , CARLETTI ELENA
Published: February 2010

What caused the crisis? Initially many thought that it was due to incentive problems in the U.S. mortgage industry. However, after the large economic meltdown following Lehman Brothers' bankruptcy in September 2008, it seems that much more was going on. We argue that there was a bubble in real estate prices in the United States and a number of other countries. The main causes of the bubble were loose monetary policy, particularly by the United States Federal Reserve, and global imbalances. The combination of cheap credit together with the easy availability of funds contributed to create the bubble. Many other factors such as subprime mortgages, weak regulatory structures, and high leverage in the banking sector exacerbated the effects of the crisis. We consider possible reforms aimed at minimizing the occurrence of future crises in the governance structure of central banks, measures to reduce global imbalances, and changes in banking regulation.
The use of multi‐element behaviour support planning with a man with severe learning disabilities and challenging behaviour
Authors: MacDonald Anne , Hume Linda , McGill Peter
Published: February 2010

Accessible summary

 People with learning disabilities who have challenging behaviour often experience poor support which affects their quality of life.

 This paper looks at an example of work done with an individual and his staff team which helped reduce challenging behaviour and provided him with an improved service and better quality of life.

 The research indicates the importance of people with learning disabilities who have challenging behaviour receiving behaviour support to enable them to live full lives in the community.

Research has indicated that challenging behaviour leads to placement breakdown and poor quality of life for people with learning disabilities. This paper provides a case study example of successful intervention with an individual with learning disabilities and challenging behaviour, using a Multi‐element model of support, including functional assessment, behaviour support plans and use of a monitoring system (Periodic Service Review). Outcomes of this intervention are presented and their possible implications considered.
Support workers within learning/intellectual disability services perception of their role, training and support needs
Authors: Windley Debbie , Chapman Melanie
Published: February 2010

Accessible summary

 Support staff were asked what were the important things they did to support people with learning/intellectual disabilities, and what training and support they needed to do their job.

 Support staff said they had difficulties in communicating with each other, and feel stressed when asked to do things which did not make the people they support happy.

 Support staff also stated that there should be more training and support for new staff.

 Support staff need more help to learn: how to give each other advice and how to cope with being stressed.

This study explores the perceptions of support workers working with adults with learning/intellectual disabilities, training and support needs. Data was collected by focus group (n = 3) and semi‐structured interviews (n = 5). Participants saw their key role as maximising quality of life, identified ‘Trial and error’ as the main mode of skill development for new staff and experienced stress as a result of conflict between their beliefs and demands of the service. Participants recognised their responsibility to model good and challenge poor practice; however, poor communication and assertiveness skills affected their ability to do this. A preference for more on site supervision to provide leadership was indicated. Training by the community learning disability team was highly regarded; however, there were indications that carers found this difficult to put into practice. It is suggested that development of personal skills and relating training to human rights and person‐centred planning perspectives would best enable staff to carry out their roles.
Trajectories leading to autism spectrum disorders are affected by paternal age: findings from two nationally representative twin studies
Authors: Lundström Sebastian , Haworth Claire M.A. , Carlström Eva , Gillberg Christopher , Mill Jonathan , Råstam Maria , Hultman Christina M. , Ronald Angelica , Anckarsäter Henrik , Plomin Robert , Lichtenstein Paul , Reichenberg Abraham
Published: February 2010

Background:  Despite extensive efforts, the causes of autism remain unknown. Advancing paternal age has been associated with various neurodevelopmental disorders. We aim to investigate three unresolved questions: (a) What is the association between paternal age and autism spectrum disorders (ASD)?; (b) Does paternal age moderate the genetic and environmental etiological factors for ASD? (c) Does paternal age affect normal variation in autistic‐like traits?

Methods:  Two nationally representative twin studies from Sweden (n = 11, 122, assessed at age 9 or 12) and the UK (n = 13, 524, assessed at age 9) were used. Categorical and continuous measures of ASD, autistic‐like traits and autistic similarity were calculated and compared over paternal age categories.

Results:  Both cohorts showed a strong association between paternal age and the risk for ASD. A U‐shaped risk association could be discerned since the offspring of both the youngest and oldest fathers showed an elevation in the risk for ASD. Autistic similarity increased with advancing paternal age in both monozygotic and dizygotic twins. Both cohorts showed significantly higher autistic‐like traits in the offspring of the youngest and oldest fathers.

Conclusions:  Phenomena associated with paternal age are clearly involved in the trajectories leading to autistic‐like traits and ASD. Mechanisms influencing the trajectories might differ between older and younger fathers. Molecular genetic studies are now needed in order to further understand the association between paternal age and ASD, as well as normal variation in social, language, and repetitive behaviors in the general population.
The influence of breed on the organoleptic characteristics of Zamorano sheep’s raw milk cheese and its assessment by instrumental analysis
Authors: LURUEÑA‐MARTÍNEZ MIGUEL A , REVILLA ISABEL , SEVERIANO‐PÉREZ PATRICIA , VIVAR‐QUINTANA ANA M
Published: February 2010

The aim of this study was to investigate the effects of three different somatic cell count (SCC) values on the sensory characteristics of sheep’s milk cheeses from the Castellana and Churra breeds (allowed for Protected Designation of Origin Zamorano cheese manufacture) and the Assaf breed (foreign), determined by typical consumers and instrumentally. The results show that the sensory characteristics of hardness, intensity of taste, and pungency reflect a significant influence of the SCCs of the original milk whereas breed significantly affects colour intensity and hardness (Warner‐Bratzler maximum shear force; WBSF). The instrumental parameters most closely related to the assessments of the typical consumers were WBSF and the value of a*, for hardness and colour respectively.
Optimisation of sweetener blends for the preparation of lassi
Authors: GEORGE VISHWAS , ARORA SUMIT , WADHWA BALBIR KAUR , SINGH ASHISH KUMAR , SHARMA GHANSHYAM S
Published: February 2010

Sucrose was successfully replaced with sweetener blends for the preparation of lassi. Optimisation of the levels of sweeteners added individually or in blends, viz. binary, tertiary and quaternary and finally selection of the best blend among them was based on organoleptic assessment. Binary blend aspartame × acesulfame‐k scored the highest when compared with the best optimised single sweetener aspartame, tertiary and quaternary blend in lassi and had nonsignificant differences with control in all sensory attributes. It showed maximum synergy in sweetness intensity in comparison to tertiary and quaternary blends. Use of binary blend resulted in 38% reduction of usage level when compared with single sweetener aspartame.
Maternal perception of foetal movement compared with movement detected by real‐time ultrasound: An exploratory study
Authors: HIJAZI Zina R. , CALLAN Susan E. , EAST Christine E.
Published: February 2010

In this exploratory study, women perceived 35.8% of 763 foetal movements seen on 14 ultrasound scans, with increased sensitivity when movements involved more than one foetal body part (adjusted odds ratio (OR) 1.92, 95% confidence interval (CI) 1.232–2.999), contacted the uterus (adjusted OR: 2.57, 95% CI: 1.653–3.995) and were of increasing duration (adjusted OR: 9.33, 95% CI: 5.616–15.513). These findings may inform future studies of the importance of and ability to improve women’s perception of foetal movements.
Uptake of the Perinatal Society of Australia and New Zealand perinatal mortality audit guideline
Authors: FLENADY V. , MAHOMED K. , ELLWOOD D. , CHARLES A. , TEALE G. , CHADHA Y. , JEFFERY H. , STACEY T. , IBIEBELE I. , ELDER M. , KHONG Y.
Published: February 2010

Background:  Deficiencies in investigation and audit of perinatal deaths result in loss of information thereby limiting strategies for future prevention. The Perinatal Society of Australia and New Zealand (PSANZ) developed a clinical practice guideline for perinatal mortality in 2004.

Aims:  To determine the current use and views of the PSANZ guideline, focussing on the investigation and audit aspects of the guideline.

Methods:  A telephone survey was conducted of lead midwives and doctors working in birth suites of maternity hospitals with over 1000 births per annum in Australia and New Zealand.

Results:  Sixty‐nine of the 78 eligible hospitals agreed to participate. A total of 133 clinicians were surveyed. Only 42% of clinicians surveyed were aware of the guideline; more midwives than doctors were aware (53 vs 28%). Of those, only 19% had received training in their use and 33% reported never having referred to them in practice. Implementation of even the key guideline recommendations varied. Seventy per cent of respondents reported regularly attending perinatal mortality audit meetings; midwives were less likely than doctors to attend (59 vs 81%). Almost half (45%) of those surveyed reported never receiving feedback from these meetings. The majority of clinicians surveyed agreed that all parents should be approached for consent to an autopsy examination of the baby; however, most (86%) reported the need for clinician training in counselling parents about autopsy.

Conclusions:  Effective implementation programmes are urgently required to address suboptimal uptake of best practice guidelines on perinatal mortality audit in Australia and New Zealand.
Extrafocal threshold reductions in amygdala‐kindled rats
Authors: Scott Brian W. , Park Harrison , Han Hua , Wahidie Ahsanullah , Burnham W. McIntyre
Published: February 2010

Purpose:  Racine’s classic study suggested that after discharge thresholds were reduced in the primary stimulation site (amygdala) of kindled rats, but that that they were not reduced in secondary (nonstimulated) sites. However, recent reports of neurochemical changes related to excitation and inhibition in nonstimulated sites in kindled brains would be expected to cause reductions in afterdischarge thresholds in these sites. More recently Sanei et al. have reported a significant threshold reduction in the piriform cortex of amygdala‐ and hippocampus‐kindled cats, but not in the entorhinal cortex. The present study was designed to determine whether the results of Sanei et al. in cats could be replicated in rats kindled in the amygdala—a model commonly used in studies of seizure mechanisms and anticonvulsant drug development.

Methods:  Adult, male Long‐Evans rats were kindled in the amygdala or given matched handling. Beginning 48 h following the last stimulation, afterdischarge thresholds were determined in the ipsilateral piriform and entorhinal cortices. Amygdala thresholds were determined 24 h later.

Results:  Afterdischarge thresholds were significantly reduced in both the amygdala and the ipsilateral entorhinal cortex of amygdala‐kindled rats. Afterdischarge thresholds in the piriform cortex did not differ significantly between kindled and control subjects.

Discussion:  These data suggest that threshold reduction occurs outside the primary kindling site in rats as well as in cats. Extrafocal changes in afterdischarge threshold may be functionally important, and might possibly relate to extrafocal neurochemical changes and progressive generalization of seizure discharge from discrete focal sites.
Pregnancy registries: Differences, similarities, and possible harmonization
Authors: Tomson Torbjörn , Battino Dina , Craig John , Hernandez‐Diaz Sonia , Holmes Lewis B , Lindhout Dick , Morrow Jim , French Jacqueline ,   for the ILAE Commission on Therapeutic Strategies
Published: February 2010

Epilepsy and pregnancy registries have been operational for more than 10 years, have accrued considerable experience, and collected an impressive amount of data. As findings have been published, it has become important to understand how observations from the different registries are comparable, especially since their methodologies differ somewhat. In September 2008, representatives of the UK Epilepsy and Pregnancy Register, the North American AED Pregnancy Registry (NAAPR), and the European and International Registry of Antiepileptic Drugs in Pregnancy (EURAP) met for a workshop. Their objectives were to exchange information on their methodologies and to discuss areas where harmonization might be possible. This report summarizes these discussions.
Expression of growth differentiation factor 15 is not elevated in individuals with iron deficiency secondary to volunteer blood donation
Authors: Tanno Toshihiko , Rabel Antoinette , Lee Y. Terry , Yau Yu Ying , Leitman Susan F. , Miller Jeffery L.
Published: February 2010

BACKGROUND: Low serum hepcidin levels provide a physiologic response to iron demand in patients with iron deficiency (ID). Based on a discovery of suppressed hepcidin expression by a cytokine named growth differentiation factor 15 (GDF15), it was hypothesized that GDF15 may suppress hepcidin expression in humans with ID due to blood loss.

STUDY DESIGN AND METHODS: To test this hypothesis, GDF15 and hepcidin levels were measured in peripheral blood from subjects with iron‐deficient erythropoiesis before and after iron supplementation.

RESULTS: Iron variables and hepcidin levels were significantly suppressed in iron‐deficient blood donors compared to healthy volunteers. However, ID was not associated with elevated serum levels of GDF15. Instead, iron‐deficient subjects' GDF15 levels were slightly lower than those measured in the control group of subjects (307 ± 90 and 386 ± 104 pg/mL, respectively). Additionally, GDF15 levels were not significantly altered by iron repletion.

CONCLUSIONS: ID due to blood loss is not associated with a significant change in serum levels of GDF15.
Posttransfusion platelet count increments after ABO‐compatible versus ABO‐incompatible platelet transfusions in noncancer patients: an observational study
Authors: Pavenski Katerina , Warkentin Theodore E. , Shen Hua , Liu Yang , Heddle Nancy M.
Published: February 2010

BACKGROUND: Major incompatible platelet (PLT) transfusions have been associated with inferior posttransfusion PLT count increments compared with ABO‐compatible transfusions. However, most studies to date have been small and involved hematology/oncology patients.

STUDY DESIGN AND METHODS: We conducted a prospective observational study in predominantly nononcologic patients to determine whether ABO‐compatible (defined as ABO identical and minor incompatible) PLT transfusions resulted in superior posttransfusion PLT count increments. We collected data on consecutive inpatients at Hamilton General Hospital receiving a PLT transfusion during a 50‐month period. We compared the absolute count increment (ACI) and corrected count increment (CCI) values in ABO‐compatible versus incompatible PLT transfusions. Linear regression was performed to adjust for factors potentially affecting the posttransfusion PLT count response. Univariate models were applied to each explanatory variable with p values of less than 0.10 considered potentially significant. Multivariate models were applied to all potential explanatory variables of interest. p values of less than 0.05 were considered significant.

RESULTS: A total of 1030 transfusions were included in the primary analysis, 73.7% of which were ABO compatible. The median ACI was 35 (interquartile range [IQR], 18‐55) for compatible transfusions versus 31 (IQR, 13‐51) for incompatible transfusions (p = 0.1480). The median posttransfusion CCI (n = 686) was 18.6 (IQR, 10.2‐28.4) for compatible transfusions versus 15.2 (IQR, 4.7‐25.7) for incompatible transfusions (p = 0.0499).

CONCLUSIONS: ABO‐compatible transfusions in nononcologic patients are associated with a significantly better CCI although the observed difference is small (approx. 20%) and may not be clinically significant.
Association of ABO(H) and I blood group system development with von Willebrand factor and Factor VIII plasma levels in children and adolescents
Authors: Klarmann Dieter , Eggert Christine , Geisen Christof , Becker Sabine , Seifried Erhard , Klingebiel Thomas , Kreuz Wolfhart
Published: February 2010

BACKGROUND: The modulation of Factor (F)VIII activity (FVIII : C), von Willebrand factor antigen (VWF : Ag), and von Willebrand factor ristocetin cofactor (VWF : RCo) by the ABO(H) blood group is well established in adults. Expression of ABH antigens on N‐linked glycans of VWF protects plasma VWF from proteolysis and clearance. Protection by H antigens is less effective than by AB antigens, resulting in approximately 25% lower VWF plasma levels in adults with blood group O compared to non‐O. Given the reduced branching of ABO(H) bearing structures (I blood group system) with lower numbers of H, A, and B antigen sites during the first 18 months of life, we reasoned that if the relationship between ABO(H) blood group and VWF levels were causal, the difference of ABO(H) blood group–dependent VWF levels should be marginal or not be observed in the first months of life.

STUDY DESIGN AND METHODS: We undertook quantification of FVIII : C and VWF in 574 presumably healthy children aged 1 to 210 months and correlated the values with ABO(H) blood type. Moreover, we establish reference intervals for common coagulation variables for several pediatric age groups.

RESULTS: Significant differences between blood group O versus non‐O values of FVIII : C, VWF : Ag, and VWF : RCo were not observed in the first months of life, started to develop during childhood, and in adolescence reached adult values.

CONCLUSION: In comparison to the levels for adults and adolescents, we report fundamental differences of VWF levels in the first year of life, which may be associated with the physiologic development of the ABO(H) and I blood group system.
Detection of Gunshot Residue in Blowfly Larvae and Decomposing Porcine Tissue Using Inductively Coupled Plasma Mass Spectrometry (ICP‐MS)*
Authors: LaGoo Lisa , Schaeffer Luther S. , Szymanski David W. , Smith Ruth Waddell
Published: February 2010

Abstract:  Blowfly larvae and porcine tissue contaminated with gunshot residue (GSR) were collected during summer and winter months, over a 37‐day and a 60‐day sampling period, respectively. Wound samples were microwave‐digested and analyzed by inductively coupled plasma mass spectrometry (ICP‐MS) for the detection of antimony, barium, and lead. During summer, the 37‐day sampling period encompassed all stages of decomposition, except skeletonization. The three elements were detected in larvae only on days 3 and 4 after death but were detected at significant levels in tissue samples throughout the entire sampling period. In winter, no significant decomposition was observed throughout the 60‐day sampling. Although temperatures were too low for blowfly activity, the three elements were detected in the tissue samples at relatively constant, significant levels. Hence, GSR determination in tissue was more dependent on decomposition stage rather than time since death.
An Autopsy Case of Sudden Unexplained Death Caused by Malaria*
Authors: Menezes Ritesh G. , Kanchan Tanuj , Rai Sharada , Jagadish Rao P. P. , Naik Ramadas , Suresh Kumar Shetty B. , Lobo Stany W. , Chauhan Aman , Shetty Mahabalesh , Mathai Alka Mary
Published: February 2010

Abstract:  Sudden unexplained deaths, especially those unwitnessed can lead to forensic issues and would necessitate the need for a meticulous and complete postmortem examination including ancillary investigations to discover the cause of death. We herein report a case of sudden unexplained death caused by malaria in an apparently healthy individual. This fatal case is presented to remind the forensic pathologist of the possibility of malaria as a cause of sudden unexplained death in malaria‐endemic regions. In the present case, histopathological examination demonstrated the presence of parasitized red blood cells with malarial pigment in the blood capillaries in the brain, myocardium, pericardium, lungs, kidneys, liver, and the spleen. Cerebral malaria with acute renal insufficiency or pulmonary edema with an acute respiratory distress syndrome might have been the cause of death.
A Fatal Leopard Attack
Authors: Hejna Petr
Published: February 2010

Abstract:  A rare case of a big cat fatal attack is presented. A male leopard that had escaped from its unlocked cage attacked a 26‐year‐old male zoo worker. The man sustained penetrating injuries to the neck with consequent external bleeding. The man died while being transported to the hospital as a result of the injuries sustained. The wounds discovered on the victim’s body corresponded with the known methods of leopard attacks and with findings on the carcasses of animals killed by leopards in the wild. The conclusion of the medicolegal investigation was that the underlying cause of death was a bite wound to the neck which lacerated the left internal jugular vein, the two main branches of the left external carotid artery, and the cervical spine. The cause of death was massive external bleeding. Special attention is paid to the general pattern of injuries sustained from big cat attacks.