bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in pain and nausea in children operated on by Tonsillectomy or Tonsillotomy – a prospective follow‐up study
Authors: Ahlstav Mårtensson Ulrica , Erling Hasselqvist Nann , Boström Barbro
Published: June 2012

Ahlstav Mårtensson U., Erling Hasselqvist N. & Boström B. (2013) Differences in pain and nausea in children operated on by Tonsillectomy or Tonsillotomy – a prospective follow‐up study. Journal of Advanced Nursing69(4), 782–792. doi: 10.1111/j.1365‐2648.2012.06060.x

Aim.  To evaluate the differences in postoperative pain, nausea and time of discharge in children 3–12 years old after Tonsillectomy or Tonsillotomy at the postanaesthetic care unit, children’s ward and at home.

Background.  Tonsillectomy involves risk of bleeding, severe postoperative pain and nausea. Tonsillotomy is a less invasive method with lower risk of bleeding, postoperative pain and nausea according to previous studies.

Design.  A prospective, comparative follow‐up study design.

Method.  From December 2008–April 2009 following parental agreement, 87 children in the ages 3–12 undergoing Tonsillectomy or Tonsillotomy participated. Visual analogue scale was used for children’s pain and nausea reports.

Result.  Significantly, fewer children operated on by the Tonsillotomy reported postoperative pain ≥ 3 according to the visual analogue scale than children operated on by the Tonsillectomy at the postanaesthetic care unit and the children’s ward. A statistically significant difference of postoperative nausea was only present during the care at the postanaesthetic care unit and children’s ward with fewer Tonsillotomy children reporting nausea ≥ 3. The time of postoperative care was shorter among the Tonsillotomy children in both the postanaesthetic care unit and the children’s ward. Postoperative pain and pain related difficulties in eating after discharge was significantly more present among the Tonsillectomy children compared with the Tonsillotomy children.

Conclusion.  The results of our study showed duration of postoperative pain and nausea in both groups, but indicated that Tonsillotomy is a more favourable alternative than Tonsillectomy in children.
Longitudinal follow‐up of malaria transmission dynamics in two villages in a Sahelian area of Niger during a nationwide insecticide‐treated bednet distribution programme
Authors: LABBO R. , CZEHER C. , DJIBRILA A. , ARZIKA I. , JEANNE I. , DUCHEMIN J.‐B.
Published: June 2012

Malaria transmission was monitored in two villages in the Sahel zone of Niger over 4 years. During this period, a nationwide vector control programme was carried out in which insecticide‐treated bednets were distributed free to mothers of children aged <5 years. Anopheles gambiae and Anopheles arabiensis (Diptera: Culicidae) were found to be the major malaria vectors. The dynamics of An. gambiae s.l. did not vary dramatically over the study period although the proportion of female mosquitoes found resting indoors decreased in both villages and, in one village, the parity rate and sporozoite index were significantly reduced after bednet distribution. By contrast with An. gambiae, the dynamics of Anopheles funestus altered greatly after the bednet distribution period, when adult density, endophagous rate and sporozoite rates decreased dramatically. Our observations highlight the importance of quantifying and monitoring the dynamics and infections of malaria vectors during large‐scale vector control interventions.
Spatially and temporally varying selection on intrapopulation quantitative trait loci for a life history trade‐off in Mimulus guttatus
Authors: MOJICA JULIUS P. , LEE YOUNG WHA , WILLIS JOHN H. , KELLY JOHN K.
Published: June 2012

Why do populations remain genetically variable despite strong continuous natural selection? Mutation reconstitutes variation eliminated by selection and genetic drift, but theoretical and experimental studies each suggest that mutation‐selection balance insufficient to explain extant genetic variation in most complex traits. The alternative hypothesis of balancing selection, wherein selection maintains genetic variation, is an aggregate of multiple mechanisms (spatial and temporal heterogeneity in selection, frequency‐dependent selection, antagonistic pleiotropy, etc.). Most of these mechanisms have been demonstrated for Mendelian traits, but there is little comparable data for loci affecting quantitative characters. Here, we report a 3‐year field study of selection on intrapopulation quantitative trait loci (QTL) of flower size, a highly polygenic trait in Mimulus guttatus. The QTL exhibit antagonistic pleiotropy: alleles that increase flower size, reduce viability, but increase fecundity. The magnitude and direction of selection fluctuates yearly and on a spatial scale of metres. This study provides direct evidence of balancing selection mechanisms on QTL of an ecologically relevant trait.
A Novel Cytotoxic T lymphocyte Epitope Analogue with Enhanced Activity Derived From Cyclooxygenase‐2
Authors: Wu Y. H. , Gao Y. F. , He Y. J. , Shi R. R. , Zhai M. X. , Wu Z. Y. , Sun M. , Zhai W. J. , Chen X. , Qi Y. M.
Published: June 2012

Cyclooxygenase‐2 is a promising target for cancer immunotherapy. Here, we designed the analogues p321‐9L and p321‐1Y9L (YLIGETIKL) from cyclooxygenase‐2‐derived native peptide p321. Then, we tested the binding affinity and stability of the analogues and their ability to elicit specific immune response both in vitro (from PBMCs of HLA‐A*02+ healthy donors) and in vivo (from HLA‐A2.1/Kb transgenic mice). Our results indicated that the activity of cytotoxic T lymphocytes induced by p321‐9L and p321‐1Y9L was more potent than that of p321. In conclusion, the epitope analogue, especially p321‐1Y9L, may be a good candidate which could be used to the immunotherapy of patients with tumours expressing cyclooxygenase‐2.
Expression of Genes Associated with H Factor in Fibroblasts Infected with Borrelia Spirochaetes
Authors: Gęca A. , Gola J. , Dudek S. , Jasik K. , Muc‐Wierzgoń M. , Nowakowska‐Zajdel E. , Niedworok E. , Mazurek U.
Published: June 2012

Infection with Borrelia spirochaetes leads to the launch of specific and non‐specific immunological response in humans. Activation of the complement system is one of the first defence mechanisms against penetrating pathogens. The aim of this study was to select genes related to the alternative pathway of the complement system [including complement factor H (CFH)], differentiating the type of infection in the system model, that is, a culture of normal human diploid fibroblasts infected with three different spirochaete genospecies: Borrelia afzelii, Borrelia garinii and Borrelia burgdorferii sensu stricto, by comparing the infected fibroblast culture with the control fibroblast one. With the use of oligonucleotide microarrays HGU‐133A, the differences in the expression of genes selected on the basis of a scientific database Affymetrix were studied by comparing transcriptomes from the four cultures of fibroblasts. In the result of infection of fibroblast cultivation with a specific Borrelia genospecies, a variable expression of certain CFH and complement system‐associated genes, specific for one genospecies only, B. afzelii– C1QBP, CD59, C2, CD46 and FHL1; B. garinii – C1S and CLU; Borrelia burgeforii– CFB, A2M and VSIG4, was observed. CFH differentiates infections induced by B. afzelii and B. garinii from infections induced by B. burgdorferii sensu stricto.
Weed seed survival during mesophilic anaerobic digestion in biogas plants
Authors: WESTERMAN P R , HEIERMANN M , POTTBERG U , RODEMANN B , GEROWITT B
Published: June 2012

Westerman PR, Heiermann M, Pottberg U, Rodemann B & Gerowitt B (2012). Weed seed survival during mesophilic anaerobic digestion in biogas plants. Weed Research52, 307–316.

Digestate, the semi‐solid leftover after anaerobic digestion in biogas reactors, is frequently used as a crop fertiliser. The ability of seeds from five plant species (four weed species and one vegetable crop) to survive commercial biogas plants was tested, to assess the likelihood that these could be spread via digestate and to compare with results obtained from laboratory‐scale reactors. Seeds were selected from among the best surviving species in experimental batch reactors in an earlier study. They were exposed for 1–9 days in two large‐scale, commercial mesophilic biogas plants. The resulting exponential decay functions were estimated. The decimal reduction time, D, was estimated at 1.5 days for Abutilon theophrasti population D2003, 2 days for A. theophrasti population ES2008, 5.8 days for Malva neglecta, 4.7 and 19.7 days for Chenopodium album, and 1.2–9.1 days for Fallopia convolvulus. Given the differences in ranking of plant species, laboratory reactors are not necessarily a good model system for commercial reactors. Seeds could survive passage through biogas plants, although at (extremely) low numbers. If the objective is to eliminate all risks and dispose of all weed seeds, it will be necessary to either add extra sanitation steps, or to identify and manipulate the factors that are responsible for high seed mortality. However, it is currently unknown what these factors are.
The quantitative genetic basis of adaptive divergence in the moor frog (Rana arvalis) and its implications for gene flow
Authors: HANGARTNER S. , LAURILA A. , RÄSÄNEN K.
Published: June 2012

Knowledge on the relative contribution of direct genetic, maternal and environmental effects to adaptive divergence is important for understanding the drivers of biological diversification. The moor frog (Rana arvalis) shows adaptive divergence in embryonic and larval fitness traits along an acidification gradient in south‐western Sweden. To understand the quantitative genetic basis of this divergence, we performed reciprocal crosses between three divergent population pairs and reared embryos and larvae at acid and neutral pH in the laboratory. Divergence in embryonic acid tolerance (survival) was mainly determined by maternal effects, whereas the relative contributions of maternal, additive and nonadditive genetic effects in larval life‐history traits differed between traits, population pairs and rearing environments. These results emphasize the need to investigate the quantitative genetic basis of adaptive divergence in multiple populations and traits, as well as different environments. We discuss the implications of our findings for maintenance of local adaptation in the context of migrant and hybrid fitness.
Linking altitudinal gradients and temperature responses of plant phenology in the Bavarian Alps
Authors: Cornelius C. , Estrella N. , Franz H. , Menzel A.
Published: June 2012

Global climate change influences ecosystems across the world. Alpine plant communities have already experienced serious impacts, and will continue to do so as climate change continues. The aim of our study was to determine the sensitivity of woody and herbaceous species to shifts in temperature along an altitudinal gradient. Since 1994, park rangers have been making phenological observations at 24 sites from 680 to 1425 m a.s.l. Each year 21 plant species were observed once or twice weekly from March to July; with a main focus on flowering and leaf unfolding. Our study showed a very high degree of dependence of phenophases and species on inter‐annual temperature variation and altitude. Averaged over all species and phenophases, there was a delay of 3.8 days with every 100 m increase in altitude and, across all elevations, an advance of phenophases of 6 days per 1 °C increase in temperature. Temperature lapse rates assessed indirectly by phenology, as the quotient of altitudinal to temperature response coefficients, were higher than directly calculated from March to July mean temperatures, most likely due to snow effects. Furthermore, a significant difference in sensitivity to temperature change was found between growth forms (herbs versus trees). Sensitivity was less pronounced in events occurring later in the season. Our results show that species reactions will differ in magnitude during global warming. Consequently, impacts of shifts in the timing of phenological events on plant migration and plant–pollinator interactions due to rising temperatures should be considered at the species level.
Treatment of distal subungual onychomycosis with a topical preparation of urea, propylene glycol and lactic acid: results of a 24‐week, double‐blind, placebo‐controlled study
Authors: Emtestam L. , Kaaman T. , Rensfeldt K.
Published: June 2012

Onychomycosis is difficult to cure as this requires eradication of the primary infection and protection of new areas of growth from reinfection. A new topical treatment (K101) has been developed. The aim of this study was to assess the efficacy, safety and tolerability of K101 treatment of distal subungual onychomycosis. This was a 24‐week (plus 2‐week washout), multicentre, randomised, double‐blind, placebo‐controlled study in 493 patients with distal subungual onychomycosis (K101, n = 346; placebo, n = 147), stratified according to degree of nail involvement. More patients with ≤50% nail involvement achieved the primary endpoint (mycological cure after 26 weeks) in the K101 group (27.2%) than placebo (10.4%; P = 0.0012). Proportions for patients with 51–75% involvement were 19.1% for K101 and 7.0% for placebo (not significant). More patients applying K101 than placebo judged that their condition had improved from week 2 (P = 0.0148) to week 24 (P = 0.0004). No safety issues were identified. K101 provides early visible improvements in nail appearance and a clinically meaningful antifungal activity.
Seminal Plasma Proteins as Modulators of the Sperm Function and Their Application in Sperm Biotechnologies
Authors: Caballero I , Parrilla I , Almiñana C , del Olmo D , Roca J , Martínez EA , Vázquez JM
Published: June 2012

Contents

Seminal plasma (SP) is known to play an important role in mammalian fertilization. However, the variability found in its composition among species, males and even fractions of the same ejaculate has made difficult to completely understand its effect in sperm function. Proteins are one of the major SP components that modulate sperm functionality. During the last years, intensive work has been performed to characterize the role of these proteins. They have been found to influence sperm capacitation, formation of the oviductal sperm reservoir and sperm–oocyte interaction. Sperm biotechnologies, such as sperm cryopreservation and flow cytometric sex‐sorting, that involve a substantial dilution of the SP are detrimental to sperm quality. Attempts to improve the outcome of these biotechnologies include the restoration of SP, which has produced contradictory results. To overcome this variability, different research groups have proposed the application of isolated SP proteins. Herein, we will review the current knowledge in the role of the major SP proteins as modulators of sperm functionality. Furthermore, we will discuss the possible applications of the SP proteins in sperm cryopreservation and flow cytometric sex‐sorting.
Ovarian Ultrasonography in the Mare
Authors: Miro J
Published: June 2012

Contents

Ultrasonography has become indispensable in the control of equine reproduction. Mare ovary layers are inverted with respect to other species, with the follicles and corpus luteum found inside the ovary; only large follicles protrude from the organ’s surface. This renders the making of diagnoses via rectal palpation of the ovaries very difficult. Ultrasound imaging, however, provides another avenue of examination. Since its first use in 1980, the diagnostic potential of ultrasonography has greatly improved. Colour Doppler ultrasonography can even asses blood flow, allowing for much better monitoring of ovarian activity. This study discusses the use of ultrasound, and in particular colour Doppler ultrasonography, in the monitoring of mare ovarian function and disease.
Brain accumulation of amyloid β protein visualized by positron emission tomography and BF‐227 in Alzheimer's disease patients with or without diabetes mellitus
Authors: Tomita Naoki , Furukawa Katsutoshi , Okamura Nobuyuki , Tashiro Manabu , Une Kaori , Furumoto Shozo , Iwata Ren , Yanai Kazuhiko , Kudo Yukitsuka , Arai Hiroyuki
Published: June 2012

Aim:  Although diabetes mellitus (DM) is considered to be one of the most consistent risks for developing dementia, it is not known if the pathology in dementia patients with DM is similar to or distinct from typical pathological features of Alzheimer's disease (AD). To discover the mechanism of developing dementia in AD patients with DM in a living state, we studied the distribution of amyloid β (Αβ) protein of diabetic AD patients.

Methods:  To evaluate the accumulation of Aβ, we examined 14 normal controls, four diabetic patients with AD and 11 non‐diabetic patients with AD by positron emission tomography (PET) using BF‐227, a currently developed Aβ tracer.

Results:  The analysis of PET images among the three groups showed an abundant aggregated Aβ accumulation in the cerebral cortex of both AD patients with and without DM. The extent and distributions of BF‐227 accumulation in diabetic AD patients were not significantly different from these of non‐diabetic AD patients.

Conclusion:  These results suggest that the degree and extent of Aβ deposition is not significantly different between AD with DM and AD alone. Geriatr Gerontol Int 2013; 13: 215–221.
Impact of pharmacy outreach services on blood pressure management in the elderly community of Hong Kong
Authors: Lee Vivian WY , Yi Pang Tin , Kong Kathy WY , Chan Peter KH , Kwok Fanny LM
Published: June 2012

Aim:  To investigate the impact of the Pharmacy Outreach Service (POS) on blood pressure (BP) and disease knowledge among community‐dwelling elderly patients with hypertension, and to evaluate the sustainability of such impact of POS.

Methods:  A prospective open‐labeled study of elderly adults (aged ≥65 years) with hypertension (BP ≥140/90 mmHg for non‐diabetics and ≥130/80 mmHg for diabetics) was carried out at seven elderly community centers from July 2008 to March 2010. Pharmacists provided BP monitoring, medication review and disease knowledge assessment. The target BP was <140/90 mmHg for non‐diabetics and <130/80 mmHg for diabetics. The primary outcome was BP change, whereas the secondary outcome was the change of disease knowledge of hypertension. All outcomes were compared between baseline and the last visit. For POS 2008/09 participants, BP was compared between values obtained during POS 2008/09 and 2009/10.

Results:  A total of 97 participants were recruited. Systolic BP reduced significantly from 152.38 ± 18.80 mmHg to 147.04 ± 20.72 mmHg (P = 0.021), and diastolic BP reduced from 73.84 ± 11.36 mmHg to 71.03 ± 10.97 mmHg (P = 0.010). Cumulative reductions in mean systolic BP and diastolic BP throughout the 2‐year study period were 21.39 ± 24.72 mmHg and 9.88 ± 13.48 mmHg, respectively (P < 0.001). A 12% increase in the at‐goal rate was observed in new participants recruited in 2009 (P = 0.039). Disease knowledge of hypertension improved significantly (P < 0.005), particularly in areas that included the definition of hypertension, diet and lifestyle modification.

Conclusions:  The POS might improve blood pressure control, hypertension and diabetes knowledge in elderly adults with hypertension in Hong Kong. The effect on blood pressure improvement was sustainable. Geriatr Gerontol Int 2013; 13: 175–181.
Early prediction of adverse events in enhanced recovery based upon the host systemic inflammatory response
Authors: Lane J. C. , Wright S. , Burch J. , Kennedy R. H. , Jenkins J. T.
Published: June 2012

Aim  Early identification of patients experiencing postoperative complications is imperative for successful management. C‐reactive protein (CRP) is a nonspecific marker of inflammation used in many specialties to monitor patient condition. The role of CRP measurement early in the elective postoperative colorectal patient is unclear, particularly in the context of enhanced recovery (ERAS).

Methods  Five hundred and thirty‐three consecutive patients who underwent elective colorectal surgery between October 2008 and October 2010 within an established ERAS programme were studied. Patients were separated into a development group of 265 patients and a validation group of 268 patients by chronological order. CRP and white cell count were added to a prospectively maintained ERAS database. The primary outcome of the study was all adverse events (including infective complications, postoperative organ dysfunction and prolonged length of stay) during the initial hospital admission. Significant predictors for adverse events on univariate analysis were submitted to multivariate regression analysis and the resulting model applied to the validation group. The validity and predictive accuracy of the regression model was assessed using receiver operating characteristic curve/area under the curve (AUC) analysis.

Results  CRP levels > 150 mg/l on postoperative day 2 and a rising CRP on day 3 were independently associated with all adverse events during the hospital admission. A weighted model was applied to the validation group yielding an AUC of 0.65 (95% CI 0.58–0.73) indicating, at best, modest discrimination and predictive accuracy for adverse events.

Conclusion  Measurement of CRP in patients after elective colorectal surgery in the first few days after surgery within ERAS can assist in identifying those at risk of adverse events and a prolonged hospital stay. A CRP value of > 150 mg/l on day 2 and a rising CRP on day 3 should alert the surgeon to an increased likelihood of such events.
Does the incidence of unexpected malignancy in ‘benign’ rectal neoplasms undergoing trans‐anal endoscopic microsurgery vary according to lesion morphology?
Authors: Dash I. , Walter C. J. , Wheeler J. M. D. , Borley N. R.
Published: June 2012

Aim  Mucosectomy by trans‐anal endoscopic microsurgery (TEMS) allows safe and effective excision of benign rectal lesions. Preoperative endoscopic, clinical and ultrasonographic assessment aims to select benign lesions whilst avoiding inappropriate mucosectomy in lesions with malignancy. This study examines the relationship between lesion morphology and accurate benign preoperative classification of rectal lesions undergoing TEMS.

Method  Primary lesions preoperatively assessed as benign were identified from a prospective TEMS database. Operative specimen morphology was independently classified by two blinded investigators, using photographs, into flat‐sessile, exophytic or mixed morphology. The accuracy of the preoperative assessment by rectal ultrasonography was compared with the results of histological examination of the excised specimen (χ2 and Fisher’s exact tests).

Results  Of 167 lesions with adequate data, the morphological classification showed 60 flat‐sessile, 56 mixed morphology and 51 exophytic tumours, of which 5, 7 and 9, respectively, contained unexpected malignancy (P = 0.48). Accurate preoperative assessment of a lesion as benign occurred in 89% of flat‐sessile and mixed morphology (n = 55 and 49, respectively) and in 70% of exophytic lesions (n = 36) (P = 0.01). Only the exophytic group contained patients in whom preoperative endoscopic and ultrasonographic staging could not be confidently made (uTx). Histology demonstrated six of the seven uTx cases to be benign.

Conclusion  In this study exophytic polyps were less likely to be accurately classified as benign using preoperative ultrasonography/endoscopy when compared with flat‐sessile or mixed morphology polyps.
Associations between surrogate measures of insulin resistance and waist circumference, cardiovascular risk and the metabolic syndrome across Hispanic and non‐Hispanic white populations
Authors: Martínez‐Larrad M. T. , Lorenzo C. , González‐Villalpando C. , Gabriel R. , Haffner S. M. , Serrano‐Ríos M.
Published: June 2012

Aims  We evaluated the relations between surrogate indices of insulin resistance and waist circumference, metabolic syndrome and coronary heart disease risk across Hispanic and non‐Hispanic white populations.

Methods  The study was a cross‐sectional analysis of participants without diabetes in the San Antonio Heart Study, Mexico City Diabetes Study and Spanish Insulin Resistance Study. We evaluated commonly used indices of insulin resistance, including homeostasis model assessment, McAuley’s index, Gutt’s insulin sensitivity index, Avignon’s insulin sensitivity index and the Stumvoll index with and without demographics, the modified Matsuda index and the product of the triglycerides and glucose index. The metabolic syndrome was defined by American Heart Association/National Heart, Lung, and Blood Institute criteria and coronary heart disease risk by Framingham risk scores.

Results  The Stumvoll index with demographics and the Avignon’s insulin sensitivity index had the strongest correlations with waist circumference across populations. The triglycerides and glucose and McAuley’s indices had the most robust correlations with Framingham risk score. The triglycerides and glucose index had the greatest ability to detect individuals with the metabolic syndrome and ≥ 10% coronary heart disease risk. Some indices display significant variability in the strength of the relationship with adiposity and coronary heart disease risk across populations.

Conclusions  There are significant differences between insulin resistance indices regarding the ability to detect the metabolic syndrome and coronary heart disease risk across populations. Studies may need to consider the index of insulin resistance that best suits the objectives.
Displacement in urban areas: new challenges, new partnerships
Authors: Crisp Jeff , Morris Tim , Refstie Hilde
Published: June 2012

Rapid urbanisation is a key characteristic of the modern world, interacting with and reinforcing other global mega trends, including armed conflict, climate change, crime, environmental degradation, financial and economic instability, food shortages, underemployment, volatile commodity prices, and weak governance. Displaced people also are affected by and engaged in the process of urbanisation. Increasingly, refugees, returnees, and internally displaced persons (IDPs) are to be found not in camps or among host communities in rural areas, but in the towns and cities of developing and middle‐income countries. The arrival and long‐term settlement of displaced populations in urban areas needs to be better anticipated, understood, and planned for, with a particular emphasis on the establishment of new partnerships. Humanitarian actors can no longer liaise only with national governments; they must also develop urgently closer working relationships with mayors and municipal authorities, service providers, urban police forces, and, most importantly, the representatives of both displaced and resident communities. This requires linking up with those development actors that have established such partnerships already.
Purposes for literacy in children's use of the online virtual world Club Penguin
Authors: Marsh Jackie
Published: June 2012

This paper reports on a study of the purposes for literacy discernible in young children's use of the virtual world, Club Penguin. Twenty‐six children aged between 5 and 11 took part in semi‐structured interviews in which their use of virtual worlds was explored. Further, three 11‐year‐old children were filmed using Club Penguin four times each over the period of 1 month in their own homes and they and their parents took part in interviews regarding their use of this virtual world. Findings indicate that the purposes for literacy in virtual worlds such as these are varied and have much in common with purposes for literacy in the off ine world. The virtual world Club Penguin provided a motivating and enjoyable context for reading and writing and enabled the construction and maintenance of online social networks. The implications for research, policy and practice are discussed.
Zurich Fabry study – prevalence of Fabry disease in young patients with first cryptogenic ischaemic stroke or TIA
Authors: Sarikaya H. , Yilmaz M. , Michael N. , Miserez A. R. , Steinmann B. , Baumgartner R. W.
Published: June 2012

Background and purpose

The etiology of stroke in young patients remains undetermined in up to half of the cases. Data on prevalence of Fabry disease (FD) in young people with cryptogenic ischaemic stroke are limited and controversial. We aimed to evaluate the frequency of unrecognized FD in a cohort of stroke patients at a tertiary stroke center.

Methods

Patients suffering from first cryptogenic ischaemic stroke or transient ischaemic attack (TIA) at the age of 18–55 years were screened for the presence of FD. We measured the serum activity of α‐galactosidase (α‐GAL) in all patients. In addition, sequencing of α‐GAL gene was performed in men with low enzyme activity and in all women.

Results

Between January, 2006, and October, 2009, we recruited 150 patients (102 men, 48 women) with a mean age of 43 ± 9 years at symptom onset (135 ischaemic stroke, 15 TIA). The α‐GAL activity was low in nine patients (6%; six men and three women). Genetic sequencing in six men with low enzyme activity and all 48 women detected no α‐GAL gene mutation.

Conclusion

Our study suggests that the yield of screening for FD in patients with first cryptogenic ischaemic stroke or TIA is very low. Further large‐scale studies are needed to investigate the importance of FD amongst patients with recurrent cryptogenic strokes.
Early seizures in first‐ever acute stroke patients in India: incidence, predictive factors and impact on early outcome
Authors: Goswami R. P. , Karmakar P. S. , Ghosh A.
Published: June 2012

Background and purpose

Stroke‐associated early seizures (ES) often complicate the initial course of acute stroke. This study intended to estimate the rate of and the predictive factors for ES and the impact of ES on the clinical outcome in patients with first‐ever acute stroke.

Materials and methods

Consecutive patients with first‐ever acute stroke admitted in the Department of Medicine from June 2010 to December 2011 were prospectively included. ES were defined as seizures occurring within 7 days from acute stroke. Patients with history of epilepsy, transient ischaemic attack, subarachnoid haemorrhage and cerebral venous thrombosis were excluded. Clinical outcomes were measured under the subheadings of mortality and disability at discharge, according to modified Rankin score.

Results

Of the 441 (56.92% male patients, median age 55 years, 49.43% had haemorrhagic stroke) patients, 79 (17.91%, 95% confidence interval (CI): 14.61–21.78%) suffered from ES. At discharge, 37.64% were disabled, and 19.5% were dead. In multivariate analysis, alcoholism, NIHSS at admission, haemorrhagic stroke and cortical location were significant predictors of ES. Thirty‐day mortality was predicted by NIHSS at admission [hazard ratio (HR): 1.14, 95% CI: 1.11–1.18, P < 0.001], history of hypertension (HR: 3.79, 95% CI: 2.1–6.85, P < 0.001), history of alcoholism (HR: 2.43, 95% CI: 1.49–3.95, P < 0.001) and early seizure (HR: 2.58, 95% CI: 1.54–4.34, P = 0.001).

Conclusions

Early seizures occurred in about 18% acute stroke patients. Alcoholism, haemorrhagic stroke, cortical and severe strokes predict development of ES. ES are an independent important risk factor for early mortality.
Evaluating an anxiety group for people with learning disabilities using a mixed methodology
Authors: Marwood Hayley , Hewitt Olivia
Published: June 2012

Accessible Summary

We held an anxiety group for people with learning disabilities

The group ran for 6 weeks and eight people came

After the group, we found out if people felt better. We did this by asking them what was good about the group and asking them to fill out questionnaires.

The effectiveness of group therapy for people with learning disabilities and anxiety management issues is reviewed. People with learning disabilities face increased levels of psychological distress compared to the general population, yet are often faced with a lack of social support and poor coping techniques to manage their distress. A 6‐week cognitive behavioural therapy (CBT) anxiety management group was delivered to eight adults with a mild learning disability by a trainee psychologist and an assistant psychologist. Participants' ages ranged from 17 to 73 years. All participants lived in the local community. Not all participants had a specific anxiety diagnosis, but all required anxiety management input. A mixed methodology using quantitative and qualitative analysis of group outcomes was used. The outcomes from this group suggest that the intervention was successful in treating anxiety for people with learning disabilities. Measures included the Quality of Life Scale, the Glasgow Anxiety Scale and the Health of the Nation Outcome Scale–Learning Disability Version. Interpretative Phenomenological Analysis (IPA) was also used. Data from interviews were coded and analysed thematically. The main themes that emerged included group versus individual input, helpful aspects of the group, talking in front of other people, group composition (including age differences), support partners, and written materials. The outcomes for this group suggest that the intervention was successful in treating anxiety for people with learning disabilities. Practical applications of group therapies for these clients are considered, and recommendations for future groups made. Quantitative and qualitative evaluation methods are compared.
‘Still finest wits are stilling Venus Rose’: Robert Southwell's ‘Optima Deo’, Venus and Adonis, and Tasso's canto della rosa
Authors: LAWRENCE JASON
Published: June 2012

It has been argued, with reference to Venus and Adonis, that Shakespeare is the poet targeted specifically by Robert Southwell in his mournful stanza on love poetry in ‘The Author to the Reader’; this essay argues instead that Southwell's remark has a wider application to English poets of the early 1590s. The image of ‘Venus Rose’ draws attention to Tasso's celebrated canto della rosa (1581), which survives in a manuscript translation attributed to Southwell, although there is a significant shift, where Tasso's carpe diem conclusion is replaced with an invocation to turn to God. It has been suggested that the translation dates from Southwell's time in Rome in the 1580s; this essay favours a later date of composition, arguing that the poet was aware of both Spenser's adaptation of the song, and Daniel's rendering of it in Delia (1592), and that his translation should be read as further evidence of an engagement with contemporary poetry during the Jesuit mission in England. The essay also considers Shakespeare's treatment of the carpe florem motif in Venus and Adonis, arguing for the poet's direct awareness of Tasso's song and the Armida episode, and highlighting his bold reworking of it at the end of the poem.
Phylogenetic relationships among superfamilies of Cicadomorpha (Hemiptera: Auchenorrhyncha) inferred from the wing base structure
Authors: YOSHIZAWA Kazunori , WAGATSUMA Mutsumi
Published: June 2012

The infraorder Cicadomorpha is a monophyletic group of the order Hemiptera, suborder Auchenorrhyncha, and is composed of three superfamilies: Cercopoidea (spittle bugs), Cicadoidea (cicadas) and Membracoidea (leafhoppers and treehoppers). Phylogenetic relationships among the superfamilies have been highly controversial morphologically and molecularly, but recent molecular phylogenetic analyses provided support for Cercopoidea + Cicadoidea. In this study, we examined morphology of the wing base structure in Cicadomorpha and tested the previous phylogenetic hypotheses using the characters selected from the wing base. As a result, a sister‐group relationship between Cicadoidea and Cercopoidea was supported by three synapomorphies (presence of a projection posterior to the anterior notal wing process, presence of a novel notal process anterior to the posterior notal wing process, presence of a novel sclerite between the distal median plate and the base of anal vein). The present study provides the first unambiguous and prominent morphological support for Cicadoidea + Cercopoidea.
Red Blood Cell Transfusion Risks in Patients with End‐Stage Renal Disease
Authors: Tanhehco Yvette C. , Berns Jeffrey S.
Published: June 2012

Prior to the introduction of recombinant human erythropoietin (EPO), red blood cell (RBC) transfusions were frequently required when iron and anabolic steroids failed to improve the clinical symptoms of anemia associated with hemoglobin (Hb) levels that were commonly less than 7 g/dl. After the approval of EPO in the United States in 1989, the Hb levels of patients on hemodialysis dramatically improved and the need for RBC transfusions decreased significantly. The need for RBC transfusion remains for patients who require an immediate increase in their RBC mass due to symptomatic anemia and is likely to increase due to changes in the management of anemia in dialysis patients resulting from clinical trials data, regulatory changes, and new reimbursement policies for EPO. The safety of the blood supply has greatly improved over the last few decades, and the risk of transfusion‐transmitted diseases has now been dramatically reduced. Noninfectious complications of transfusion currently cause the majority of morbidity and mortality associated with transfusion in the United States. Transfusion also brings a risk of alloimmunization, a particular concern for dialysis patients waiting for kidney transplantation. Knowledge of the risks of RBC transfusions will help clinicians better assess the risks and benefits of transfusing patients with ESRD. This article reviews the modern day infectious and noninfectious risks of allogeneic RBC transfusions.
Determination of Bone Architecture and Strength in Men and Women with Stage 5 Chronic Kidney Disease
Authors: West Sarah L. , Jamal Sophie A.
Published: June 2012

Fractures are common in men and women with dialysis‐dependent chronic kidney disease (stage 5D CKD) and are associated with substantial morbidity and mortality. The clinical utility of dual energy X‐ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), noninvasive measures of bone mass and architecture that reflect fracture risk in healthy men and women, is uncertain in patients with stage 5D CKD. This review will outline the epidemiology and etiology of fractures and will summarize the published data that describe the association between fractures, bone mass, and bone strength in stage 5D CKD. Fracture risk assessment in stage 5D CKD is complicated as the etiology of fractures is multifactorial and includes impairments in bone quantity and quality. Cross‐sectional data suggest that bone density by DXA is lower among stage 5D CKD patients with fractures compared with those without, and that this may be particularly true at cortical sites. However, DXA does not capture bone microarchitecture and cannot differentiate between cortical and trabecular bone. Some, but not all studies, that measure cortical and trabecular bone by pQCT in stage 5D CKD, demonstrate a preferential decrease in cortical bone; however, these studies are limited by small sample sizes and cross‐sectional study design. No studies have reported on longitudinal relationships between bone architecture, strength, and incident fractures in patients with stage 5D CKD. Further research is needed to identify noninvasive measures of bone strength that can be used for fracture risk assessment in stage 5D CKD.
Relationship of Negative Affect and Outcome of an Opioid Therapy Trial Among Low Back Pain Patients
Authors: Jamison Robert N. , Edwards Robert R. , Liu Xiaoxia , Ross Edgar L. , Michna Edward , Warnick Meredith , Wasan Ajay D.
Published: June 2012

Objectives:  Patients with chronic noncancer pain frequently report symptoms of depression and anxiety (negative affect), which are associated with higher ratings of pain intensity and a greater likelihood of being prescribed chronic opioid therapy. The purpose of this secondary analysis was to test the hypothesis that initial levels of negative affect can predict treatment‐related outcomes in a double‐blind, placebo‐controlled study of extended‐release (ER) hydromorphone among opioid‐tolerant patients with chronic low back pain.

Methods:  Four hundred fifty‐nine (N = 459) patients participated in the titration/conversion phase of a multicenter study, of which 268 were randomized to receive once‐daily hydromorphone or placebo. All patients completed the Hospital Anxiety and Depression Scale (HADS) at baseline and were divided evenly into Low (N = 157), Moderate (N = 155), and High (N = 147) negative affect groups based on their scores. Group differences in numerical pain intensity measures at home and in the clinic, Roland–Morris Disability ratings, and measures of symptoms from the Subjective Opiate Withdrawal Scale (SOWS) throughout the trial were analyzed.

Results:  Two hundred sixty‐eight of the initial 459 subjects who entered the 2 to 4‐week titration/conversion phase (pretreatment) were successfully randomized to either placebo or ER hydromorphone; a total of 110 patients then completed this double‐bflind phase of the study. Those in the Moderate and High negative affect groups tended to drop out more often during the titration/conversion phase because of the adverse effects or lack of efficacy of their prescribed opioid than those in the Low negative mood group (P < 0.05). Overall, those patients in the Moderate and High groups reported significantly higher pain intensity scores in at‐home and in‐clinic pain intensity ratings (P < 0.05), greater disability on the Roland–Morris Scale (P < 0.01), and more withdrawal symptoms on the SOWS (P < 0.05) than those in the Low group. Higher negative affect scores also predicted less favorable ratings of the study drug during the titration phase (P < 0.05). Interestingly, the High negative affect group showed the most improvement in pain in the placebo condition (P < 0.05).

Conclusions:  Negative affect is associated with diminished benefit during a trial of opioid therapy and is predictive of dropout in a controlled clinical trial.
Beyond Iraq and Afghanistan: Religion and Politics in United States War‐Culture
Authors: Denton‐Borhaug Kelly
Published: June 2012

Abstract:  This article digs beneath the surface of American assumptions regarding war to explore the ethical interconnections between national identity, war, and religion. Striking differences emerge between the dynamics of religion and politics with regard to war and peace in presidential speeches regarding the Iraq and Afghanistan wars, and the analysis of war from an earlier generation, encapsulated by Dr. Martin Luther King Jr.'s “Beyond Vietnam: A Call to Conscience,” from 1967. Study of this political discourse helps us better understand our own reality in the United States, and the moral consequences of our beliefs about war, sacrifice, the human character, and the identity of the nation.
The Power of Invitation: The Moral Discourse of Kairos Palestine
Authors: Fretheim Kjetil
Published: June 2012

Abstract:  In this article I analyze the moral discourse of the Palestinian kairos document A Moment of Truth (2009) using the distinctions between prophetic, ethical, narrative, policy, and participatory discourse offered by James M. Gustafson and Lisa S. Cahill. I conclude that the document articulates a sixth variety: invitational discourse. This is a kind of moral discourse that invites a wide range of groups and individuals into a normative discussion on a given issue.
The Identification of the Triune God: Robert W. Jenson's Approach to the Doctrine of the Trinity
Authors: Tavast Timo
Published: June 2012

Abstract:  Robert W. Jenson's programmatic approach to the doctrine of the Trinity consists of his aim to identify the triune God in an anti‐religious and anti‐nihilistic way. Jenson has in a unique manner carried out this identification, i.e., ontologically, contextually, and narratively; and then defined the limits of his trinitarian doctrine in accordance with this approach. The fundamental prerequisite of Jenson's approach is his “negative” natural theology, including his existential analysis of living in time.
Prospective Study of the Incidence of Contrast‐induced Nephropathy Among Patients Evaluated for Pulmonary Embolism by Contrast‐enhanced Computed Tomography
Authors: Mitchell Alice M. , Jones Alan E. , Tumlin James A. , Kline Jeffrey A.
Published: June 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:618–625 © 2012 by the Society for Academic Emergency Medicine

Objectives:  Contrast‐enhanced computed tomography (CECT) of the pulmonary arteries (CTPA) has become the mainstay to evaluate patients with suspected pulmonary embolism (PE) and is one of the most common CECT imaging studies performed in the emergency department (ED). While contrast‐induced nephropathy (CIN) is a known complication, this risk is not well defined in the ED or other ambulatory setting. The aim of this study was to define the risk of CIN following CTPA.

Methods:  The authors enrolled and followed a prospective, consecutive cohort (June 2007 through January 2009) of patients who received intravenous (IV) contrast for CTPA in the ED of a large, academic tertiary care center. Study outcomes included 1) CIN defined as an increase in serum creatinine (sCr) of ≥0.5 mg/dL or ≥25%, 2 to 7 days following contrast administration; and 2) severe renal failure defined as an increase in sCr to ≥3.0 mg/dL or the need for dialysis within 45 days and/or renal failure as a contributing cause of death at 45 days, determined by the consensus of three independent physicians.

Results:  A total of 174 patients underwent CTPA, which demonstrated acute PE in 12 (7%, 95% confidence interval [CI] = 3% to 12%). Twenty‐five patients developed CIN (14%, 95% CI = 10% to 20%) including one with acute PE. The development of CIN after CTPA significantly increased the risk of the composite outcome of severe renal failure or death from renal failure within 45 days (relative risk = 36, 95% CI = 3 to 384). No severe adverse outcomes were directly attributable to complications of venous thromboembolism (VTE) or its treatment.

Conclusions:  In this population, CIN was at least as common as the diagnosis of PE after CTPA; the development of CIN was associated with an increased risk of severe renal failure and death within the subsequent 45 days. Clinicians should consider the risk of CIN associated with CTPA and discuss this risk with patients.