bluuebunny/crossref_metadata_2025 huggingface dataset:
Pancreatoduodenectomy with occlusion of the residual stump by Neoprene® injection
Authors: Di Carlo Valerio , Chiesa Roberto , Pontiroli Antonio E. , Carlucci Michele , Staudacher Carlo , Zerbi Alessandro , Cristallo Marco , Braga Marco , Pozza Guido
Published: May 2005

Pancreatojejunal anastomosis disruption still represents the main postoperative complication after pancreatoduodenectomy. In this study, a technique of occlusion of the residual pancreatic stump instead of pancreatojejunal anastomosis is proposed. Between March, 1981 and August, 1987, we performed 51 pancreatoduodenectomies, using Neoprene®injection in the Wirsung duct, for carcinoma of the pancreatic head (28 cases), ampullary carcinoma (12 cases), islet cell carcinoma (5 cases), and chronic pancreatitis (6 cases). We observed a 33.3% overall morbidity, with a 5.8% operative mortality. The complications observed seemed not to be related to the technique of pancreatic stump occlusion, except for 2 pancreatic fistulas which spontaneously resolved. Abdominal ultrasound and computed tomography scan performed during the follow‐up did not show any significant morphological alteration of the residual stump. Pancreatic endocrine function was assessed in 10 patients by evaluating blood glucose, plasma insulin and plasma glucagon levels both fasting and after oral glucose, and intravenous arginine infusion. These tests were performed before surgery and 15 days, 6 months, 1, 2, and 3 years after surgery. The results showed that 60% of the patients had impaired glucose tolerance before surgery and the percentage did not significantly change up to 3 years later (75%). No patient developed diabetes mellitus, and only 1 patient progressed from a normal to an impaired glucose tolerance. In conclusion, intraductal injection of Neoprene®after pancreatoduodenectomy seems to be a safer procedure compared to pancreatojejunal anastomosis and does not induce a postsurgical diabetes.
Chronic traumatic aneurysms of the thoracic aorta
Authors: Thévenet André , Du Cailar Claude
Published: May 2005

During the last 10 years (1975–1985), a total of 18 cases of posttraumatic aneurysm at the level of the thoracic isthmus were operated on. Six of the 18 were women (19–71 years of age) and 12 were men (17–61 years of age). The mean age at the time of injury was, respectively, 22 and 25.8 years and, at the time of operation, 34.5 and 35.5 years. The patients were all involved in a motor vehicle accident, except for 2 (1 falling, 1 crushing).

Thirty‐nine percent of the patients had no apparent thoracic injury and 89% had associated injuries (bony fractures, craniofacial, visceral and abdominal). Eight of the 18 were asymptomatic at the time of operation, the others had various symptoms (pain, fever, dyspnea, cough, hoarseness, murmur, or hemoptysis). Enlargement of the aortic button was present in every case.

Seventeen patients were operated on electively from 4 months to 50 years after the injury. Circumferential rupture was total in 9 patients and partial (2/3 to 9/10) in the others. Complete repair was done by either prosthetic Dacron®tube (3), Dacron®patch (2), or direct suture (12). Protection by femoro‐femoral bypass was used in 3 and simple aortic cross‐clamp was used in 14. Mean time of aortic cross‐clamp was 36.9 minutes (range, 16–80 min).

Among these 17 patients, there was no hospital mortality and no late death. One patient had regressive paraplegia. One patient was submitted to an emergency operation for an intrapulmonary rupture of an infected aneurysm and died in the operating room before completion of the repair.

Due to the lethal risk of rupture, traumatic aneurysms of the thoracic aorta have to be looked for systematically and treated surgically.
Lymph node involvement as the only prognostic factor in curative resected gastric carcinoma: A multivariate analysis
Authors: Msika Simon , Chastang Claude , Houry Sidney , Lacaine François , Huguier Michel
Published: May 2005

The aim of this study was to evaluate the independent influence of clinical and pathological variables on survival of patients with gastric carcinoma using the Cox regression proportional hazard model. Of 156 patients operated on for gastric carcinoma, 46 (29.5%) underwent palliative operation, 24 (15.5%) had a palliative resection, and 86 (55%) had a curative resection. The overall 5‐year survival rate was 25±4%. After curative resection, the 5‐year survival rate was 44±6%. Univariate analysis applied to these patients showed that poor survival was related(p<0.01)to : age (over 80 years), absence of epigastric pain, vomiting and dysphagia, total gastrectomy, tumor size (more than 4 cm), lymph node involvement (LNI), invasion through the muscularis propria, absence of intestinal metaplasia near the tumor, and linitis plastica. In multivariate analysis, lymph node involvement was found to be the only independent prognostic factor. The 5‐year survival rate was 75.5±8% without LNI, 28±10% with proximal LNI, and 7±6% with distal LNI. Our results suggest that classification into 3 LNI groups is the best staging system for curative resection in gastric carcinoma.
The surgical treatment of infective endocarditis
Authors: Mullany Charles J. , McIsaacs Andrew I. , Rowe Michael H. , Hale George S.
Published: May 2005

We have reviewed 108 cases of bacterial endocarditis treated surgically since 1968. The mean age of the patients was 47.7±15.6 years (± SD) (range, 14–79 yr). Seventy‐seven percent were male. The most common causative organisms were staphylococci (46%), streptococci viridans group (25%), and other streptococci (20%). Forty‐five percent, 25%, and 13% of patients had native aortic valve, native mitral valve, or native double valve (AV/MV) involvement, respectively. Eighteen patients had prosthetic valve endocarditis. No patient underwent surgery for tricuspid valve endocarditis. Seventy‐three patients were considered to have active endocarditis (AE) (positive blood or tissue cultures and/or annular abscesses). The 35 remaining patients had healed endocarditis (HE). Preoperative complications in patients with either AE or HE were stroke (11%, 11%), renal failure (33%, 3%;p<0.001), pulmonary edema (83%, 34%;p<0.001), anemia (36%, 8%;p<0.01), and inotrope dependence (22%, 6%;p<0.05). Hospital mortality for native valve AE was 19.6% (11/56), and for healed endocarditis, 5.7% (2/35). Independent predictors of hospital mortality were inotrope dependence (p<0.001), annular abscess (p<0.01), pulmonary edema (p<0.01), and staphylococcal infection (p<0.05). The 5‐year actuarial survival for operative survivors was 68.4±7.5% (AE) and 78.3±9.2% (HE). We conclude that the operative mortality for patients with continuing sepsis is high and that surgery should be undertaken early in staphylococcal endocarditis. If surgery is successful, then the long‐term prognosis is good.
Contribution of di-nitrogen fixation by pea to the productivity and N budget of a wheat-based cropping system
Authors: SOON Y. K. , ARSHAD M. A.
Published: May 2005

The productivity and N budget of three crop rotations were determined in a field study beginning in 1997. A duplicate experiment was initiated in 1998; each experiment lasted 3 years. The rotations were: continuous wheat (WWW), oilseed rape-wheat-wheat (RWW) and pea-wheat-wheat (PWW). Wheat and oilseed rape received 0 or 60 kg N/ha, apart from fertilized wheat following pea, which received 22·5 kg N/ha, and in the third year of the rotation all plots received 60 kg N/ha. Peak N2 fixation by pea averaged 86 kg N/ha and grain N offtake was 74 kg N/ha. In the spring following the unfertilized crops the trend for soil NO3-N was: pea>oilseed rape>wheat. The yields of second and third phase wheat followed the order: PWW>WWW>RWW. The superior yield of second phase wheat following pea is attributed to greater availability of N, mainly below the 25 cm depth of soil. Yields of second phase wheat of the other rotations showed no response to N fertilizer, probably because of dry surface soil in those years. Nitrogen deficits of the no-N treatments over the rotation cycle were 31 kg/ha for PWW and RWW and 87 kg/ha for WWW. Application of N fertilizer reduced the N deficit to 13 kg/ha for PWW and resulted in N gains of 22 kg/ha for WWW and 82 kg/ha for RWW. Oilseed rape yields of this study were much lower than normal for the region, thus N removal in the grain was low. It is concluded that pea is superior to oilseed rape as a break crop, and to maintain N balance through the rotation, wheat following pea required about 20 kg/ha less fertilizer N than was applied to wheat following non-legume crops.
Relationships between stomatal character, photosynthetic character and seed chemical composition in grass pea at different water availabilities
Authors: YANG H. M. , ZHANG X. Y. , WANG G. X.
Published: May 2005

Grass pea (Lathyrussativus) is a potentially valuable feed and food crop in semi-arid regions. Much work has been done on lowering toxicity and on selection of low toxicity varieties, while research on the eco-physiological characteristics of grass pea is very rare. Stomatal character, photosynthetic character and seed chemical composition were measured in four varieties of L. sativus to investigate their relationships at different water availabilities. For L. sativus cv. Yongshou (YS), L. sativus cv. Dingxi (DX), L. sativus cv. Heilongjiang (HLJ) and L. sativus cv. Xide (XD), stomatal density was in the order XD>HLJ>DX>YS under both control and drought conditions. Stomatal aperture, photosynthetic rate (Pn), transpiration rate (E), and the concentrations of seed β-N-oxalyl-L-α, β-diaminopropionic acid (ODAP), protein and starch were in the order YS>HLJ>DX>XD, while the opposite order was found for water use efficiency (WUE). Under drought conditions, stomatal aperture, Pn and E were lower than those under the control, while the other parameters were higher. A significant positive correlation was observed between stomatal density and WUE, while negative correlations were found between stomatal density and the remaining parameters. Obvious positive correlations were also observed between stomatal aperture and Pn, E, the concentrations of seed ODAP, protein and starch, while a negative correlation appeared between stomatal aperture and WUE. Under drought conditions, R2 values were more comparable with the control. Intriguingly, the R2 values of stomatal aperture were higher than of stomatal density, especially under drought conditions. These results indicate that stomatal aperture may be more closely related to photosynthetic character and seed chemical composition in grass pea, and water deficit may enhance the correlations.
Effects of dietary algal docosahexaenoic acid oil supplementation on fatty acid deposition and gene expression in laying Leghorn hens
Authors: CHENG C. H. , SHEN T. F. , CHEN W. L. , DING S. T.
Published: May 2005

The purpose of the current study was to determine the effects of dietary docosahexaenoic acid (DHA) on fatty acid deposition in egg yolk and various tissues of laying Leghorn hens, and on the expression of hepatic lipogenesis-related transcription factors. There were three treatments with 10 Leghorn hens per treatment. Diets were based on maize-soybean meal (ME: 12 MJ/kg; CP: 171 g/kg; Ca: 34 g/kg) supplemented with 0 (plus 20 g butter/kg), 5 g (plus 15 g butter/kg) or 20 g algal DHA oil/kg. The egg production of the birds was not affected by dietary DHA oil (P>0·05). The DHA content in egg yolks of the laying hens increased significantly (P<0·01) with the dietary supplementation of DHA. The DHA content of the total fatty acids in the egg yolk of laying hens was 4±16, 11±43 and 20±90 g/kg for 0, 5 and 20 g/kg DHA treatments, respectively for the first week, and 6±16, 18±49 and 31±86 g/kg for the second week. Therefore, algal DHA oil can be utilized by laying Leghorn hens to enhance egg yolk DHA content and produce high DHA eggs. The concentrations of triacylglycerol (TG) and cholesterol in plasma of laying Leghorn hens were not affected by dietary DHA treatments (P>0·005). The DHA content in plasma and livers of laying hens was increased with the addition of DHA in the diet (P<0·05). The DHA content in the skeletal muscle of Leghorn hens was also increased with the increase in dietary DHA. The data indicate that dietary DHA oil can be incorporated into plasma, egg yolks and various tissues. The mRNA concentrations of the lipogenesis-related transcription factors, sterol regulatory element binding protein 1 (SREBP1) and SREBP2, in the livers of laying Leghorn hens were not affected by the supplement of algal DHA oil for 2 weeks, suggesting that the expressions of these transcription factors are tightly controlled and not sensitive to DHA treatments in laying hens.
Reductions in insecticide use from adoption of Bt cotton in South Africa: impacts on economic performance and toxic load to the environment
Authors: BENNETT R. , ISMAEL Y. , MORSE S. , SHANKAR B.
Published: May 2005

The study reported presents the findings relating to commercial growing of genetically-modified Bt cotton in South Africa by a large sample of smallholder farmers over three seasons (1998/99, 1999/2000, 2000/01) following adoption. The analysis presents constructs and compares groupwise differences for key variables in Bt v. non-Bt technology and uses regressions to further analyse the production and profit impacts of Bt adoption. Analysis of the distribution of benefits between farmers due to the technology is also presented. In parallel with these socio-economic measures, the toxic loads being presented to the environment following the introduction of Bt cotton are monitored in terms of insecticide active ingredient (ai) and the Biocide Index. The latter adjusts ai to allow for differing persistence and toxicity of insecticides.

Results show substantial and significant financial benefits to smallholder cotton growers of adopting Bt cotton over three seasons in terms of increased yields, lower insecticide spray costs and higher gross margins. This includes one particularly wet, poor growing season. In addition, those with the smaller holdings appeared to benefit proportionately more from the technology (in terms of higher gross margins) than those with larger holdings. Analysis using the Gini-coefficient suggests that the Bt technology has helped to reduce inequality amongst smallholder cotton growers in Makhathini compared to what may have been the position if they had grown conventional cotton. However, while Bt growers applied lower amounts of insecticide and had lower Biocide Indices (per ha) than growers of non-Bt cotton, some of this advantage was due to a reduction in non-bollworm insecticide. Indeed, the Biocide Index for all farmers in the population actually increased with the introduction of Bt cotton.

The results indicate the complexity of such studies on the socio-economic and environmental impacts of GM varieties in the developing world.
Comparative performance and heterosis in single, three-way and double cross pepper hybrids
Authors: GELETA L. F. , LABUSCHAGNE M. T.
Published: May 2005

Eight single, six three-way and six double cross hybrids were evaluated with a standard control to assess their yield potential and agronomic performance. The study was conducted in the field and greenhouse using a randomized complete block design with three replications at the University of the Free State during 2002/03. The three categories of hybrids performed differently and showed high variation for the majority of characters studied. Three-way cross hybrids showed better performance for days to flowering (70·9 days after sowing), fruit diameter (3·2 cm) and fruit weight (30·3 g/fruit). As expected, single cross hybrids were the most uniform followed by three-way cross hybrids. Three-way cross hybrids showed 36·1 and 13·6% heterosis for fruit yield and fruit length, respectively. Higher mean heterosis for fruit yield (35·6%), fruit number (24·0%) and fruit weight (16·9%) was also observed in double cross hybrid. This study shows that three-way and double cross hybrids can be used in pepper hybrid breeding. Selection of inbred lines for crossing from a similar market group can decrease heterogeneity in these categories of hybrids.
When Was Anti-Catholicism? A Response
Authors: HUGHES TRYSTAN OWAIN
Published: May 2005

In his critique of my article Paul O'Leary brings his expertise on nineteenth-century Wales to bear on issues I raise. In doing so, he consolidates and complements certain areas of my original thesis. My aim was, after all, to highlight anti-Catholicism in twentieth-century Wales, rather than dismiss hostility a century earlier. In other areas, however, he misinterprets or misrepresents my article, largely because he fails to recognise the subtleties in the character and nature of Welsh anti-Catholicism over the two centuries. During the nineteenth century, there was undoubtedly a deep-seated hatred and fear of Roman Catholicism in Wales. Protestant dissent was, by its very nature and disposition, hostile to Rome. Anti-Catholicism was, therefore, endemic to Wales during this time and my work has never suggested otherwise. However, it is essential that the nuances in the different types of hostility, already touched upon in my initial article, be identified. The clear diversity between the form that anti-Catholicism took in the nineteenth century and the character it took a century later can then be compared and assessed.
Mediating the Word: Language and Dialects in the British and Irish Reformations
Authors: HEAL FELICITY
Published: May 2005

Translating the Scriptures into the vernacular was a primary concern of Protestant reformers. This led to worries about the precise language-form in which they should be made accessible to lay folk. This article situates such evangelical debates within contemporary understanding of the nature and role of native tongues. Tudor and Stuart governments sometimes saw English as a tool of political control; humanists questioned the ‘copiousness’ of the vernacular; the Celtic tongues were readily identified with barbarity; the status of the written word might be contaminated by the use of dialect. Translators and authors sought to address these concerns, with great success in England, Lowland Scotland and Wales, but much less effectively in Gaelic-speaking Ireland and Scotland.
Popular Religion in Decline: A Study from the Black Country
Authors: SYKES RICHARD
Published: May 2005

This article contributes to the debates about nineteenth- and twentieth-century working-class religiosity and about the nature, timing and extent of secularisation. After defining ‘popular religion’ and identifying its key components in the context of the Black Country from 1914 to 1965, its decline during the last thirty years of the period is analysed, using extensive oral evidence, in terms of four principal factors: the effects of war; an increasing emphasis on the private nuclear family and changing attitudes to children; the disappearance of older working-class neighbourhoods and communities; and greater prosperity and the availability of secular leisure facilities.
Reginald Pecock on the Authority of Reason, Scripture and Tradition
Authors: LAHEY STEPHEN E.
Published: May 2005

Bishop Reginald Pecock (c. 1390–1461) is remembered for vernacular works formulated to combat Lollardy using reason, not the force of ecclesiastical authority. He argued that Scripture's teachings are true not because they are in Scripture, but because they are evident to unassisted reason. While scholars have explored his arguments in ecclesiastical and historical context, little analysis exists of the scholastic background to Pecock's conception of the relation of reason to faith. This article suggests that Pecock's arguments are grounded in the thought of Aquinas and Scotus, and illustrates how his understanding of reason's capabilities directs his conception of the authority of Scripture and church tradition.
The ‘Cleveland Medea’ Calyx Crater and the Iconography of Ancient Greek Theatre
Authors: REVERMANN MARTIN
Published: May 2005

This article examines a spectacular example of Greek theatre-related vase iconography, the so-called ‘Cleveland Medea’, by studying the ways in which a painter appropriates iconography for his own narrative purposes. Of special interest are the interactions called for by the vessel from its prospective viewers in the symposium context. Throughout, the artefact is treated as an important document of the cultural history of Greek tragedy in the fourth century BCE.
Of Textual Bodies and Actual Bodies: the Abjection of Performance in Lessing's Dramaturgy
Authors: JÜRS-MUNBY KAREN
Published: May 2005

Proceeding from the observation that Gotthold Ephraim Lessing's famous Hamburgische Dramaturgie (Hamburg Dramaturgy) soon abandons the analysis of actual performances in favour of a discussion of character, the article explores Lessing's problematic relationship with the performing body, situating it in the context of an increasingly textual culture. It shows the implications of this move in terms of gender prescriptions before discussing Lessing's ‘disgust’ with a particular performance of his Emilia Galotti. Reading this example with Lessing's treatise Laokoon and drawing on Julia Kristeva's theory of abjection, it argues that Lessing's struggle with the performers reveals a profound crisis in subject formation in the sense that the disturbing corporality of the performing body is always threatening sympathetic identification. The article concludes that the Dramaturgie itself constitutes an ‘abjection’ of performance. A postscript opens up the view onto the contemporary relevance and refiguration of Lessing's Laokoon in the Laokoon Festival in Hamburg.
The Emotional Memory of Directing
Authors: BLAU HERBERT
Published: May 2005

Stanislavsky's ‘emotion memory’, basic to Method acting, is a pretext, if not subtext, for reflections on the vicissitudes of directing, most particularly as it confronts the one inescapable emotion, stage fright, which may be seen, rather, as an existential condition – without which, actually, there would be no theatre. Or at least, without a sense of psychic or physical risk, no theatre of any consequence. If susceptibility to such risk is expected of the actor, whose technique is a way of dealing with stage fright, much of what is done in directing is an equivocal cover up, because the credibility of performance draws upon that fright, hiding it and exploiting it, all the more as we approach the limits of performance. As for the emotion memories of the essay, and the emotions about memory too, these are drawn from a long career in theatre, marked by experiment and controversy, and an insistence that, for all the stress on emotions, the mandate of performance is to bring it into thought, or what – neurally, analytically, bodies, minds, psyche, senses, every form of intelligence activated – is referred to as blooded thought.
Challenging the Ghosts: Leopold Jessner's Hamlet
Authors: MARX PETER W.
Published: May 2005

When in 1926 Leopold Jessner (1878–1945) staged Hamlet at the Prussian State Theatre in Berlin, the production created a major scandal. This uproar was not only related to aesthetic matters but also to the discourse of national identity. With reference to Marvin Carlson's concept of the ‘haunted stage’ the article examines the traces of this scandal in the genealogy of Hamlet on the German stage and its intersection with the politics of national identity. These traces indicate that German productions of Hamlet have always been determined by an implicit politics of exclusion. Jessner's production, by contrast, offered a radical re-reading of Hamlet, aiming to adapt it for the, then newly democratized society. The rejection of this adaptation by major parts of the audience, thus revealed the still powerful and active anti-democratic forces in the Weimar Republic.
Editorial
Authors: BALME CHRISTOPHER
Published: May 2005

It is my pleasure to present the first number of Theatre Research International in 2005. This issue is the second of several under my editorship that will have a focus section. The first on ‘postdramatic theatre’ (29.1) has occasioned a great deal of interest (at least judging by the number of downloads from the journal's website) and this positive response suggests that the policy of publishing focus issues meets a genuine need. Focus issues will seek to explore a particular topic from a number of different perspectives. In keeping with the journal's international readership this invariably translates into articles from scholars working in different countries and scholarly traditions. A focus issue does not usually mean, however, that an entire issue will be given over to the topic. As the present number on the ‘director in the theatre’ indicates, three to four articles are usually sufficient to define (but certainly not exhaust) a topic. This means that some space in the journal will be reserved for articles submitted and reviewed in the normal fashion.
Transmission of F4+ E. coli in groups of early weaned piglets
Authors: GEENEN P. L. , DÖPFER D. , VAN DER MEULEN J. , DE JONG M. C. M.
Published: May 2005

The aim of this study was to estimate transmission parameters of enterotoxigenic F4+ Escherichia coli F4 (F4+ E. coli) in groups of early weaned piglets with F4-receptor-positive (F4R+) and F4-receptor-negative piglets (F4R−). Transmission of F4+ E. coli was quantified in four heterogeneous groups of F4R+ and F4R− piglets. Infectiousness was determined by the number of F4+ E. coli/g faeces shed during 8 days. Transmission parameters were estimated using generalized linear models assuming a stochastic SIR model. F4R+ piglets were found to be more susceptible than F4R− piglets, but F4R+ and F4R− piglets were not different in infectiousness. The reproduction ratios for homogeneous F4R+ and F4R− populations were estimated as 6·37 (95% CI 1·89–21·48) and 0·02 (95% CI 0·00–1·13) respectively. The implication of these results is that in order to prevent major outbreaks, the fraction of F4R+ piglets should be small (approximately 10% or less). Therefore, selective breeding programmes could contribute to reducing F4+ E. coli-related diarrhoea and transmission.
Patterns of spread and persistence of foot-and-mouth disease types A, O and Asia-1 in Turkey: a meta-population approach
Authors: GILBERT M. , AKTAS S. , MOHAMMED H. , ROEDER P. , SUMPTION K. , TUFAN M. , SLINGENBERGH J.
Published: May 2005

Despite significant control efforts, foot-and-mouth disease (FMD) persists in Turkey, and new strains of serotypes A, O and Asia-1 are periodically reported to enter the country from the east. The status of FMD in Turkey is important regionally because the country forms a natural bridge between Asia where the disease is endemic, and Europe which has disease-free status. This study analysed spatial and temporal patterns of FMD occurrence in Turkey to explore factors associated with the disease's persistence and spread. Annual records of FMD distribution in Turkish provinces throughout 1990–2002, grouped by serotype (O, A and Asia 1), were analysed using geostatistical techniques to explore their spatial and temporal patterns. A meta-population model was used to test how disease status, expressed in terms of presence/absence, extinction, and colonization, and measured at the province level throughout the periods 1990–1996 and 1997–2002, could be predicted using province-level data on: ruminant livestock numbers; meat production-demand discrepancy (as a surrogate measure of animal and animal products marketing, i.e. long-distance contagion through the traffic of mainly live animals to urban centres); and the disease prevalence distribution as recorded for the previous year. A drastic overall reduction in FMD occurrence was observed from the period 1990–1996 to 1997–2002 when the disease was shown to retract into persistence islands. FMD occurrence was associated with host abundance, short distance contagion from adjacent provinces, and meat production-demand discrepancies. With FMD retracting into identified provinces, a shift in predictors of FMD occurrence was observed with a lower contribution of short-distance contagion, and a relatively higher association with meat production-demand discrepancies leading to live animal transport over long distances, and hence presenting opportunities for identifying critical-control points. The pattern of persistence differed according to serotype groups and is discussed in relation to their differential affinity to cattle and small ruminant hosts.
A model-adjusted space–time scan statistic with an application to syndromic surveillance
Authors: KLEINMAN K. P. , ABRAMS A. M. , KULLDORFF M. , PLATT R.
Published: May 2005

The space–time scan statistic is often used to identify incident disease clusters. We introduce a method to adjust for naturally occurring temporal trends or geographical patterns in illness. The space–time scan statistic was applied to reports of lower respiratory complaints in a large group practice. We compared its performance with unadjusted populations from: (1) the census, (2) group-practice membership counts, and on adjustments incorporating (3) day of week, month, and holidays; and (4) additionally, local history of illness. Using a nominal false detection rate of 5%, incident clusters during 1 year were identified on 26, 22, 4 and 2% of days for the four populations respectively. We show that it is important to account for naturally occurring temporal and geographic trends when using the space–time scan statistic for surveillance. The large number of days with clusters renders the census and membership approaches impractical for public health surveillance. The proposed adjustment allows practical surveillance.
Incidence of congenital toxoplasmosis estimated by neonatal screening: relevance of diagnostic confirmation in asymptomatic newborn infants
Authors: CARVALHEIRO C. G. , MUSSI-PINHATA M. M. , YAMAMOTO A. Y. , DE SOUZA C. B. S. , MACIEL L. M. Z.
Published: May 2005

Congenital toxoplasmosis is rarely identified by routine clinical examination. The aim of this study was to estimate the incidence of the disease in the region of Ribeirão Preto, south-eastern Brazil. A definitive diagnosis was made on the basis of the persistence of anti-Toxoplasma IgG antibodies beyond 1 year of age. Blood samples obtained from 15162 neonates and adsorbed onto filter paper were tested for anti-Toxoplasma IgM antibodies. Fifteen samples gave positive results. A definitive diagnosis was confirmed in five of the 13 infants (38·5%) who completed follow-up. These five infants presented with serum IgM and/or IgA antibodies, and clinical abnormalities. Disease incidence was estimated to be 3·3/10000 (95% CI 1·0–7·7), indicating the need for preventive measures. Neonatal screening is feasible, but screening tests with a better performance are required; positive screening results must be carefully confirmed.
Epidemiology of pericardial effusions at a large academic hospital in South Africa
Authors: REUTER H. , BURGESS L. J. , DOUBELL A. F.
Published: May 2005

The aim was to establish the prevalence of large pericardial effusions in the Western Cape Province of South Africa, and to determine the incidence of various types of effusions. A total of 233 patients presented with large pericardial effusions. Each patient underwent tests for HIV, sputum smear and culture, blood culture, blood biochemistry and serological testing. Tuberculous pericardial effusions were diagnosed according to pre-determined criteria. Eighty-four patients (36·1%) were found to be HIV positive; 81 of these (96·4%) had tuberculous pericarditis. More than 65% of the study population was aged between 15 and 39 years. The prevalence of HIV amongst unemployed individuals was 49·0% compared to 30·0% amongst employed individuals. Tuberculous pericarditis was the most common cause of pericardial effusions (69·5%, n=162). It was concluded that tuberculosis (TB) is a leading cause of pericarditis in this province of South Africa. The prevalence of TB confounded by HIV co-infection is steadily increasing, burdening the health-care facilities.
Shigellosis remains an important problem in children less than 5 years of age in Thailand
Authors: LEE H. , KOTLOFF K. , CHUKASERM P. , SAMOSORNSUK S. , CHOMPOOK P. , DEEN J. L. , VON SEIDLEIN L. , CLEMENS J. D. , WANPEN C.
Published: May 2005

This is a review of existing data on the burden of shigellosis in Thailand to determine trends, vulnerable groups, predominant species and serotypes, and antimicrobial resistance patterns. Diarrhoea and dysentery morbidity and mortality data from 1991 to 1999 was collected from the routine surveillance system and demographic data from the government census. International and local literature published between 1988 and 2000 was systematically reviewed. Based on the routine surveillance system, the annual incidence of bacillary dysentery decreased from 1·3 to 0·2/10000 persons per year. The remaining burden is highest in children <5 years of age at 2·7/10000 persons per year. In comparison, a prospective study utilizing active surveillance found an incidence in children <5 years of age that was more than 100-fold higher at 640/10000 persons per year. Despite the decrease in morbidity and mortality based on routinely collected data, shigellosis remains an important problem in children <5 years of age in Thailand.
Risk factors of sexually transmitted infections among migrant and non-migrant sexual partnerships from rural South Africa
Authors: ZUMA K. , LURIE M. N. , WILLIAMS B. G. , MKAYA-MWAMBURI D. , GARNETT G. P. , STURM A. W.
Published: May 2005

In October 1998, cohorts of circular migrant men and their non-migrant sexual partners, and non-migrant men and their non-migrant sexual partners from rural South Africa were recruited and followed-up every 4 months until October 2001. At each visit, information on socio-demographic, sexual behaviour, sexually transmitted infections (STIs) and HIV was collected. In total, 553 individuals aged between 18 and 69 years were recruited. A man and his sexual partner(s) form a sexual partnership. Migration status, age, marital status, age at sexual debut, recent sexual partners and HIV status were found to be important determinants of STI. The risk of STI varies (σ2=1·45, P<0·001) significantly across sexual partnerships even after controlling for important determinants. The variance implies substantial correlation (0·59) between members of the same sexual partnership. Ignoring this correlation leads to incorrect inference. Migration contributes significantly to the spread of STIs. Community interventions of HIV/STI should target co-transmitter sexual partnerships rather than high-risk individuals.
Outbreaks of gastroenteritis due to infections with Norovirus in Switzerland, 2001–2003
Authors: FRETZ R. , SVOBODA P. , LÜTHI T. M. , TANNER M. , BAUMGARTNER A.
Published: May 2005

Viral infections, especially those with noroviruses are the most common cause of acute gastroenteritis in Europe. To obtain information about the epidemic situation of noroviruses in Switzerland, an initial study was launched in the German-speaking part of the country to systematically compile Norovirus outbreak information between 2001 and 2003. In total, 73 outbreaks were registered. Most affected were closed settings, e.g. nursing homes (34%) and hospitals (25%). Transmission pathways were identified in 74% of Norovirus outbreaks. In 81% of these cases person-to-person transmission was the primary route of infection and on seven occasions (13%), a foodborne transmission was the possible cause. Furthermore, Norovirus outbreak characteristics of epidemiological importance are highlighted with a discussion of four selected events.
Risk factors for toxoplasmosis in pregnant women in Kent, United Kingdom
Authors: NASH J. Q. , CHISSEL S. , JONES J. , WARBURTON F. , VERLANDER N. Q.
Published: May 2005

The aim of this study was to establish the relative importance of various risk factors for toxoplasmosis in a United Kingdom antenatal population. Toxoplasma immune status was determined by an immunoassay and linked to a questionnaire exploring dietary and environmental exposure to toxoplasmosis. The overall seroprevalence found was 9·1% (172/1897). A significantly higher seroprevalence was associated with rural location of the childhood home, childhood home in Europe excluding the United Kingdom, feeding a dog raw meat and increased age. A non-significant higher prevalence of toxoplasmosis was observed in women who had lived with a cat or kitten as a child. In contrast to recent European studies only weak associations between diet and toxoplasmosis were found. Gardening activity was not associated with seropositivity but a non-significant lower seroprevalence was seen in gardeners who always wore gloves. This study confirms that toxoplasma prevalence in the United Kingdom has continued to decline since the 1960s. The increasing seroprevalence with age found in this study, highlights the continuing need to educate women of childbearing age about the risk factors for toxoplasmosis.
Sensitivity of the Swedish statutory surveillance system for communicable diseases 1998–2002, assessed by the capture–recapture method
Authors: JANSSON A. , ARNEBORN M. , EKDAHL K.
Published: May 2005

To assess the sensitivity of the Swedish surveillance system, four notifiable communicable diseases in Sweden were examined during 1998–2002 with the two-sources capture–recapture method, based on parallel clinical and laboratory notifications. The sensitivity (proportion of diagnosed diseases actually being notified) was highest for salmonellosis (99·9%), followed by meningococcal infection (98·7%), and tularaemia (98·5%). For penicillin-resistant pneumococci, introduced as a notifiable disease in 1996, the overall sensitivity was 93·4% – increasing from 86·5% in 1998 to 98·5% in 2002. The system benefited from parallel reporting, with a sensitivity of clinical and laboratory notifications alone (all diseases combined) of 91·6% and 95·9% respectively. The sensitivity of both clinical and laboratory notifications was markedly higher in counties using the national electronic reporting system, SmiNet. Thus, sensitivity was higher for diseases with a long tradition of reporting, and there is a run-in period after a new disease becomes notifiable.
Experimental rabies infection in haematophagous bats Desmodus rotundus
Authors: ALMEIDA M. F. , MARTORELLI L. F. A. , AIRES C. C. , SALLUM P. C. , DURIGON E. L. , MASSAD E.
Published: May 2005

In order to determine the susceptibility and serum neutralizing antibody response of Desmodus rotundus to rabies virus, bats were inoculated with a virus isolated from a naturally infected haematophagous bat. Bats were divided into four groups of 10 animals each. Dilutions of rabies virus containing 100, 1000, 10000 and 100000 MICLD50 (lethal dose 50% for mice inoculated by the intracerebral route) were administrated in the pectoral muscle. The presence of rabies virus was detected in brain and salivary glands by fluorescent antibody, mouse inoculation and RT–PCR. The observed mortality for each virus dose was 0, 20, 20 and 60% respectively. Serum neutralizing antibodies were tested for by the rapid fluorescent focus inhibition test, and antibody titres greater than 0·5 IU/ml were found in 53% of bats 30 days after virus inoculation. Resistance to infection was seen in bats that developed low or no detectable antibody response as well as in bats with high titres. Among the 10 bats that died of rabies, eight showed signs of paralytic rabies and two bats showed no clinical signs.
The occurrence of encephalomyocarditis virus (EMCV) in European pigs from 1990 to 2001
Authors: MAURICE H. , NIELEN M. , BROCCHI E. , NOWOTNY N. , BAKKALI KASSIMI L. , BILLINIS C. , LOUKAIDES P. , O'HARA R. S. , KOENEN F.
Published: May 2005

The occurrence of encephalomyocarditis virus (EMCV) among domestic pigs and wild boar in several European countries is described and discussed. From 1990 to 2001 clinical outbreaks were analysed and serum samples, partly from existing screening programmes, were tested for antibodies against EMCV. Most clinical EMCV outbreaks were reported in Belgium (320), followed by Italy (110), Greece (15) and Cyprus (6). The outbreaks appeared to be clustered in ‘endemic areas’ with an increase in outbreaks during the autumn and winter months. The within-herd seroprevalence measured in clinically affected pig farms varied considerably among farms (2–87%), with age (0–84%) and by country. Data from farms with no clinical disease showed that subclinical infection with EMCV was found both within (seroprevalence 6–62%) and outside (up to 17%) the endemic areas of the clinically affected countries as well as in the non-clinically affected countries Austria and France (3–5·4%). Among wild boar, the seroprevalence varied between 0·6 and 10·8%, and a study in Belgium found a prevalence of virus infection of 3·3%.
Exposure time to hepatitis B virus and associated risk factors among children in Edirne, Turkey
Authors: OTKUN M. , ERDOGAN M. S. , TATMAN-OTKUN M. , AKATA F.
Published: May 2005

Hepatitis B virus (HBV) infection is endemic in Turkey, but the main routes of transmission were not well established. This study aims to detect the exposure time to HBV and associated risk factors among children. In a sampling group of chıldren aged 0–19 years living in Edirne, antiHBc, antiHBs and HBsAg were screened by the microELISA method. A questionnaire was also completed for each child. In 717 children that were included in the study, the total antiHBc seropositivity was 5·4% and was 1·8, 0·8, 1·7, 6·8, 11·8% in 0–1, 2–5, 6–10, 11–14, 15–19 years age groups respectively. The overall HBsAg seropositivity was 1·7%. The risk of HBV infection increased after the age of 10 years (OR 7·79, 95% CI 3·01–20·16). Collective circumcision was the only independent factor according to regression analysis. Children living in Edirne should be vaccinated against HBV before reaching 11 years of age.
Molecular epidemiology of rabies in northern Colombia 1994–2003. Evidence for human and fox rabies associated with dogs
Authors: PÁEZ A. , SAAD C. , NÚÑEZ C. , BÓSHELL J.
Published: May 2005

During the period 2000–2003, wild grey foxes (Urocyon cinereoargenteus) in northern Colombia became infected with rabies. In order to derive phylogenetic relationships between rabies viruses isolated in foxes, dogs and humans in this region, 902 nt cDNA fragments containing the G–L intergenic region and encoding the cytoplasmic domain of protein G and a fragment of protein L were obtained by RT–PCR, sequenced and compared. Phylogenetic analysis showed that rabies viruses isolated in foxes, dogs and humans belonged to a single genetic variant. Speculative analysis together with epidemiological data indicated that rabies in foxes may have been due to contact with rabid dogs. Rabies transmission between dogs, wild foxes and humans may happen in natural conditions in northern Colombia. This finding is the first to suggest dog-to-fox rabies transmission in South America, and provides another example of dog rabies variants being able to successfully colonize wildlife hosts.
Wound infections caused by Vibrio vulnificus and other marine bacteria
Authors: OLIVER J. D.
Published: May 2005

Infections caused by Vibrio vulnificus were first reported in 1979 by Blake et al. of the US Centers for Disease Control. At that time described as a ‘rare, unnamed halophilic lactose-fermenting Vibrio species’, V. vulnificus has emerged as the most virulent foodborne pathogen in the United States with a hospitalization rate of 0·910 and a case-fatality rate of 0·390. It is in addition a significant cause of potentially life-threatening wound infections. Infections following ingestion of raw or undercooked seafood, commonly raw oysters, can lead to a primary septicaemia with a fatality rate of 50–60%. An unusual symptom, occurring in 69% of 274 cases reviewed by Oliver, is the development of secondary lesions, typically on the extremities, which are generally severe (often a necrotizing fasciitis) and require tissue debridement or amputation. These cases occur almost exclusively in males over the age of 50 years. Interestingly, this gender specificity has been found to be due to the female hormone oestrogen, which in some manner provides protection against the lethal V. vulnificus endotoxin. Further, most cases occur in persons with certain underlying diseases which are either immunocompromising or which lead to elevated serum iron levels (e.g. liver cirrhosis, chronic hepatitis, haemochromatosis). V. vulnificus infections resulting in primary septicaemia have been extensively studied, and the subject of several reviews. This review concentrates on the wound infections caused by this marine bacterial pathogen, including the more recently described biotypes 2 and 3, with brief discussions of those caused by other marine vibrios, and the increasingly reported wound/skin infections caused by Mycobacterium marinum, Erysipelothrix rhusiopathiae, and Aeromonas hydrophila.
Frail older people – margins of care
Authors: Hughes Jane , Challis David
Published: May 2005

The search for the most appropriate, effective and efficient ways to care for vulnerable older people is an enduring one. Hence, the importance of research which seeks to explore how best to meet the needs of frail older people at the margins of care, whose care needs can therefore be appropriately met in more than one setting. The theme of balance of care has been a recurrent theme in the literature of long-term care and relates to ideas of optimality and efficiency in resource use and has been primarily, but not exclusively, applied to the care of older people. Interestingly, it is not a new concept but rather one which is implicit in policy relating to the care of vulnerable older people since the 1970s, although periodically it has risen to become more explicit. In this context it almost always relates to the relative priority accorded to services provided in the community compared to those provided in long-term care settings, such as care homes or hospital.
Coronary artery disease in the elderly patient
Authors: Cowell S. Joanna , Newby David E. , Boon Nicholas A.
Published: May 2005

Coronary atherosclerosis is a nearly universal finding in people over 75 years old living in developed countries, but is often sub-clinical. Broadly speaking, symptomatic patients manifest coronary artery disease in two distinct ways: chronic stable angina or an acute coronary syndrome. Stable angina produces symptoms of exertional chest pain due to fixed atherosclerotic narrowing of the coronary artery, and requires chronic therapy. In contrast, the acute coronary syndromes, namely acute myocardial infarction (MI) and unstable angina, occur as a result of plaque rupture or erosion leading to acute coronary arterial thrombosis and occlusion that requires emergency hospitalization and treatment.
Diseases of the prostate
Authors: Cannon A , Abrams P
Published: May 2005

Benign enlargement of the prostate gland does not always cause symptoms or obstruction to the flow of urine. Old terminology, for example, ‘prostatism’ can therefore be misleading, and the British Association of Urological Surgeons (BAUS), the International consultation on BPH and the International Continence Society accept the definitions given below:

Benign prostatic hyperplasia (BPH) is a histological diagnosis. The first pathological signs appear under the age of 40 years, followed by a rapid increase in prevalence with age; 80% of 80-year-olds have evidence of BPH. The onset of BPH is dependent on the presence of functioning testes and increasing age. It is characterized by a combination of atrophy and proliferation in both glandular and stromal tissue. Although BPH is detectable in most elderly men, it does not always cause enlargement of the prostate, symptoms, or obstruction to the flow of urine.