bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance measurement action research
Authors: Zhou Moss Qi , Alho Johanna , Alexander Keith
Published: September 2007

Purpose

The purpose of this paper is to summarise the four phases of the action learning processes that Centre for Facilities Management have undertaken with a major central government department.

Design/methodology/approach

Action research. The researchers have been imbedded in the client organisation through knowledge transfer programme and went through an action learning process with the organisation.

Findings

The researchers have implemented the new and improved performance management system and shared KPIs with the department. The new system has been aimed to address the problems within the previous system.

Research limitations/implications

The action learning cycle was not fully completed as the new system has not been evaluated by the researcher yet.

Practical implications

The problems with the department's performance measurement system (PMS) are very common among other facilities department who are trying to manage their suppliers. Therefore, they should be able to learn the lessons and processes of how to establish an effective performance management system.

Originality/value

This is the first time the researchers have published the whole action research process they went through in trying to review, design and implement the PMS.
Epidermal growth factor receptor mutation status and clinicopathological features of combined small cell carcinoma with adenocarcinoma of the lung
Authors: Fukui Tomoya , Tsuta Koji , Furuta Koh , Watanabe Shun‐ichi , Asamura Hisao , Ohe Yuichiro , Maeshima Akiko Miyagi , Shibata Tatsuhiro , Masuda Noriyuki , Matsuno Yoshihiro
Published: September 2007

In lung cancer, somatic mutations of epidermal growth factor receptor (EGFR) are concentrated in exons 18–21, especially in adenocarcinoma (Ad), but these mutations have rarely been reported in small cell lung carcinoma (SCLC). Combined SCLC is rare, and the EGFR mutation status and its relationship to the clinicopathological features of this tumor type have not yet been elucidated. We retrospectively studied six patients with combined SCLC with Ad components among 64 consecutive patients who underwent resection of SCLC. The clinicopathological features of each patient were reviewed, especially for the distribution pattern of the Ad component and lymph node metastases. EGFR mutations were screened by high‐resolution melting analysis in each case, and were confirmed by sequencing of each mutation in the microdissected SCLC or Ad components. Regarding EGFR, no specific mutation was detected in five of the six patients, whereas one female patient who had never smoked had a missense mutation. In this case, both the SCLC and Ad components shared the same mutation in exon 21 (L858R). We identified a patient with combined SCLC with Ad sharing an identical EGFR mutation in both the SCLC and Ad components. In addition to the clinicopathological characteristics of this rare histological type of lung cancer, these findings provide useful information for better understanding the biology, natural history and clinical management of SCLC. (Cancer Sci 2007; 98: 1714–1719)
Suicidal behaviour and associated risk factors among opioid‐dependent individuals: a case–control study
Authors: Maloney Elizabeth , Degenhardt Louisa , Darke Shane , Mattick Richard P. , Nelson Elliot
Published: September 2007

Aims  To examine suicidal behaviour and the associated risk factors among opioid‐dependent cases and non‐opioid‐dependent controls.

Design  Case–control study.

Setting  Sydney, Australia.

Participants  A total of 726 opioid‐dependent cases and 399 non‐opioid‐dependent controls, matched on age, sex and employment status.

Findings  Cases had significantly higher life‐time prevalence of suicidal thoughts (66% versus 55%), suicide attempts (31% versus 20%) and multiple attempts (19% versus 11%) compared to controls. Cases were significantly more likely to indicate a severe intent to die (63% versus 43%). Both cases and controls who had attempted suicide were significantly more likely than others to suffer from substance use and psychological disorders, as well as childhood maltreatment. Risk factors which predicted suicide attempts were the same among cases and controls, including screening positive for borderline personality disorder, post‐traumatic stress disorder and persistent suicidal thoughts.

Conclusions  Although controls had elevated levels of suicidal behaviour compared to those seen in general population surveys, the prevalence of suicidal behaviour among cases was still much higher. Although opioid dependence was related to suicidal behaviour, it did not make a unique contribution to the risk of suicide attempts over and above the other risk factors identified.
The effect of epidural opioids on maternal oxygenation during labour and delivery
Authors: PORTER J. S. , BONELLO E. , REYNOLDS F.
Published: September 2007

The effects of epidural fentanyl on the incidence of maternal hypoxaemia during labour and on neonatal welfare were examined. Women were randomly allocated to receive one of two epidural infusions, bupivacaine 0.125% alone or bupivacaine 0.0625% with 2.5 μg.ml−1 fentanyl, and maternal arterial oxygen saturation was monitored continuously until delivery. The median incidence of desaturation (Spo2 < 95%) during the active phase of the second stage of labour was significantly greater in the fentanyl group than in controls (2.9 versus 0.6 min.h−1, p = 0.02). Similarly, the incidence ofdesaturation to Spo2 < 90% was greater in the fentanyl group than in controls (p = 0.02). There was no correlation between maternal oxygenation or plasma fentanyl concentration and neonatal welfare as measured by umbilical arterial and venous blood gas and acid base status. Apgar score and Neurologic and Adaptive Capacity Score.
Use of the Airtraq laryngoscope in a model of difficult intubation by prehospital providers not previously trained in laryngoscopy
Authors: Woollard M. , Mannion W. , Lighton D. , Johns I. , O'Meara P. , Cotton C. , Smyth M.
Published: September 2007

This study evaluated the ability of prehospital providers who had no previous training in intubation, to use an Airtraq laryngoscope to intubate a manikin model of a Cormack and Lehane grade III/IV view. Volunteers attending the Australian College of Ambulance Professionals conference, Adelaide, in November 2006 received approximately 5 min of Airtraq training. First‐time intubation success rate was 26/33 (79%) (95% CI 61–91%); oesophageal intubation rate was 0/33 (0%) (95% CI 0–11%); median time to intubation was 17 s (IQR 10–25 s (range 5–30 s)); and median subject‐rated difficulty of use score was 21 out of a maximum of 100 (IQR 7.5–35.5 (range 1–65)). Pre‐hospital providers without previous laryngoscopy training achieved high first‐time intubation success rates when managing a model of a grade III/IV difficult intubation with an Airtraq laryngoscope. Users evaluated it as easy to use and achieved intubation within an acceptable breath‐to‐breath interval.
Comparison of cricothyroidotomy on manikin vs. simulator: a randomised cross‐over study*
Authors: John B. , Suri I. , Hillermann C. , Mendonca C.
Published: September 2007

We compared the time taken to perform cricothyroidotomy on a manikin to that on a medium fidelity simulator, to assess the effect of psychological stress and time pressure on performance. Seventy anaesthetists participated in this randomised cross‐over study. Fifty‐four (77%) anaesthetists took longer on the simulator, with the mean (SD) time taken to perform the procedure on the manikin and simulator 34 (18) and 48 (11) s, respectively (p < 0.001). Anaesthetists with more experience performed the procedure more quickly on both manikin and simulator. We conclude that psychological stress and time pressure in real‐life scenarios can affect the performance of cricothyroidotomy.
A novel tool for the detection of allergic sensitization combining protein microarrays with human basophils
Authors: Lin J. , Renault N. , Haas H. , Schramm G. , Vieths S. , Vogel L. , Falcone F. H. , Alcocer M. J. C.
Published: September 2007

Background
Protein microarray (PM) is a powerful alternative to costly or labour‐intensive diagnostic for the large‐scale detection of allergen‐specific IgE. In this study, we established a proof‐of‐concept that coupling the diversity of protein array with the biological output of basophilic cells is a feasible proposition.

Method
Human basophils purified from the peripheral blood of healthy donors were stripped, re‐sensitized with the serum or IgE preparation to be tested, and incubated with manually spotted protein array chips (FAST slides). The basophilic cell lines KU‐812 and RBL‐703/21 likewise sensitized were compared with peripheral blood basophils by the same approach. Purified basophils or other basophilic cells were incubated with FAST slides for various periods of time, washed, and cell binding was visualized by light microscopy. Basophil activation, indicating the effective cross‐linking of IgE by allergens, was monitored via up‐regulation of basophil activation surface marker (CD 63).

Results
Purified stripped peripheral basophils, re‐sensitized with the serum of a grass pollen‐allergic patient, displayed strong binding to anti‐IgE antibody and grass pollen extract with relatively low unspecific binding. Similar results were obtained with RBL‐703/21, which may be a good replacement for peripheral basophils to avoid the costly, cumbersome and time‐consuming basophil purification.

Conclusion
Our data suggest that coupling the diversity of a PM approach with the potential functionality and biological activity of a cell‐based test is feasible and may result in a new system to detect allergic sensitization.
Wide variation in surgical outcomes for acromegaly in the UK
Authors: Bates P. R. , Carson M. N. , Trainer P. J. , Wass J. A. H. ,   the UK National Acromegaly Register Study Group (UKAR‐2)
Published: September 2007

Objective  Unsuccessful surgery for acromegaly has major consequences for the patient as well as financial consequences for the National Health Service (NHS). Surgical expertise affects the outcome. We have used the UK National Acromegaly Register to assess surgical outcomes in different centres to investigate whether these match the previously published case series.

Design  Retrospective and prospective observational study by analysis of anonymized national computer register records derived from individual clinical case records from 22 UK endocrine units and their associated pituitary surgical services.

Patients  Cases of acromegaly, presenting in 1970–2004, with levels of GH or IGF‐1 (785 and 430 cases, respectively) recorded prior to transsphenoidal adenomectomy and in the 12 months postsurgery, before any subsequent pituitary surgery or radiotherapy. GH‐lowering pharmacological therapy was permitted only if suspended for biochemical testing.

Measurements  Percentage of cases with ‘safe’ mean postoperative GH levels (< 5 mU/l) and/or IGF‐1 in the age‐ and sex‐adjusted normal range.

Results  ‘Safe’ GH, normal IGF‐1, or both was achieved for 26%, 29% and 20% of extrasellar macroadenomas (> 1 cm), respectively, 39%, 39% and 29% of intrasellar macroadenomas, 56%, 51% and 37% of microadenomas (< 1 cm) and 39%, 39% and 28% of cases overall. In centres contributing more than 10 patients’ data, rates of safe GH levels ranged from 20% to 68% and IGF‐1 from 19% to 55%. Success rates in attaining safe postsurgical levels of GH improved only slightly in the UK between 1974 and 1999 but markedly thereafter.

Conclusions  Surgical outcomes for acromegaly in UK centres vary widely and historically have not, except in a few centres, matched those of large published series, which mostly have a success rate around 60%. Results have, however, improved substantially since 2000 and in the most successful units match those of the best published series. Experience is an important determinant of surgical success in acromegaly and the very recent improvement in surgical results in the UK coincides with a trend to concentrate pituitary surgery in the hands of a smaller number of specialists. Therefore, patients should be offered surgery by a dedicated pituitary surgeon with a caseload sufficient to offer the prospect of safe postsurgical GH and IGF‐1 levels for the majority of cases.
Predictors of anterior pituitary insufficiency after traumatic brain injury
Authors: Schneider M. , Schneider H. J. , Yassouridis A. , Saller B. , Von Rosen F. , Stalla G. K.
Published: September 2007

Background  Several studies have reported a high prevalence of hypopituitarism after traumatic brain injury (TBI). Risk stratification is a prerequisite for cost‐effective hormonal screening of these patients. However, it is still unclear which risk factors predispose patients to develop anterior hypopituitarism after TBI.

Objective  To assess clinical and radiological risk factors for post‐traumatic hypopituitarism.

Patients and methods  Seventy‐eight consecutive patients (52 men, 26 women; mean age 36·0 years, range 18–65 years) with mild, moderate or severe TBI were studied. Endocrine and clinical parameters were assessed 3 and 12 months after TBI.

Results  We found diffuse axonal injury, basal skull fracture and older age to be major risk factors of post‐traumatic hypopituitarism.

Conclusions  We have defined specific risk factors for the development of post‐traumatic hypopituitarism that are consistent with pathophysiological considerations. These findings might help to identify at‐risk patients.
Plankton populations at the bifurcation of the North Pacific Current
Authors: BATTEN SONIA D. , FREELAND HOWARD J.
Published: September 2007

As the eastward‐flowing North Pacific Current approaches the North American continent it bifurcates into the southward‐flowing California Current and the northward‐flowing Alaska Current. This bifurcation occurs in the south‐eastern Gulf of Alaska and can vary in position. Dynamic height data from Project Argo floats have recently enabled the creation of surface circulation maps which show the likely position of the bifurcation; during 2002 it was relatively far north at ∼53°N then, during early 2003, it moved southwards to a more normal position at ∼45°N. Two ship‐of‐opportunity transects collecting plankton samples with a Continuous Plankton Recorder across the Gulf of Alaska were sampled seasonally during 2002 and 2003. Their position was dependent on the commercial ship’s operations; however, most transects sampled across the bifurcation. We show that the oceanic plankton differed in community composition according to the current system they occurred in during spring and fall of 2002 and 2003, although winter populations were more mixed. Displacement of the plankton communities could have impacts on the plankton’s reproduction and development if they use cues such as day length, and also on foraging of higher trophic‐level organisms that use particular regions of the ocean if the nutritional value of the communities is different. Although we identify some indicator taxa for the Alaska and California currents, functional differences in the plankton communities on either side of the bifurcation need to be better established to determine the impacts of bifurcation movement on the ecosystems of the north‐east Pacific.
Fine needle aspiration vs. mTESE in non‐obstructive azoospermia
Authors: El‐Haggar S. , Mostafa T. , Abdel Nasser T. , Hany R. , Abdel Hadi A.
Published: September 2007

This study was carried out on 100 patients with non‐obstructive azoospermia (NOA) to compare between results and complications of fine needle aspiaartion (FNA) vs. microdissection testicular sperm extraction (mTESE) sperm retrieval. They underwent history taking, clinical examination, semen analysis, serum follicle stimulating hormone estimation and scrotal Duplex. One testis was subjected to FNA screening whereas the other testis was subjected to mTESE and histopathology. Follow‐up was by ultrasonography at 1, 3 and 6 months. The overall sperm retrieval rate was 54% by mTESE and 10% by FNA. Spermatozoa were retrieved by mTESE from all cases with hypospermatogenesis, severe hypospermatogenesis, 30% of Sertoli cell only (SCO), 16.7% of germ cell arrest and in 28.6% of tubular hyalinization. Sperms were retrieved by FNA in 33.3% of hypospermatogenesis, 9% in severe hypospermatogenesis, 5% in SCO, 16.7% in germ cell arrest, while no sperms were retrieved in the tubular hyalinization group. The total complication rate following mTESE was 10% in the early phase and none in the long‐term follow‐up compared to 24% of FNA side. It is concluded that mTESE is superior to FNA as regards sperm retrieval rate and lower incidence of complications in NOA patients.
Perceptions of psychiatric care among foreign‐ and Swedish‐born people with psychotic disorders
Authors: Hultsjö Sally , Berterö Carina , Hjelm Katarina
Published: September 2007

Title.  Perceptions of psychiatric care among foreign‐ and Swedish‐born people with psychotic disorders

Aim.  This paper is a report of a study to explore different perceptions of psychiatric care among foreign‐ and Swedish‐born people with psychotic disorders.

Background.  Research from different countries reports a high‐incidence of psychosis among migrants. The risk‐factors discussed are social disadvantages in the new country. To understand and meet the needs of people from different countries, their perspective of psychiatric care must be illuminated and taken into consideration.

Method.  A phenomenographic study was conducted in 2005–2006 using semi‐structured interviews with a convenience sample of 12 foreign‐born people and 10 Swedish‐born people with psychosis.

Findings.  Three categories were identified: personal and family involvement in care; relating to healthcare staff; and managing illness and everyday life. Foreign‐born people differed from Swedish‐born people in that they struggled to attain an everyday life in Sweden, relied on healthcare staff as experts in making decisions, and had religious beliefs about mental illness. Among Swedish‐born people, the need for more support to relatives and help to perform recreational activities was important.

Conclusion.  It is important to identify individual perceptions and needs, which may be influenced by cultural origins, when caring for patients with psychosis. Previous experience of care, different ways of relating to staff, and individual needs should be identified and met with respect. Social needs should not be medicalized but taken into consideration when planning care, which illustrates the importance of multi‐professional co‐operation.
Leichhardt’s maps: 100 years of change in vegetation structure in inland Queensland
Authors: Fensham R. J.
Published: September 2007

Aim  To address the hypothesis that there has been a substantial increase in woody vegetation cover (‘vegetation thickening’) during the 100 years after the burning practices of aboriginal hunter‐gatherers were abruptly replaced by the management activities associated with pastoralism in north‐east Australia.

Location  Three hundred and eighty‐three sites on 3000 km transect, inland Queensland, Australia.

Methods  Vegetation structure descriptions from the route notes of the first European exploration of the location by Ludwig Leichhardt in 1844–45 were georeferenced and compiled. Leichhardt’s application of structural descriptors (e.g. ‘scrub’, ‘open forest’, ‘plain’) was interpreted as domains within a matrix of tall stratum and low stratum woody cover. Woody cover was also interpreted for the same locations using aerial photography that largely pre‐dates extensive land clearing (1940s–1970s) and compared with their structural domain in 1844–45. The fire‐sensitive tree, cypress‐pine (Callitris glaucophylla) was singled out for case study because it has been widely proposed that the density of this tree has substantially increased under European pastoral management.

Results  The coarse resolution of this analysis indicates that the structure of the vegetation has been stable over the first 100 years of pastoralism. For example treeless or sparsely treed plains described by Leichhardt (1844–45) had the same character on the aerial photography (1945–78). Leichhardt typically described vegetation that includes cypress‐pine as having a ‘thicket’ structure suggesting dense regenerating stands of small trees, consistent with the signature typical on the aerial photography.

Main conclusions  A large data set of geographically located descriptions of vegetation structure from the first European traverse of inland Australia compared with vegetation structure determined from aerial photography does not support the hypothesis that vegetation thickening has been extensive and substantial. On the contrary the study suggests that the structure of the vegetation has been relatively stable for the first 100 years of European settlement and pastoralism except for those areas that have been affected by broad‐scale clearing.
Home enteral tube feeding in children following percutaneous endoscopic gastrostomy: perceptions of parents, paediatric dietitians and paediatric nurses
Authors: Brotherton A. , Abbott J. , Hurley M. , Aggett P. J.
Published: September 2007

Background: The perceptions of parents and professionals are important in deciding to feed children by gastrostomy, yet there are few published studies in this field. This study explored and compared the perceptions of parents to those of paediatric outreach nurses and paediatric dietitians.

Methods: A cross‐sectional mixed‐method study with purposive sampling was undertaken using structured interviews and questionnaires to explore perceptions of percutaneous endoscopic gastrostomy (PEG) placement and feeding. Binomial regression was used to investigate differences in perceptions across the groups of participants.

Results: Parents, paediatric outreach nurses and dietitians shared similar perceptions regarding success of feeding, support for gastrostomy reinsertion and the acceptability of the child’s quality of life. Much greater differences in perceptions were evident regarding the parents’ involvement in the decision‐making process for PEG placement and the adequacy of the support received from healthcare professionals.

Conclusions: A high level of support for feeding was demonstrated together with strong perceptions across all groups that feeding was successful. It is important for healthcare professionals to consider the perceptions of the parents throughout decision making and provision of care following PEG placement because it is highly likely there will be differences in the perceptions between parents and healthcare professionals.
ADP/ATP carrier is required for mitochondrial outer membrane permeabilization and cytochrome c release in yeast apoptosis
Authors: Pereira Clara , Camougrand Nadine , Manon Stéphen , Sousa Maria João , Côrte‐Real Manuela
Published: September 2007

Adenine nucleotide translocator (ANT) is a mitochondrial inner membrane protein involved in the ADP/ATP exchange and is a component of the mitochondrial permeability transition pore (PTP). In mammalian apoptosis, the PTP can mediate mitochondrial outer membrane permeabilization (MOMP), which is suspected to be responsible for the release of apoptogenic factors, including cytochrome c. Although release of cytochrome c in yeast apoptosis has previously been reported, it is not known how it occurs. Herein we used yeast genetics to investigate whether depletion of proteins putatively involved in MOMP and cytochrome c release affects these processes in yeast. While deletion of POR1 (yeast voltage‐dependent anion channel) enhances apoptosis triggered by acetic acid, H2O2 and diamide, CPR3 (mitochondrial cyclophilin) deletion had no effect. Absence of ADP/ATP carrier (AAC) proteins, yeast orthologues of ANT, protects cells exposed to acetic acid and diamide but not to H2O2. Expression of a mutated form of Aac2p (op1) exhibiting very low ADP/ATP translocase activity indicates that AAC's pro‐death role does not require translocase activity. Absence of AAC proteins impairs MOMP and release of cytochrome c, which, together with other mitochondrial inner membrane proteins, is degraded. Our findings point to a crucial role of AAC in yeast apoptosis.
Possible flexural accommodation on the eastern edge of the Altiplano in relation to focussed erosion in the Rio La Paz drainage system
Authors: Zeilinger Gerold , Schlunegger Fritz
Published: September 2007

It has been proposed that erosional unloading by focused incision can be accommodated by flexural rebound, which in turn, potentially exerts a positive feedback on erosion. This paper presents morphometric data from the La Paz drainage basin in the Bolivian Andes to illustrate the effects of such a feedback mechanism between erosion and crustal bending. The Rio La Paz is a prominent system with the headwaters on the Altiplano and a trunk stream segment that cuts across the Cordillera Real thereby connecting large portions of the Altiplano with the Amazon Basin. The flexural feedback model explains why all drainages beyond the watershed disperse their waters to the Altiplano. It also provides an explanation for the presence of the highest peaks just next to the location where the La Paz River cuts into the bedrock across the Cordillera Real.
Pemphigus foliaceus‐like drug reaction in a 3‐month‐old crossbreed dog treated for juvenile cellulitis
Authors: Horvath Christa , Neuber Ariane , Litschauer Barbara
Published: September 2007

Two weeks after administration of routine vaccinations, a 3‐month‐old, male crossbreed dog developed cutaneous lesions that were clinically and histopathologically consistent with a diagnosis of juvenile cellulitis. The patient was treated with systemic antibacterial, antibacterial ophthalmic ointment and nonsteroidal anti‐inflammatory drugs. Within 1 week, new skin lesions that were clinically, histopathologically and immunohistochemically consistent with pemphigus foliaceus developed. The latter completely resolved following drug withdrawal, suggesting a pemphigus foliaceus‐like drug reaction. However, the initial lesions persisted and required glucocorticoid therapy to effect resolution. To the authors’ knowledge, this is the first reported case of a puppy developing juvenile cellulitis followed by a pemphigus foliaceus‐like reaction shortly thereafter, in response to drug therapy.
Clinical, pathologic, and immunopathologic features of dermatitis herpetiformis: review of the Mayo Clinic experience*,†
Authors: Alonso‐Llamazares Javier , Gibson Lawrence E. , Rogers Roy S.
Published: September 2007

Background  Dermatitis herpetiformis (DH) is a cutaneous manifestation of gluten sensitivity, occasionally associated with other autoimmune disorders, and reportedly associated with an increased risk of lymphoproliferative disorders. We describe a series of patients with DH, focusing on associated disorders (particularly celiac disease), incidence of lymphoma, histopathology, and sensitivity of direct immunofluorescence (DIF) testing and serologic testing with antiendomysium antibodies for the diagnosis of DH.

Methods  The medical records of 264 patients with DH diagnosed between 1970 and 1996 were reviewed retrospectively. In addition, the records of six patients evaluated before the advent of DIF testing between 1932 and 1969 were reviewed.

Results  Established celiac disease was present in 12.6% of patients with DH, autoimmune systemic disorders in 22.2%, malignant neoplasms in 10.4%, sarcoidosis in four patients, and ulcerative colitis in six patients. Lymphoproliferative disorders were found in seven patients. The histopathologic examinations showed a marked predominance of neutrophils in the inflammatory infiltrate. DIF testing was positive in 92.4% of the patients tested. Indirect immunofluorescence assay indicated circulating antiendomysial antibodies in the sera of 40 of the 63 patients tested (63.5%).

Conclusions  In this large series of patients with DH from a single institution, patients had a low incidence of symptomatic gluten‐sensitive enteropathy, low risk of lymphoproliferative disorders, and associations with other systemic autoimmune disorders. The value of DIF testing in the diagnosis of DH was confirmed. The detection of antiendomysial antibodies by indirect immunofluorescence was less sensitive than indicated by other reports.
Look who’s taking notes in your clinic: mystery shoppers as evaluators in sexual health services
Authors: Baraitser Paula , Pearce Vikki , Walsh Nathalie , Cooper Richard , Brown Kirsty Collander , Holmes Jo , Smith Lovelle , Boynton Petra
Published: September 2007

Objectives  To test the feasibility of professional patients as a tool for sexual health service evaluation. Professional patients are paid to use services specifically for audit or evaluation purposes without disclosing their identity as evaluators.

Methods  Professional patients visited five large sexual health departments used by 3000 clients per week in two inner London Boroughs with very high rates of sexual ill health. They recorded their experience on a structured evaluation form. Semi‐structured telephone interviews were completed with seven service providers to document their experience of the programme.

Results  Recruitment and training for professional patients is described. Forty professional patients made 105 visits during two rounds of visits 9 months apart. After 47% (round 1) and 62% (round 2) of visits, the professional patients felt that they would recommend the service to a friend. The professional patients provided detailed and specific feedback on all aspects of service provision. This information was highly valued by service providers who reported few objections from staff to the visits. A small number of examples of very poor care were documented.

Conclusions  Professional patients are a useful tool for sexual health service evaluation. They provide high quality feedback because they are both ‘experts’ on sexual health service provision and users of sexual health services. This method of evaluation raises ethical issues about the acceptability of deception as part of the evaluation process, the right of staff to anonymity and to refuse to be visited. Professional patient programmes provide an opportunity for regular cycles of user feedback to monitor quality improvement.
Circulating myeloid and plasmacytoid dendritic cells after allergen inhalation in asthmatic subjects
Authors: Farrell E. , O’Connor T. M. , Duong M. , Watson R. M. , Strinich T. , Gauvreau G. M. , O’Byrne P. M.
Published: September 2007

Background:  Dendritic cells are key contributors to initiation and maintenance of T‐cell immunity to inhaled allergen. The purpose of this study was to enumerate the changes in peripheral blood myeloid (mDCs) and plasmacytoid dendritic cells (pDCs), the DCs expressing chemokine receptor 6 (CCR6) and chemokine receptor 7 (CCR7), following diluent and allergen inhalation in asthmatic subjects.

Methods:  Peripheral blood was obtained from 16 allergic asthmatic subjects before and at 0.5, 1, 2, 3, 4, 6, 24, and 48 h after inhaled diluent and allergen challenges. Dendritic cells were enumerated using flow cytometry.

Results:  Allergen inhalation significantly reduced mDCs at 6 h (21.3 ± 2.0 vs 15.0 ± 1.8/μl blood; P < 0.05) and 24 h (21.5 ± 3.4 vs 16.4 ± 2.4/μl blood; P < 0.05) after challenge. Circulating pDCs were significantly lower than baseline up to 24 h after both allergen and diluent challenges. There was a significant efflux of CCR6+ mDCs from peripheral blood at 6 h and CCR6+ pDCs at 4 h after allergen challenge, when compared with diluent. There was no difference in the number of circulating CCR7+ mDCs or pDCs after diluent or allergen challenges.

Conclusions:  Peripheral blood mDCs and CCR6+ mDCs, but not pDCs, are reduced up to 24 h after allergen inhalation. Thus, allergen inhalation causes trafficking of immature CCR6+ DCs from blood into the airway, while that of the trafficking of the mature CCR7+ DCs from the airways into the regional lymph nodes probably occurs through the lymphatic system.
CD‐sens and clinical changes during withdrawal of Xolair after 6 years of treatment
Authors: Nopp A. , Johansson S. G. O. , Ankerst J. , Palmqvist M. , Öman H.
Published: September 2007

Background:  Many clinical trials with omalizumab, Xolair, have been reported but the treatment period has always been short, i.e. <12 months. After withdrawal, the clinical symptoms tend to return. A group of patients who stopped treatment after approx. 6 years allowed studies of the long‐term effects of Xolair.

Methods:  The patient’s cat or mite allergen sensitivity was quantitated as basophil allergen threshold sensitivity, CD‐sens, and immunoglobulin E (IgE) and IgE‐ and IgG4‐antibodies were determined before start and during treatment withdrawal. Asthma severity was evaluated from forced expiratory volume (FEV), peak expiratory flow (PEF) and a questionnaire.

Results:  At 6–14 months without Xolair 13 of the 18 cat and mite allergic asthmatics had either improved or remained the same as on treatment. Most of the patients were in a stable clinical condition reporting high quality of life, no increased nightly asthma attacks, no emergency visits as well as little or no increase in medication. The CD‐sens to cat showed a peak 4 months after withdrawal but then decreased to levels below those of untreated patients with allergic asthma and at 12 months six of 14 had nonreactive basophils. Cat IgG4 antibody levels were higher than in cat allergics in general.

Conclusion:  Most of the patients 12–14 months had, after closing of 6‐year Xolair treatment, a surprisingly mild asthma. Interestingly, and probably contributing to the clinical results, a downregulation of basophil, and presumably also mast cell, reactivity, was seen.
Quantification of atopy and the probability of rhinitis in preschool children: a population‐based birth cohort study
Authors: Marinho S. , Simpson A. , Söderström L. , Woodcock A. , Ahlstedt S. , Custovic A.
Published: September 2007

Background:  Atopy quantification using IgE levels/skin test diameter (SPT‐MWD) may better predict the expression of rhinitis than using atopy as a dichotomous variable.

Objective:  To investigate the association between the presence, temporal pattern and severity of rhinitis in preschool children and specific IgE levels/SPT‐MWDs.

Methods:  Children were followed prospectively to age 5 years in a whole‐population birth cohort study. We administered questionnaires (n = 815), skin prick tested children (n = 717) and measured specific serum IgE (n = 478) to inhalant and food allergens. Main outcomes were current rhinitis (CR) and current rhinoconjunctivitis (CRC).

Results:  The prevalence of CR and CRC was 26.1% and 12.1%, respectively. The risk of CR and CRC increased significantly with increasing IgE to grass, mite and cat; CRC was also associated with increasing IgE to dog and peanut. Similarly, increasing SPT‐MWDs to inhalant allergens were significantly associated with CR and CRC. This association was also shown for grass within the group of atopic children. Perennial and seasonal rhinitis were associated with increasing IgE/SPT‐MWD to mite and grass, respectively. Moderate/severe rhinitis was associated with increasing IgE/SPT‐MWD to grass. In a multivariate analysis, increasing levels of IgE/SPT‐MWD to grass were the strongest independent predictors of both CR (for IgE: OR 1.42, 95% CI 1.23–1.64, P < 0.001) and CRC (for IgE: 1.51, 1.30–1.76, P < 0.001).

Conclusion:  The probability of CR/CRC increases with increasing specific IgE levels or SPT‐MWD. With respect to allergic rhinitis, the absolute levels of specific IgE antibody or the size of SPT wheal offer more information than just the presence/absence of sensitization.
The Bipolar Depression Rating Scale (BDRS): its development, validation and utility
Authors: Berk Michael , Malhi Gin S , Cahill Catherine , Carman A Catherine , Hadzi‐Pavlovic Dusan , Hawkins Mary T , Tohen Mauricio , Mitchell Philip B
Published: September 2007

Objectives:  Unipolar and bipolar depression differ neurobiologically and in clinical presentation. Existing depression rating instruments, used in bipolar depression, fail to capture the necessary phenomenological nuances, as they are based on and skewed towards the characteristics of unipolar depression. Both clinically and in research there is a growing need for a new observer‐rated scale that is specifically designed to assess bipolar depression.

Methods:  An instrument reflecting the characteristics of bipolar depression was drafted by the authors, and administered to 122 participants aged 18–65 (44 males and 78 females) with a diagnosis of DSM‐IV bipolar disorder, who were currently experiencing symptoms of depression. The Bipolar Depression Rating Scale (BDRS) was administered together with the Hamilton Depression Rating Scale (HAM‐D), Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS).

Results:  The BDRS has strong internal consistency (Cronbach’s alpha = 0.917), and robust correlation coefficients with the MADRS (r = 0.906) and HAM‐D (r = 0.744), and the mixed subscale correlated with the YMRS (r = 0.757). Exploratory factor analysis showed a three‐factor solution gave the best account of the data. These factors corresponded to depression (somatic), depression (psychological) and mixed symptom clusters.

Conclusions:  This study provides evidence for the validity of the BDRS for the measurement of depression in bipolar disorder. These results suggest good internal validity, provisional evidence of inter‐rater reliability and strong correlations with other depression rating scales.
The joint evolution of mating system, floral traits and life history in Clarkia (Onagraceae): genetic constraints vs. independent evolution
Authors: DUDLEY L. S. , MAZER S. J. , GALUSKY P.
Published: September 2007

Genetic correlations caused by pleiotropy or linkage disequilibrium may influence the joint evolution of multiple traits as populations or taxa diverge. The evolutionary transition from outcrossing to selfing has occurred numerous times and is often accompanied by phenotypic and genetic changes in multiple traits such as flower size, pollen–ovule ratio, stigma and anther maturity and the age of reproductive maturity. Determining whether the recurring patterns of multitrait change are because of selection on each trait independently and/or the result of genetic correlations among traits can shed light on the mechanism that accounts for such convergence. Here, we evaluate whether floral traits are genetically correlated with each other and/or with whole‐plant traits within‐ and between‐populations and taxa. We report results from a greenhouse study conducted on two pairs of sister taxa with contrasting mating systems: the autogamously selfing Clarkia exilis and its predominantly outcrossing progenitor C. unguiculata and the autogamous Clarkia xantiana ssp. parviflora and its outcrossing progenitor C. xantiana ssp. xantiana. We examined variation within and covariation among maternal families in three populations of each taxon with respect to the age at first flower, the rate of successive flower production and the number of days between bud break and anther dehiscence and stigma receptivity within individual flowers. Based on phenotypic divergence between sister taxa, bivariate regressions, correlations among maternal family means and analysis of covariance (ancova), we did not find unilateral support indicating that genetic constraints govern the joint distribution of floral and whole‐plant traits.
A possible link between parasite defence and residual reproduction
Authors: KARELL P. , PIETIÄINEN H. , SIITARI H. , BROMMER J. E.
Published: September 2007

Life‐history theory centres around trade‐offs between current and future reproduction, but we have little understanding of how such trade‐offs are mediated. We supplementary fed Ural owls (Strix uralensis) during the nestling period and quantified parents’ current and future life‐history components as well as their physiological health by monitoring haematocrit, leucocyte profile, intra‐ and extracellular blood parasites. Feeding led to reduced parental effort but did not improve offspring viability, male parasite defence, or parental survival. Intracellular leucocytozoan infection was reduced in fed females which lasted to the following year's reproductive season (carry‐over effect), when fed females also laid larger and earlier clutches.Leucocytozooninfection therefore may mediate the life‐history trade‐off between current and residual reproduction in this species.
Nitrogen Rates and Water Stress Effects on Production, Lipid Peroxidation and Antioxidative Enzyme Activities in Two Maize (Zea mays L.) Genotypes
Authors: Zhang L.‐X. , Li S.‐X. , Zhang H. , Liang Z.‐S.
Published: September 2007

Effects of nitrogen rates and water stress (WS) on production, lipid peroxidation and antioxidative enzyme activities in two maize (Zea mays L.) genotypes were assessed at different stages under two levels of water supply conditions. WS caused a significant decline in dry matter, grain yield and activities of superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT) whereas a marked rise in malondialdehyde (MDA) concentration was observed in leaves for the two genotypes. However, the responses of the two varieties to WS were different: significantly higher dry matter, grain yield and antioxidative enzyme activities and lower MDA content were observed for Shaandan 9 than Shaandan 911, therefore the former could be treated as a drought tolerance variety comparatively. A better correlation was obtained amongst dry matter, grain yield and physiological traits. The addition of nitrogen increased dry matter and grain yield as well as activities of SOD, POD and CAT to different levels and significantly decreased MDA content under WS. These effects were higher for Shaandan 911 than for Shaandan 9. Furthermore, a significant effect was found for Shaandan 911 between N rates for all traits unlike Shaandan 9. Hence, we suggest that nitrogen should be applied to a water‐sensitive variety to bring out its potential fully under drought.
Naildex: pilot evaluation of an onychodystrophy severity instrument
Authors: Warshaw Erin M. , Traywick Carmen A. , Hoffman Allison A. , Lilly Kia K. , Koshnick Rebecca L. , Robinson Janet W. , Suwattee Pitiporn , Foster Jovonne K. , Chen Suephy C.
Published: September 2007

A valid and reliable measure that captures onychodystrophy disease severity is important for both clinical and research applications. Three hundred and twenty‐two patients at two Veterans Affairs Medical Centers with clinical evidence of onychodystrophy suggesting onychomycosis (at least 25% in a distal subungual pattern) were examined using Naildex parameters. Naildex scores were calculated by a combination of: per cent of each nail infected, area of each nail and number of infected nails. Patients also completed a nail‐specific quality of life questionnaire (NailQoL) and nail samples were collected and examined mycologically. Data was analysed for all enrolled patients (n = 322) and patients with mycologically‐confirmed onychomycosis (n = 243). Inter‐rater reliability was calculated from two examiners who each evaluated 17 patients with mycologically‐confirmed onychomycosis. Significant correlations (P < 0.01) between Naildex and NailQoL as well as proxy measures (duration of infection) indicated construct validity of the instrument for all patients as well as mycologically‐confirmed cases. Strong correlation (r = 0.754, P < 0.01, n = 17) indicated high inter‐rate reliability. This pilot evaluation suggests that Naildex is a valid and reliable measure of onychomycosis severity.
An ex‐vivo oral mucosa infection model for the evaluation of the topical activity of antifungal agents
Authors: Ohnemus U. , Willers C. , Bubenheim M. , Horstkotte M. A. , Houdek P. , Fischer F. , Schmage P. , Moll I. , Brandner J. M.
Published: September 2007

Although Nystatin has been used since 1950s as a non‐absorbable antifungal agent, there is still no reliable in‐vivo data available stating a dose–effect relationship of Nystatin‐suspension in the treatment of oropharyngeal infection with Candida albicans. Here, we studied the efficacy of a commercially available topical Nystatin suspension in a new ex‐vivo model of candidiasis using porcine oral mucosa. After 48 and 96 h of C. albicans infection, 230 IU Nystatin (standard dosage), 100 IU and 20 IU proved to be equally efficacious. Multiple applications of Nystatin were not superior compared with single application. In dosages of 10 and 0.1 IU the activity of Nystatin suspension against C. albicans was no longer confirmed. In an agar diffusion model, the minimal biocidal concentration of Nystatin proved to be 0.25 IU. Our results suggest that the proposed porcine ex‐vivo model is much closer to the in‐vivo situation compared with other established in‐vitro models of the treatment of muco‐cutaneous candidiasis and may provide a substitute for animal models in the investigation of antifungal agents. Additionally, it seems to be a valuable tool for further investigations of the pathogenesis of C. albicans infections.
Hodgkin’s disease of the oesophagus: A literature review
Authors: Jones K , Pacella J , Wasty F
Published: September 2007

Hodgkin’s disease rarely involves the gastrointestinal tract. Primary Hodgkin disease of the oesophagus seems to be extremely rare. We report a case of classical Hodgkin’s disease involving lower end of oesophagus.
Long‐term clinical remission following radiotherapy in tracheal adenocarcinoma: Review of the published work
Authors: Puri T , Gunabushanam G , Malik M , Kukreja M , Julka PK , Rath GK
Published: September 2007

A 55‐year‐old man with tracheal adenocarcinoma presented with difficulty in breathing and cough with blood‐tinged expectoration. As the patient refused surgery, he was treated with definitive radiotherapy to the neck and superior mediastinum to a total dose of 50 Gy (initially 40 Gy by AP/PA portals followed by 10 Gy with a three‐field technique). He showed significant symptomatic relief to radiotherapy and defaulted from further treatment. He remained asymptomatic for 7 years, following which he developed sternal metastases and a local tumour recurrence. This case illustrates that long‐term clinical remission can be achieved by radiotherapy alone in this rare histological subtype of tracheal carcinoma.
Survey of the current practices for neonatal gastrointestinal contrast studies in Australia
Authors: Travadi J , Patole S , Thonell S , Simmer K
Published: September 2007

A wide range of contrast agents with varying osmolality (290–849 mmol/kg) and iodine content (150–370 mg/mL) are currently available for neonatal gastrointestinal contrast studies. A nationwide survey was hence conducted to identify current practices. A questionnaire was mailed to the 22 Australian neonatal units registered with the Australian and New Zealand Neonatal Network. Seventeen (72%) of the 22 units responded to the questionnaire and 54% had some guidelines for term neonates. No unit had a specific policy for preterm neonates. Seventy‐seven per cent of the respondents used a contrast agent with a high osmolality. There was a wide variation in the volume and dilution of contrast used. Guidelines for gastrointestinal contrast studies in high‐risk neonates are suggested.