bluuebunny/crossref_metadata_2025 huggingface dataset:
Brief interventions in routine health care: a population‐based study of conversations about alcohol in Sweden
Authors: Nilsen Per , McCambridge Jim , Karlsson Nadine , Bendtsen Preben
Published: April 2011

Aims  To investigate how brief alcohol interventions are delivered in routine practice in the Swedish health‐care system.

Design, setting and participants  A cross‐sectional sample of 6000 individuals representative of the adult population aged 18–64 years registered in the Swedish total population register was drawn randomly. Data were collected in 2010 by means of a mail questionnaire. The response rate was 54%.

Measurements  The questionnaire consisted of 27 questions, of which 15 variables were extracted for use in this study. Whether alcohol had been discussed and the duration, contents, experiences and effects of any conversations about alcohol, as reported by patients themselves, were assessed.

Findings  Sixty‐six per cent of the respondents had visited health‐care services in the past 12 months and 20% of these had had one or more conversations about alcohol during these visits (13% of the population aged 18–64 years). The duration of the conversations was generally brief, with 94% taking less than 5 minutes, and were not experienced as problematic. The duration, contents, experiences and effects of these conversations generally varied between abstainers, moderate, hazardous and excessive drinkers. Twelve per cent of those having a conversation about alcohol reported that it led to reduced alcohol consumption. Reduced alcohol consumption was more likely when conversations lasted for 1–10 minutes rather than less than 1 minute and included advice on how to reduce consumption.

Conclusions  Population survey data in Sweden suggest that when health‐care professionals give brief advice to reduce alcohol consumption, greater effects are observed when the advice is longer and includes advice on how to achieve it.
High‐altitude treatment: a therapeutic option for patients with severe, refractory asthma?
Authors: Rijssenbeek‐Nouwens L. H. , Bel E. H.
Published: April 2011

Cite this as: L. H. Rijssenbeek‐Nouwens and E. H. Bel, Clinical & Experimental Allergy, 2011 (41) 775–782.

High‐altitude treatment has been applied for more than a century in the treatment of pulmonary diseases including asthma. Many uncontrolled and controlled studies have shown its beneficial effects in children and adolescents with house dust mite allergic asthma. A recent study also showed an improvement in markers of airway inflammation in adult patients with severe intrinsic asthma, suggesting that factors other than HDM avoidance may contribute to the beneficial influence of the high‐altitude climate therapy on asthma. The dry mountain climate not only has decreased levels of mite allergens but also decreased levels of pollens, fungal spores and air pollution, as well as high exposure to UV light with immunomodulatory and anti‐inflammatory effects. Treatments targeting environmental control have never been investigated systematically in severe asthma, which is surprising, as environmental factors have been recognized as important contributors to asthma severity for many years and more evidence has been accumulating ever since. Preliminary evidence shows the beneficial effects of high‐altitude treatment in patients with severe refractory asthma on symptoms, lung function and oral corticosteroid requirement, irrespective of atopic status. In this narrative review, we will discuss why high‐altitude treatment might be a promising therapeutic option for patients who suffer from this disabling disease.
Validation of a self‐questionnaire for assessing the control of allergic rhinitis
Authors: Demoly P. , Jankowski R. , Chassany O. , Bessah Y. , Allaert F‐A.
Published: April 2011

Cite this as: P. Demoly, R. Jankowski, O. Chassany, Y. Bessah and F‐A. Allaert, Clinical & Experimental Allergy, 2011 (41) 860–868.

Background
Allergic rhinitis affects the lives of patients for whom discomfort is, in most cases, significantly improved by pharmacological treatment.

Objective
To develop and validate a self‐assessment global score for allergic rhinitis control (five items scored from 1 to 5 assessing the rhinitis over the 2 previous weeks).

Methods
Study of acceptability, reliability, validity and sensitivity to change during a prospective observational study in 902 patients selected by 411 general practitioners or allergists.

Results
The score correlated significantly to the clinical picture and to the impact of the rhinitis on social and sports activities at inclusion (P<0.0001). A significant improvement in the score was observed after 15 days of treatment: 14.9±4.0 at inclusion and 21.5±2.9 at re‐evaluation after 15 days of treatment (P<0.0001). Using receiver operating characteristics curve, a score of 20 was the cut‐off for poor vs. well‐controlled rhinitis; a score strictly higher than 20 (best being 25) had a sensitivity of 67%, a specificity of 82%, a negative predictive value of 32% and a positive predictive value of 95%.

Conclusion and Clinical Relevance
The self‐assessment score for allergic rhinitis control appeared to be sensitive to change and correlated to the clinical expression of rhinitis and also to its involvement with treatment. These results suggest that this self‐completion questionnaire could be used in daily practice at each consultation to determine, in a standardized manner, the level of control of the allergic rhinitis of an individual patient.
Plasma FGF21 displays a circadian rhythm during a 72‐h fast in healthy female volunteers
Authors: Andersen Birgitte , Beck‐Nielsen Henning , Højlund Kurt
Published: April 2011

Objective  Fibroblast growth factor (FGF21) is a potent regulator of glucose and lipid metabolism. In rodents, the hepatic expression of FGF21 is controlled by fasting and a circadian regulation, but the physiological role and regulation of FGF21 in humans is not well established. Therefore, the objective of this study was to elucidate the 24‐h profiling of plasma FGF21 during a 72‐h fast.

Study design  After an initial 12‐h overnight fast, plasma levels of FGF21 together with circulating levels of glucose, insulin, glucagon and free fatty acids (FFA) were measured every 6 h during a 72‐h fast in healthy female volunteers (n = 14).

Results  During the fast, plasma glucose and serum insulin gradually decreased whilst glucagon and FFA levels increased. Mean 24‐h plasma FGF21 levels did not increase during the 72‐h fast, but, despite large inter‐individually variations, a significant circadian rhythm was observed. Thus, during the first day, plasma FGF21 increased from 125 pg/ml (16–142) at 8.30 a.m to peak levels of 224 pg/ml (88–326) at 2.30 a.m (P = 0·0215), the second day from 60 pg/ml (7–74) at 8.30 a.m to 268 pg/ml (103–410) at 2.30 a.m. (P = 0·0010) and the third day from 94 pg/ml (9–146) to 151 pg/ml (87–207) at 2.30 a.m. (P = 0·0049). Cortisol also showed circadian regulation and peaked at 8.30 a.m every day, 6 h after the observed FGF21 peak.

Conclusion  Plasma FGF21 follows a circadian rhythm during a 72‐h fast in healthy female subjects. The circadian regulation has a stronger impact on plasma FGF21 than the fasting status over 72‐h period.
Identifying metabolically obese but normal‐weight (MONW) individuals in a nondiabetic Korean population: the Chungju Metabolic disease Cohort (CMC) study
Authors: Lee Seung‐Hwan , Ha Hee‐Sung , Park Young‐Jun , Lee Jin‐Hee , Yim Hyeon‐Woo , Yoon Kun‐Ho , Kang Moo‐Il , Lee Won‐Chul , Son Ho‐Young , Park Yong‐Moon , Kwon Hyuk‐Sang
Published: April 2011

Objective  To investigate the prevalence and identify the phenotype of individuals suspected to be metabolically obese but normal weight (MONW).

Design and subjects  Eight thousand nine hundred and eighty‐seven nondiabetic subjects aged over 40 years were selected from the Chungju Metabolic disease Cohort study performed in 2003–2006 in Korea. Those within the highest quartile in the homeostasis model assessment of insulin resistance (HOMA‐IR) with a normal body mass index (BMI) between 18·5 and 23 kg/m2 were classified as MONW.

Measurements  Data on anthropometry, lipid profiles and HOMA‐IR values were analysed.

Results  The prevalence of MONW was 14·2% for men and 12·9% for women amongst normal‐weight subjects. Multiple logistic regression analysis showed that total cholesterol (TC) levels over 5·17 mm (odds ratio, OR = 1·481; 95% confidence intervals, CI 1·086–2·021), triglyceride (TG) levels over 1·69 mm (OR = 1·507; 95% CI 1·093–2·077) and high‐density lipoprotein‐cholesterol levels lower than 1·03 mm (OR = 1·580; 95% CI 1·053–2·371) independently had higher odds of diagnosing MONW amongst men. For women, a BMI over 21·5 kg/m2 (OR = 1·405; 95% CI 1·034–1·909), TC levels over 5·17 mm (OR = 1·524; 95% CI 1·112–2·090) and TG levels over 1·69 mm (OR = 1·799; 95% CI 1·302–2·487) were independently associated with a diagnosis of MONW.

Conclusions  More than 10% of normal‐weight subjects were classed as MONW in this cohort. Identification of these subjects based on lipid profiles could aid in the early detection of a high risk group of developing cardiometabolic diseases.
A systematic review of the use of volunteers to improve mealtime care of adult patients or residents in institutional settings
Authors: Green Sue M , Martin Helen J , Roberts Helen C , Sayer Avan Aihie
Published: April 2011

Aims and objectives.  The objective of this review was to locate and assess the evidence obtained from articles reporting empirical research that volunteers improve mealtime care of adults in institutional settings.

Background.  Malnutrition in adult patients or residents in institutional care settings is common. Poor standards of mealtime care have been suggested to contribute to the development of malnutrition.

Design.  A systematic review of the literature was undertaken.

Method.  Key words were identified and used separately and in combination to search the electronic databases MEDLINE®, CINHAL®, BNI and EMBASE and the internet for relevant articles. Searches were undertaken in August 2008, April 2009 and July 1010.

Results.  Ten studies fulfilled the criteria for inclusion. The methodologies of five of the 10 studies were unclear due to the brevity of the reports. The validity of the design of the other five studies varied. Generally the results suggested the use of volunteers in mealtime care increased satisfaction of patients, relatives, volunteers and staff concerning meal‐time assistance (assessed using methods such as questionnaires and focus groups) and three studies found increased nutritional intake in groups assisted by volunteers. However, few well designed and reported studies were identified.

Conclusions.  There is some evidence that volunteers can improve mealtime care of adult patients or residents in institutional settings, however few well designed studies are reported.

Relevance to clinical practice.  This review demonstrates that there is limited evidence that the use of volunteers improves mealtime care of adult patients or relatives in institutional settings.
Placement Development Teams and interprofessional education with healthcare students
Authors: Williamson Graham R , Callaghan Lynne , Whittlesea Emma , Mutton Lauren , Heath Val
Published: April 2011

Aims and objectives.  The aim was to investigate the impact of a new structure for supporting students and mentors in practice placements (Placement Development Teams) in fostering interprofessional education from the perspective of non‐medical health care students and staff.

Background.  Interprofessional education is an important international issue which received significant impetus in the UK as a result of many high‐profile cases where uni‐professional boundaries and cultures have contributed to adverse patient and client outcomes.

Design.  This study was part of a longitudinal qualitative evaluation of Placement Development Teams. The design for this stage was cross‐sectional.

Methods.  Data were collected using telephone interviews with key educational stakeholders in trusts and Strategic Health Authorities and focus groups with third‐year non‐medical health care students working in the south‐west peninsula of England.

Results.  Students’ focus group data indicated that interprofessional support and learning was key. Students had mixed views on how much they valued support gained from staff and students from other professions. Staff data indicated that they facilitated communication. Staff discussed their practical activities which made a difference and helped change the organisational culture in favour of interprofessional education.

Conclusion.  If interprofessional education in clinical practice is to be effective, it needs local facilitation and structures that support it. Placement Development Teams can provide this. The ‘best’ means of ‘doing interprofessional education’ in clinical practice and its impact on patient outcomes requires further large‐scale research work with rigorous methodologies at a national level.

Relevance to clinical practice.  To embed interprofessional education in practice‐based professions’ curricula and clinical placements requires active, supportive structures and local facilitation. Structures such as Placement Development Teams can help to achieve this where organisational cultures are influenced by committed staff. Students require persuasion concerning the benefits of interprofessional education.
A qualitative meta‐synthesis of adult children of parents with a mental illness
Authors: Murphy Gillian , Peters Kath , Jackson Debra , Wilkes Lesley
Published: April 2011

Aims and objectives.  This article presents a qualitative meta‐synthesis that explores the experiences of adult children of parents with a mental illness.

Background.  There has been growing interest in the experiences of children whose parents have mental illness. However, little literature explores the experiences of adult children.

Design.  Qualitative meta‐synthesis.

Method.  A review of English language literature search engines was undertaken and identified 905 relevant articles. Articles were excluded if they used quantitative methodology, had other methodological issues or had a focus on parental drug/alcohol issues. Twelve articles were identified as using qualitative or mixed methods studies, which were reviewed using the Critical Appraisal Skills Programme (Public Health Resource Unit 2006). Following this, seven studies were included in the meta‐synthesis. The main findings and themes identified by the original study authors were extracted from the results and discussions sections and further categorised into four main themes using content analysis methods.

Results.  There were 26 themes identified by the meta‐synthesis, which were collated into four wider categories and concepts. Issues related to family relationships, external familial relationship changes, the adult child’s emotional reflections and illness‐related concepts were identified.

Conclusions.  There is a paucity of qualitative research that considers adult children’s experiences of parental mental illness. In the available studies, issues related to family relationships, external familial wider relationship changes, the adult child’s emotional reflections and illness‐related concepts were identified as being of concern to adults who experienced parental mental illness during childhood.

Relevance to clinical practice.  There is a need for all health and social care services to be aware of the experiences/needs of adult children who have experienced parental mental illness. Adult children of parents with mental illnesses should be provided with opportunities to discuss their stories to validate their experiences.
Reliability and validity of Turkish version of attitudes toward old people scale
Authors: Küçükgüçlü Özlem , Mert Hatice , Akpınar Burcu
Published: April 2011

Aims and objectives.  To assess the reliability and validity of a Turkish version of Kogan’s Attitudes Toward Older People Scale.

Background.  To explore nursing students’ attitudes towards older people, standardised, well‐tested instruments are needed. Kogan’s Attitudes Toward Older People is a comprehensive instrument for assessment of attitudes toward older adults and has been validated in several languages. However, a validated Turkish version has not been available until now.

Design.  The study used psychometric testing to establish reliability and validity of the Turkish version of Kogan’s Attitudes Toward Older People Scale.

Methods.  A convenience sample of 237 nursing students in Turkey was used to collect data regarding attitudes towards older people. Content validity, construct validity, internal consistency and stability reliability of the Kogan’s Attitudes Toward Older People were assessed.

Results.  Kogan’s Attitudes Toward Older People scores were between 74–224. All of the 34 items were found to have significant item‐to‐total correlations (p < 0·05). Results of the confirmatory factor analysis established that the scale had a two‐factor construct and was appropriate use in this student population. The Cronbach’s alpha was 0·89 for the total scale (0·82 for negative, 0·85 for positive). In addition, test–retest correlation was 0·83 (negative subscale 0·77, positive subscale 0·73) (p < 0.001).

Conclusions.  The Turkish version of the Kogan’s Attitudes Toward Older People was found to be a reliable and valid tool for assessing Turkish nursing students’ attitudes toward older adults.

Relevance to clinical practice.  This study provided evidence that the Kogan’s Attitudes Toward Older People is a reliable and valid instrument for assessing Turkish nursing student’s positive and negative attitudes toward older adults. It is easy and practical to use for both informants and investigators and acceptable for Turkish Culture.
An alternative way to think about glaucoma screening, using a questionnaire as a tool, Chinese version
Authors: Kuo Li‐Lin , Tsai Ching‐Yao , Hsiao Ya‐Chuan , Chou Pesus
Published: April 2011

Rationale, aims and objectives  To develop a short screening test for the detection of preclinical glaucoma.

Method  This case–control study involved 690 participants aged 40 years or older: 338 patients with glaucoma or suspected glaucoma and 352 patients without glaucoma, who served as a control group. All participants were interviewed by a single trained research assistant. Patients' basic demographic and clinical information, past ophthalmic history and responses on the National Eye Institute 25‐item Visual Function Questionnaire were collected. Two glaucoma‐trained ophthalmologists examined all the participants using standard procedures to make a diagnosis. The biostatistical differences between the two groups were determined.

Results  Five items were selected for glaucoma screening: ‘Sense of worse vision compared with those of the same age’, ‘Ocular pain or discomfort during the past 6 months’, ‘History of cataract’, ‘Family history of glaucoma’ and ‘Hyperopia’. A score of 2 or more was used to define a group of positive cases with the most appropriate values for sensitivity (79.0%), specificity (76.7%) and predictive power (a positive predictive value of 76.5% and a negative predictive value of 79.2%).

Conclusion  A five‐item instrument was developed to detect preclinical glaucoma. Anyone with a score of 2 or more may need further ophthalmic examination and treatment.
Increasing heart‐health lifestyles in deprived communities: economic evaluation of lay health trainers
Authors: Barton Garry R. , Goodall Mark , Bower Peter , Woolf Sue , Capewell Simon , Gabbay Mark B.
Published: April 2011

Rationale, aims and objectives  Cardiovascular disease (CVD) often arises from modifiable lifestyle factors. Health care professionals may lack the skills and resources to sustain behaviour change, lay ‘health trainers’ (LHT) offer a potential alternative. We sought to assess the cost‐effectiveness of using a LHT to improve heart‐health lifestyles in deprived communities.

Methods  Participants in this randomized trial were aged ≥18 years with at least one risk factor for CVD (hypertension, raised cholesterol, diabetes, BMI>30 or current smoker). Both groups received health promotion literature. LHT were also able to provide intervention participants with information, advice and support aimed at changing beliefs and behaviour. Costs and quality‐adjusted life year (QALY) changes were estimated over 6 months. The cost‐utility [incremental cost‐effectiveness ratio (ICER)] of LHT was calculated and assessed in relation to the cost‐effectiveness threshold of £20 000–30 000 per QALY. The probability of LHT being cost‐effective was also calculated.

Results  Seventy‐two participants were randomized to a LHT, with 38 controls. The mean cost of the LHT intervention was £151. On average, other health and social service costs fell by £21 for controls and £75 for intervention participants giving a LHT mean overall incremental cost of £98. The mean QALY gains were 0.022 and 0.028, respectively. The ICER for LHT was £14 480, yet there was a 61% chance of making the wrong decision at a £20 000/QALY threshold.

Conclusion  LHT provision was estimated to be cost‐effective for people at risk of CVD. However, a large level of uncertainty was associated with that decision.
Responses of the blister beetle Hycleus apicicornis to visual stimuli
Authors: LEBESA LEFULESELE N. , KHAN ZEYAUR R. , HASSANALI AHMED , PICKETT JOHN A. , BRUCE TOBY J. A. , SKELLERN MATTHEW , KRÜGER KERSTIN
Published: April 2011

Insect attraction to host plants may be partly mediated by visual stimuli. In the present study, the responses of adult Hycleus apicicornis (Guér.) (Coleoptera: Meloidae) to plant models of different colours, different combinations of two colours, or three hues of blue of different shapes are compared. Single‐colour models comprised the colours sky blue, bright green, yellow, red, white and black. Sky blue (reflecting light in the 440–500 nm region) is the most attractive, followed by white, which reflects light over a broader range (400–700 nm). On landing on sky blue targets, beetles exhibit feeding behaviour immediately. When different hues of blue (of different shapes) are compared, sky blue is preferred over turquoise, followed by dark blue, indicating that H. apicicornis is more attracted to lighter hues of blue than to darker ones. No significant differences are found between the three shapes (circle, square and triangle) tested, suggesting that reflectance associated with colour could be a more important visual cue than shape for host location by H. apicicornis. The preference of H. apicicornis for sky blue can be exploited in designing an attractive trap for its management.
First identification of a sweet potato begomovirus (sweepovirus) in Uganda: characterization, detection and distribution
Authors: Wasswa P. , Otto B. , Maruthi M. N. , Mukasa S. B. , Monger W. , Gibson R. W.
Published: April 2011

Sweet potato begomoviruses diverge basally from all other begomoviruses and have been named sweepoviruses. In 2009, a sweepovirus was detected for the first time in sweet potato crops in Uganda by using the indicator plant Ipomoea setosa and generic primers in a polymerase chain reaction (PCR). An isolate was cloned and sequenced, the first fully sequenced genome of a sweepovirus from mainland Africa. At the nucleotide level, this isolate differed from other sweepoviruses by at least 13%, discriminating the Ugandan isolate as a new species which has been tentatively named Sweet potato leaf curl Uganda virus (SPLCUV). In infected sweet potato plants, SPLCUV showed an uneven distribution; it was detected more often in samples from the midrib and lamina of middle and lower leaves, and reversion to healthy tissue occurred, especially in shoots of cv. New Kawogo. This appears to be the first report of resistance to a sweepovirus in sweet potato. While it was only detected at relatively low efficiency by PCR, use of I. setosa plants as an indicator of sweepovirus infection in sweet potato plants was as efficient as using real‐time quantitative PCR (qPCR). Storage of dry leaves for 84 days and dried DNA extracts for 21 days did not affect the ability of PCR and qPCR to detect it. Sweepovirus(es) was detected frequently using generic primers in cultivars Ejumula, New Kawogo and 318L in eastern and central Uganda.
The fracture permeability of Hard Rock Aquifers is due neither to tectonics, nor to unloading, but to weathering processes
Authors: Lachassagne Patrick , Wyns Robert , Dewandel Benoît
Published: April 2011

Terra Nova, 23, 145–161, 2011

The hydrogeology of superficial (∼0–100 m b.g.l.) Hard Rock Aquifers (HRA; i.e. plutonic and metamorphic rocks) has so far been dominated by a few concepts considered to be relevant by a large majority of the HRA community. One of the most fundamental of these concepts is that their (secondary, fissure/fracture) permeability is either of tectonic origin or related to unloading processes. We will show that these genetic concepts are erroneous. We will demonstrate how the hydraulic conductivity of HRAs is a consequence of the (palaeo) weathering processes, with a stratiform fissured layer located immediately below the unconsolidated saprolite and, to a lesser extent, a verticalized fissured layer at the periphery of (or within) pre‐existing discontinuities (veins, joints, ancient faults, lithological contacts, etc.). This result opens up large perspectives in terms of applied hydrogeology and applied geology. A specifically dedicated methodological toolkit well adapted to the operational survey, management and protection of HRAs is briefly presented.
Fabry disease: polymorphic haplotypes and a novel missense mutation in the GLA gene
Authors: Ferri L , Guido C , la Marca G , Malvagia S , Cavicchi C , Fiumara A , Barone R , Parini R , Antuzzi D , Feliciani C , Zampetti A , Manna R , Giglio S , Della Valle CM , Wu X , Valenzano KJ , Benjamin ER , Donati MA , Guerrini R , Genuardi M , Morrone A
Published: April 2011

Ferri L, Guido C, la Marca G, Malvagia S, Cavicchi C, Fiumara A, Barone R, Parini R, Antuzzi D, Feliciani C, Zampetti A, Manna R, Giglio S, Della Valle CM, Wu X, Valenzano KJ, Benjamin ER, Donati MA, Guerrini R, Genuardi M, Morrone A. Fabry disease: polymorphic haplotypes and a novel missense mutation in the GLA gene.

Fabry disease (FD) is an X‐linked lysosomal storage disorder with a heterogeneous spectrum of clinical manifestations that are caused by the deficiency of α‐galactosidase A (α‐Gal‐A) activity. Although useful for diagnosis in males, enzyme activity is not a reliable biochemical marker in heterozygous females due to random X‐chromosome inactivation, thus rendering DNA sequencing of the α‐Gal‐A gene, alpha‐galactosidase gene (GLA), the most reliable test for the confirmation of diagnosis in females. The spectrum of GLA mutations is highly heterogeneous. Many polymorphic GLA variants have been described, but it is unclear if haplotypes formed by combinations of such variants correlate with FD, thus complicating molecular diagnosis in females with normal α‐Gal‐A activity. We tested 67 female probands with clinical manifestations that may be associated with FD and 110 control males with normal α‐Gal‐A activity. Five different combinations of GLA polymorphic variants were identified in 14 of the 67 females, whereas clearcut pathogenetic alterations, p.Met51Ile and p.Met290Leu, were identified in two cases. The latter has not been reported so far, and both mutant forms were found to be responsive to the pharmacological chaperone deoxygalactonojirimycin (DGJ; migalastat hydrochloride). Analysis of the male control population, as well as male relatives of a suspected FD female proband, permitted the identification of seven different GLA gene haplotypes in strong linkage disequilibrium. The identification of haplotypes in control males provides evidence against their involvement in the development of FD phenotypic manifestations.
In vitro susceptibility of 188 clinical and environmental isolates of Aspergillus flavus for the new triazole isavuconazole and seven other antifungal drugs
Authors: Shivaprakash M. R. , Geertsen Erik , Chakrabarti Arunaloke , Mouton Johan W. , Meis Jacques F.
Published: April 2011

Recently isavuconazole, an experimental triazole agent, was found to be active against Aspergillus species. As Aspergillus flavus is the second‐most common Aspergillus species isolated from human infection and the fungus has not been widely tested against the drug, we studied a large collection of clinical (n = 178) and environmental (n = 10) strains of A. flavus against isavuconazole and compared the results with seven other Aspergillus‐active antifungal agents (some of them triazoles, others echinocandins or polyene antifungals: voriconazole, posaconazole, itraconazole, caspofungin, anidulafungin, micafungin and amphotericin B) using Clinical and Laboratory Standards Institute methods. Strains with high minimal inhibitory concentrations (MICs) were tested by E‐test as well. The strains were collected from two different geographical locations (India and the Netherlands). Three isolates (1.6%) had high MIC (2 mg l−1 by microbroth dilution and 8 mg l−1 by E‐test) for amphotericin B. Isavuconazole showed good activity against A. flavus strains with MIC50 and MIC90 values of 1 mg l−1. As compared with voriconazole (the drug recommended for primary therapy of aspergillosis), isavuconazole had better activity (99.5% of strains had MIC of ≤1 mg l−1 for isavuconazole, compared to 74% of strains with same MIC for voriconazole). All strains were, following recently proposed clinical breakpoints, susceptible for the triazoles tested except three strains, which had MICs of 4 mg l−1 for voriconazole. Testing these strains with high MIC by E‐test, gave results of 0.5–2 mg l−1. Posaconazole had the lowest MIC50 and MIC90 of 0.125 mg l−1 and 0.25 mg l−1, respectively. Among echinocandins, 97% of strains had a minimum effective concentration (MEC) of ≤0.5 mg l−1 for caspofungin, and all strains had a MEC of ≤0.016 mg l−1 and ≤0.125 mg l−1 for anidulafungin and micafungin, respectively.
Pivotal role of pericytes in kidney fibrosis
Authors: Kida Yujiro , Duffield Jeremy S
Published: April 2011

1. Kidney pericytes were recently identified as collagen Iα1‐producing cells in healthy kidney, but the developmental, physiological and pathological roles of kidney pericytes remain poorly understood. Pericytes are stromal‐derived cells that envelop and have intimate connections with adjacent capillary endothelial cells (EC). Recent studies in the eye and brain have revealed that pericytes are crucial for angiogenesis, vascular stability and vessel integrity.

2. In response to kidney injury, pericytes promptly migrate away from the capillary wall into the interstitial space. Here, pericytes are activated and differentiate into scar‐forming myofibroblasts. In the absence of pericytes, peritubular capillaries are destabilized, leading to vascular regression. Consequently, capillary loss and fibrosis following kidney injury are intimately linked and hinge centrally around pericyte detachment from EC.

3. Kinetic mathematical modelling has demonstrated that pericytes are the major source of myofibroblasts in the fibrotic kidney. Comprehensive genetic fate mapping studies of nephron epithelia or kidney stroma has demonstrated that epithelial cells do not migrate outside of the epithelial compartment to become myofibroblasts; rather, interstitial pericytes are progenitors of scar‐forming myofibroblasts. Bidirectional signalling between pericytes and EC is necessary for pericyte detachment from peritubular capillaries.

4. In the present review, we summarize the pathologically vital roles of kidney pericytes in fibrosis, including our new findings. The study of kidney pericytes and endothelial–pericyte cross‐talk will identify novel therapeutic targets for currently incurable chronic kidney diseases.
Sticking to the facts: a systematic review of fibrin glue for pilonidal disease
Authors: Handmer Marcus
Published: April 2011

Background:  Pilonidal disease occurs when hair invading the natal cleft causes inflammation and abscess formation. Opinions vary on best practice, and most procedures have considerable morbidity and high recurrence rates of 6–40%.

Objectives:  This study systematically reviews the use of fibrin glue in the treatment of pilonidal disease. Outcomes measured were healing time and recurrence rate.

Data source:  ScienceDirect and PubMed databases were searched for relevant literature, yielding seven papers including five small trials. The total number of patients receiving fibrin glue treatments across all trials was 85. There were no exclusion criteria in this review.

Results:  Fibrin glue treatments had equivalent or better reported healing times than conventional therapies at an average of 2–6 weeks, and low recurrence rates between 0 and 17% at follow‐up periods between 4 and 28 months. Considerable heterogeneity in study methodologies and surgical techniques prevented statistical significance or aggregate figures from being determined.

Conclusions:  There appears to be early promise for the use of fibrin glue in the treatment of pilonidal disease and an impetus for definitive research.
Inguinal hernia: aetiology, diagnosis, post‐repair pain and compensation
Authors: O'Rourke Michael G. E. , O'Rourke Thomas R.
Published: April 2011

Background:  Inguinal hernia compensation depends on aetiology, diagnosis and complications, particularly post‐hernia pain. New studies in these three areas bring confusion to claims.

Methods:  A comprehensive research of the literature using Medline: in aetiology, in diagnoses, the use of ultrasound and/or other investigations, in chronic post‐hernia pain and the understanding of the pathogenesis of hernia and post‐hernia pain. Using the above data, a creation of a protocol for acceptance of compensation claim.

Results:  Although intra‐abdominal pressure has been accepted for 200 years as a significant aetiological factor in inguinal hernia, tissue studies and prospective studies suggest an inevitability. In diagnosis, the clinical detection of a lump is the gold standard; investigations are not required. An ultrasonic detection of a hernia without clinical correlation does not require surgery. Post‐hernia chronic pain is not singular to hernia, is now considered neuropathic pain and treatment is conservative.

Conclusions:  The work scene is possibly an aggravating factor but not a prime aetiological factor. The diagnosis does not require ultrasound. Chronic pain is neuropathic. A protocol for claim acceptance is presented.
Prospective evaluation of the self‐pressurized air‐Q intubating laryngeal airway in children
Authors: Jagannathan Narasimhan , Sohn Lisa E. , Mankoo Ravinder , Langen Kenneth E. , Roth Andrew G. , Hall Steven C.
Published: April 2011

Objectives:  To assess the clinical efficacy of the self‐pressurized air‐Q ILA™ (ILA‐SP).

Aim:  The purpose of this prospective audit was to evaluate the feasibility of the ILA‐SP in clinical practice and generate data for future comparison trials.

Background:  The ILA‐SP is a new first‐generation supraglottic airway for children with a self‐adjusting cuff and lack of a pilot balloon.

Methods:  Over a 4‐month period, 352 children with an ASA physical status of I–III, newborn to 18 years of age, undergoing various procedures were studied. Data points assessed included insertion success rates, airway leak pressures, quality of ventilation, and perioperative complications associated with the use of this device.

Results:  In 349 of the 352 patients in this study, the ILA‐SP was used successfully as a primary supraglottic airway device in a variety of patients. Three patients required conversion to a standard laryngeal mask airway or a tracheal tube. The mean initial airway leak pressure for all patients was 17.8 ± 5.4 cm H2O, and 20.4 ± 5.5 cm H2O when re‐checked at 10 min, which was statistically significant (P < 0.001). Complications were limited to 14 patients and related to reflex activation of the airway (coughing, laryngospasm, and bronchospasm) (n = 10), sore throat (n = 3), and blood staining on removal of the device (n = 1). There were no episodes of regurgitation, aspiration, or hoarseness.

Conclusions:  Acceptable clinical performance was demonstrated with the ILA‐SP for a variety of procedures in infants and children with spontaneous and positive pressure ventilation. Future studies comparing this device to other supraglottic airways may provide useful information regarding the safety of the ILA‐SP in pediatric clinical practice.
Medication errors – new approaches to prevention
Authors: Merry Alan F. , Anderson Brian J.
Published: April 2011

Medication errors in pediatric anesthesia represent an important risk to children. Concerted action to reduce harm from this cause is overdue. An understanding of the genesis of avoidable adverse drug events may facilitate the development of effective countermeasures to the events or their effects. Errors include those involving the automatic system of cognition and those involving the reflective system. Errors and violations are distinct, but violations often predispose to error. The system of medication administration is complex, and many aspects of it are conducive to error. Evidence‐based practices to reduce the risk of medication error in general include those encompassed by the following recommendations: systematic countermeasures should be used to decrease the number of drug administration errors in anesthesia; the label on any drug ampoule or syringe should be read carefully before a drug is drawn up or injected; the legibility and contents of labels on ampoules and syringes should be optimized according to agreed standards; syringes should always be labeled; formal organization of drug drawers and workspaces should be used; labels should be checked with a second person or a device before a drug is drawn up or administered. Dosage errors are particularly common in pediatric patients. Causes that should be addressed include a lack of pediatric formulations and/or presentations of medication that necessitates dilution before administration or the use of intravenous formulations for oral administration in children, a frequent failure to obtain accurate weights for patients and a paucity of pharmacokinetic and pharmacodynamic data. Technological innovations, including the use of bar codes and various cognitive aids, may facilitate compliance with these recommendations. Improved medication safety requires a system‐wide strategy standardized at least to the level of the institution; it is the responsibility of institutional leadership to introduce such strategies and of individual practitioners to engage in them.
Sacral nerve modulation in the treatment of chronic pain after pelvic surgery
Authors: Martellucci J. , Naldini G. , Del Popolo G. , Carriero A.
Published: April 2011

Aim  The aim of the study was to evaluate the efficacy of sacral nerve modulation for chronic pelvic pain after pelvic or anal surgery for benign disease.

Method  From January 2004 to December 2009, 17 (14 female; age 56 years) consecutive patients suffering from chronic pelvic pain underwent evaluation for sacral nerve modulation in three pelvic floor units.

Results  The previous surgery included stapled transanal rectal resection (five), hysterectomy (four), haemorrhoidectomy (two), stapled haemorrhoidopexy (one), fistulectomy (one), urethral sphincterotomy (one), appendicectomy (one), discectomy (one) and laparoscopy for endometriosis (one). Eight (47%) patients fulfilled the criteria for definitive implantation and were followed for a mean of 39 months. Using a visual analog pain score, pain levels fell from 8.2 preoperatively to 1.9, 2.1, 2.0 and 1.8 at 6, 12, 24 and 36 months, respectively. Age < 60 years and duration of symptoms of < 24 months were good predictors and stapling was a poor predictor of success.

Conclusion  Sacral nerve modulation seems to be effective over time in some patients with chronic pain related to previous surgery.
Spermatogenesis and changes in testicular structure during the reproductive cycle in Cichlasoma dimerus (Teleostei, Perciformes)
Authors: Vázquez Graciela Rey , Cuña Rodrigo H. Da , Meijide Fernando J. , Guerrero Graciela A.
Published: April 2011

Rey Vázquez, G., Da Cuña, R.H., Meijide, F.J., and Guerrero, G.A. 2012. Spermatogenesis and changes in testicular structure during the reproductive cycle in Cichlasoma dimerus (Teleostei, Perciformes). —Acta Zoologica (Stockholm) 93: 338–350.

The present study aimed at analyzing spermatogenesis and the changes occurring in the testis throughout the reproductive cycle in the South American perciform fish Cichlasoma dimerus. Testes were studied using light and electron microscopy techniques. This species has an unrestricted lobular testis composed of two compartments: germinal, containing Sertoli and germ cells, exhibiting a cystic mode of spermatogenesis; and interstitial, composed of Leydig cells and connective tissue elements. Spermatozoa belong to the anacrosomal type I aquasperm and possess two flagella, this being the first report of an externally fertilizing cichlid exhibiting biflagellate sperm. Under laboratory conditions, C. dimerus proved to be a multiple spawner throughout the year, with a season of higher reproductive activity extending from September to March, during which fish spawned on average every 29.4 days. Changes in the germinal epithelium and the germ cell stages present allowed the description of five reproductive classes: regressed, early, mid‐, and late maturation, and regression. During the high reproductive season, each cycle went through the first four classes. The regressed class overlapped with the late maturation class, because sperm was being released while spermatogonia were proliferating. The regression class occurred solely in sexually inactive males during the period of low reproductive activity.
Meal‐induced increases in C‐reactive protein, interleukin‐6 and tumour necrosis factor α are attenuated by prandial + basal insulin in patients with Type 2 diabetes
Authors: Beisswenger P. J. , Brown W. V. , Ceriello A. , Le N. A. , Goldberg R. B. , Cooke J. P. , Robbins D. C. , Sarwat S. , Yuan H. , Jones C. A. , Tan M. H. ,   for the IOOI Study Investigators
Published: April 2011

Diabet. Med. 28, 1088–1095 (2011)

Aim  To determine if a regimen with prandial + basal insulin compared with basal insulin attenuates post‐meal inflammatory and glycative biomarkers in patients with Type 2 diabetes.

Methods  This test‐meal sub‐study in the USA is from a previously reported clinical trial comparing the effect on glycaemic control of 24 weeks of thrice‐daily pre‐meal insulin lispro mix 50 (50% insulin lispro, 50% insulin lispro protamine suspension) or bedtime insulin glargine, both plus metformin. In the sub‐study, glucose, insulin, triglycerides, high‐sensitivity C‐reactive protein, tumour necrosis factor α, interleukin‐6, methylglyoxal and 3‐deoxyglucosone were measured during the post‐meal period of a mixed‐meal breakfast at the final visit. Prandial + basal (n = 25) and basal (n = 21) insulin were administered at the same times as during the previous 24 weeks.

Results  Post‐meal, the prandial + basal insulin group had significantly higher insulin, lower glucose and triglycerides, as well as lower high‐sensitivity C‐reactive protein, tumour necrosis factor α and interleukin‐6, than the basal insulin group. Glucose incremental area under the concentration curve significantly correlated with high‐sensitivity C‐reactive protein, tumour necrosis factor α, interleukin‐6, methylglyoxal and 3‐deoxyglucosone incremental area under the concentration curve. Insulin incremental area under the concentration curve correlated inversely with high‐sensitivity C‐reactive protein and tumour necrosis factor α incremental area under the concentration curve. However, after adjusting for glucose incremental area under the concentration curve, these inverse correlations were no longer significant. Triglyceride incremental area under the concentration curve was not correlated with any biomarker incremental area under the concentration curve.

Conclusions  Controlling post‐meal hyperglycaemia with prandial + basal insulin in patients with Type 2 diabetes attenuates meal‐induced increases in high‐sensitivity C‐reactive protein, interleukin‐6 and tumour necrosis factor α compared with basal insulin. The rise in post‐meal glucose, but not triglycerides, significantly correlated with the rise in post‐meal inflammatory and glycative biomarkers.
High prevalence of capillary abnormalities in patients with diabetes and association with retinopathy
Authors: Barchetta I. , Riccieri V. , Vasile M. , Stefanantoni K. , Comberiati P. , Taverniti L. , Cavallo M. G.
Published: April 2011

Diabet. Med. 28, 1039–1044 (2011)

Aims  To investigate the presence of capillary abnormalities in patients with Type 1 and Type 2 diabetes using nailfold videocapillaroscopy and to evaluate the possible correlation with the typical diabetes mellitus microangiopathic lesions detectable in retinal blood vessels.

Methods  Forty‐nine patients with diabetes mellitus (21 with Type 1 and 28 with Type 2 diabetes) and 39 subjects without diabetes were enrolled. Ophthalmoscopy was performed on all patients and was followed by retinal fluorangiography when indicated. Subjects underwent nailfold videocapillaroscopy to evaluate density, length, morphology and distribution of capillary loops, presence of ectasia, microbleedings and blood flow modifications. A score (0–3) was applied to quantify features of nailfold videocapillaroscopy.

Results  Subjects with diabetes showed a significantly increased (P = 0.0001) nailfold videocapillaroscopy score and significantly greater alterations of capillary length (P = 0.004), distribution (P = 0.02), morphology (P = 0.0001), density (P = 0.02) and flux (P = 0.004), as well as presence of ectasic loops (P = 0.009) and of oedema/exudates (P = 0.03) compared with control subjects. In addition, patients with Type 1 diabetes had a significantly higher score (P = 0.01) and greater morphologic alterations (P = 0.03) compared with subjects with Type 2 diabetes. Nailfold videocapillaroscopy score also showed a positive correlation with retinopathy, detected by both ophthalmoscopy (P = 0.0001) and fluorangiography (P = 0.02), independently from sex, age, type of diabetes and all potential confounders. Moreover, nailfold videocapillaroscopy was capable of identifying alterations in almost 50% of patients with diabetes without retinopathy.

Conclusions  A high prevalence of nailfold capillary changes is detected in patients with diabetes using nailfold videocapillaroscopy. These abnormalities tightly correlate with retinal damage and may be expression of a generalized microvessel involvement in both Type 1 and Type 2 diabetes.
Solving the Entrepreneurial Puzzle: The Role of Entrepreneurial Interpretation in Opportunity Formation and Related Processes
Authors: Barreto Ilídio
Published: April 2011

abstract

Opportunity formation plays a central role in the entrepreneurship literature. The two dominant perspectives on this topic (discovery view and creation view) tended to consider search and action as the main mechanisms. Drawing on strategic issue interpretation view and managerial cognition perspective, we argue for the inclusion of a third mechanism (entrepreneurial interpretation). Specifically, we develop the boundary assumptions and testable propositions of an entrepreneurial interpretation model. Then, we show how entrepreneurial interpretation informs both discovery and creation processes. Overall, our theory provides an expanded understanding of how individuals form and decide to exploit opportunities.