bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterisation of complementary and alternative medicine use and its impact on medication adherence in inflammatory bowel disease
Authors: Weizman A. V. , Ahn E. , Thanabalan R. , Leung W. , Croitoru K. , Silverberg M. S. , Hillary Steinhart A. , Nguyen G. C.
Published: December 2011

Background  Complementary and alternative medicine (CAM) use among inflammatory bowel disease (IBD) patients is common. We characterised CAM utilisation and assessed its impact on medical adherence in the IBD population.

Aim  To characterise CAM utilisation and assess its impact on medical adherence in the IBD population.

Methods  Inflammatory bowel disease patients recruited from an out‐patient clinic at a tertiary centre were asked to complete a questionnaire on CAM utilisation, conventional IBD therapy, demographics and communication with their gastroenterologist. Adherence was measured using the self‐reported Morisky scale. Demographics, clinical characteristics and self‐reported adherence among CAM and non‐CAM users were compared.

Results  We recruited prospectively 380 IBD subjects (57% Crohn’s disease; 35% ulcerative colitis, and 8% indeterminate colitis). The prevalence of CAM use was 56% and did not significantly vary by type of IBD. The most common reason cited for using CAM was ineffectiveness of conventional IBD therapy (40%). The most popular form of CAM was probiotics (53%). CAM users were younger than non‐CAM users at diagnosis (21.2 vs. 26.2, P < 0.0001) and more likely than non‐CAM users to have a University‐level education or higher (75% vs. 62%P = 0.006). There was no overall difference in adherence between CAM and non‐CAM users (Morisky score: 1.0 vs. 0.9, P = 0.26).

Conclusions  The use of complementary and alternative medicine is widely prevalent among IBD patients, and is more frequent among those with experience of adverse effects of conventional medications. From this cross‐sectional analysis, complementary and alternative medicine use does not appear to be associated with reduced overall adherence to medical therapy.
Profiling of differentially expressed genes in haemophilia A with inhibitor
Authors: HWANG S. H. , LIM J. A. , KIM M. J. , KIM H. C. , LEE H. W. , YOO K. Y. , YOU C. W. , LEE K. S. , KIM H. S.
Published: December 2011

Summary.  Inhibitor development is the most significant complication in the therapy of haemophilia A (HA) patients. In spite of many studies, not much is known regarding the mechanism underlying inhibitor development. To understand the mechanism, we analysed profiles of differentially expressed genes (DEGs) between inhibitor and non‐inhibitor HA via a microarray technique. Twenty unrelated Korean HAs were studied: 11 were non‐inhibitor and nine were HA with inhibitor (≥5 BU mL−1). Microarray analysis was conducted using a Human Ref‐8 expression Beadchip system (Illumina) and the data were analysed using Beadstudio software. We identified 545 DEGs in inhibitor HA as compared with the non‐inhibitor patients; 384 genes were up‐regulated and 161 genes were down‐regulated. Among them, 75 genes whose expressions were altered by at least two‐fold (>+2 or <−2) were selected and classified via the PANTHER classification method. The expressions of signal transduction and immunity‐related genes differed significantly in the two groups. For validation of the DEGs, semi‐quantitative RT‐PCR (semi‐qRT‐PCR) was conducted with the six selected DEGs. The results corresponded to the microarray data, with the exception of one gene. We also examined the expression of the genes associated with the antigen presentation process via real‐time PCR. The average levels of IL10, CTLA4 and TNFα slightly reduced, whereas that of IFNγ increased in the inhibitor HA group. We are currently unable to explain whether this phenomenon is a function of the inhibitor‐inducing factor or is an epiphenomenon of antibody production. Nevertheless, our results provide a possible explanation for inhibitor development.
Functional impact of custom‐made foot orthoses in patients with haemophilic ankle arthropathy
Authors: LOBET S. , DETREMBLEUR C. , LANTIN A.‐C. , HAENECOUR L. , HERMANS C.
Published: December 2011

Summary.  Although foot orthoses are often prescribed to patients with haemophilia (PWH) and ankle arthropathy, the efficacy and biomechanical effects of such devices are not fully understood. We experimentally investigated the effects of orthopedic insoles (OI) and shoes (OS) in PWH presenting ankle arthropathy, with specific attention being paid to pain, spatiotemporal parameters, kinematics and kinetics of lower limb joints, as well mechanical and energetic variables. Using three‐dimensional gait analysis (3DGA), synchronous kinematics, kinetics, spatiotemporal, mechanics, and metabolic gait parameters were measured in 16 PWH with ankle arthropathy. The revised Foot Function Index (FFI‐R) and 3DGA were determined in patients wearing neutral running shoes at two time points (T0 and T1), with OI (n = 11) or OS (n=5) being subsequently prescribed. Patients, while wearing their orthoses, were re‐evaluated using 3DGA, FFI‐R, and satisfaction questionnaires (T2). OI and OS provided significant pain relief and comfort improvement in more than half of the patients, with minimal side effects. OI had limited impact on gait pattern, whereas OS significantly improved the propulsive function of the ankle. Biomechanical changes induced by OI and OS were independent of their ability to improve comfort, while being insufficient to influence knee and hip kinematics and kinetics, or mechanical and energetic variables. These findings suggest that OI and OS may have beneficial effects on ankle joints in PWH. Self‐reported clinical tools such as FFI‐R and satisfaction questionnaires are sufficiently sensitive for assessing the efficacy of foot orthoses in PWH.
Emergency and out of hours care of patients with inherited bleeding disorders
Authors: FOWLER H. , LACEY R. , KEANEY J. , KAY‐JONES C. , MARTLEW V. , THACHIL J.
Published: December 2011

Summary.  Recently, the United Kingdom Haemophilia Centre Doctors Organisation published recommendations for the standard of care for assessment and treatment of patients with bleeding disorders in the emergency department (A&E). An audit was undertaken to compare the level of care to the acceptable standards in a tertiary hospital A&E, attached to a haemophilia comprehensive care centre. A&E attendances were found by cross referencing all patients with known bleeding disorders against the EDMS attendance system. Visits from the past 3 years were identified to produce sufficient data and electronic notes from these visits were then accessed, and marked against the proforma. Data were available from 45 of a total of 54 patients, who had a total of 75 emergency visits documented. In all aspects of care, the standards were not adequately met including the average length of time between booking and clinical assessment, early initiation of specific haemostatic treatment, seeking haematology advice and arrangement of follow‐up. Also no specialist clotting investigations were done with only 9/11 patients admitted having their haematological diagnosis recorded. In addition, only very few patients had the severity of bleeding disorder noted and less than half their first line treatment documented. There were significant differences in the standard of care for haemophilia patients provided by the A&E department when compared with acceptable standards. Measures have been put in place and policies have been drafted to improve this situation and provide the best possible care to persons with haemophilia.
Odontoblast RNA stability in different temperature‐based protocols for tooth storage
Authors: Conde M. C. M. , Nedel F. , Campos V. F. , Smith A. J. , Nör J. E. , Demarco F. F. , Tarquinio S. B. C.
Published: December 2011

Conde MCM, Nedel F, Campos VF, Smith AJ, Nör JE, Demarco FF, Tarquinio SB. Odontoblast RNA stability in different temperature‐based protocols for tooth storage. International Endodontic Journal, 45, 266–272, 2012.

Aim  To evaluate the effect of four tooth storage temperature‐based methods on quality of RNA obtained from cells retrieved from human dental pulps and human pre‐dentine.

Methodology  RNA was isolated from dental pulp tissue and from cells retrieved by scraping the pre‐dentine of freshly extracted human third molars (n = 15) using TRIzol® reagent. Teeth were randomly assigned to the following temperature conditions: immediate RNA isolation after tooth extraction, liquid nitrogen (24 h), −80 °C (24 h), 20 °C (24 h) and 4 °C (6 h). RNA integrity was checked by the density of 28S and 18S ribosomal RNA. RT‐PCR was used to analyse the expression of odontoblast makers (DSPP, DMP1 and MEPE) and the housekeeping gene GAPDH.

Results  All experimental conditions evaluated preserved RNA integrity. The three odontoblastic markers were amplified from the pulp tissue and from the cells associated with pre‐dentine.

Conclusion  The four storage options allowed RNA isolation for RT‐PCR analysis. These findings may facilitate the use of clinically derived human dental pulp and odontoblasts for endodontic research.
Evolution of terrestrial birds in three continents: biogeography and parallel radiations
Authors: Ericson Per G. P.
Published: December 2011

Aim To reconstruct the biogeographical history of a large clade of mainly terrestrially adapted birds (coraciiform and piciform birds, owls, diurnal raptors, New World vultures, trogons, mousebirds, cuckoo‐rollers, seriemas, parrots and passerines) to test the hypothesis of its Gondwanan origin.

Location Global.

Methods The phylogenetic tree used in the analysis was a family‐level tree estimated from previously published nuclear DNA sequence data. Each family for which a thorough and taxonomically well‐sampled phylogenetic analysis exists was subject to an initial dispersal–vicariance analysis in order to reconstruct ancestral areas for its two most basal lineages. Both basal lineages were then used to represent the family in the subsequent reconstruction of ancestral distributions for the entire radiation.

Results The analysis showed that three reciprocally monophyletic groups of terrestrial birds have diversified in the Gondwanan land areas of Australia, South America and Africa, respectively. Although each of these three groups may also have originally included other groups, the only survivors today from the Australian radiation are the passerines and parrots, while the falcons and seriemas have survived from the South American radiation. The group of survivors from the African radiation is considerably more taxonomically diverse and includes all coraciiform and piciform birds, owls, diurnal raptors (except falcons), New World vultures, trogons, mousebirds and cuckoo‐rollers.

Main conclusions The outlined evolutionary scenario with three geographically isolated clades of terrestrial birds is consistent with the available estimates of Late Cretaceous to early Palaeogene dates for these radiations. The diversifications and ecological adaptations within each of the three groups most likely took place in isolation on the different continents. Many cases of convergently evolved adaptations may be revealed through the increased understanding of the phylogenetic relationships of terrestrial birds.
Of mice and mammoths: evaluations of causal explanations for body size evolution in insular mammals
Authors: Lomolino Mark V. , Sax Dov F. , Palombo Maria Rita , van der Geer Alexandra A.
Published: December 2011

Aim  We investigated the hypothesis that the insular body size of mammals results from selective forces whose influence varies with characteristics of the focal islands and the focal species, and with interactions among species (ecological displacement and release).

Location  Islands world‐wide.

Methods  We assembled data on the geographic characteristics (area, isolation, maximum elevation, latitude) and climate (annual averages and seasonality of temperature and precipitation) of islands, and on the ecological and morphological characteristics of focal species (number of mammalian competitors and predators, diet, body size of mainland reference populations) that were most relevant to our hypothesis (385 insular populations from 98 species of extant, non‐volant mammals across 248 islands). We used regression tree analyses to examine the hypothesized contextual importance of these factors in explaining variation in the insular body size of mammals.

Results  The results of regression tree analyses were consistent with predictions based on hypotheses of ecological release (more pronounced changes in body size on islands lacking mammalian competitors or predators), immigrant selection (more pronounced gigantism in small species inhabiting more isolated islands), thermoregulation and endurance during periods of climatic or environmental stress (more pronounced gigantism of small mammals on islands of higher latitudes or on those with colder and more seasonal climates), and resource subsidies (larger body size for mammals that utilize aquatic prey). The results, however, were not consistent with a prediction based on resource limitation and island area; that is, the insular body size of large mammals was not positively correlated with island area.

Main conclusions  These results support the hypothesis that the body size evolution of insular mammals is influenced by a combination of selective forces whose relative importance and nature of influence are contextual. While there may exist a theoretical optimal body size for mammals in general, the optimum for a particular insular population varies in a predictable manner with characteristics of the islands and the species, and with interactions among species. This study did, however, produce some unanticipated results that merit further study – patterns associated with Bergmann’s rule are amplified on islands, and the body size of small mammals appears to peak at intermediate and not maximum values of latitude and island isolation.
Use of physical restraints in nursing homes and hospitals and related factors: a cross‐sectional study
Authors: Heinze Cornelia , Dassen Theo , Grittner Ulrike
Published: December 2011

Aims and objectives.  The aim of the study was to investigate factors related to the use of restraints and to explore whether the rate of nurses was an influencing factor regarding the use of restraints in German nursing homes and hospitals.

Background.  Restraints are frequently used measures in hospitals and nursing homes. Risks for falls and small nurse workforces are discussed in relation to the use of restraints.

Design.  A secondary analysis of a cross‐sectional study was carried out.

Methods.  Data were collected by trained nurses using standardised questionnaires in 76 nursing homes (n = 5521) and 15 hospitals (n = 2827). For data analysis, a 3‐level random intercept logistic model was used.

Results.  The prevalence of restraints (bed rails and/or belts) was 9·3% for hospital patients and 26·3% for nursing home residents. Amongst hospital patients, restraint use was more prevalent in women, older patients, patients with a high care dependency, patients who fell during the last two weeks, patients with a perceived risk of falls, polypharmacy, urinary incontinence, disorientation and confinement to bed. In the nursing homes, the restrained residents were significantly younger, more care dependent, had less falls and were more often urinary incontinent, disoriented and bedfast. The rate of nurses was not significantly related to the use of restraints in hospitals, and nursing homes according to the three‐level random intercept model.

Conclusions.  Hospital patients with previous falls were more often restrained, but in the nursing homes, the restrained residents experienced less falls. The number of qualified nursing staff had no significant influence on the use of physical restraints.

Relevance to clinical practice.  Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study.
Outcomes from the workshop ‘Putting Complexity to Work – Supporting the Practitioners’: implications for health care
Authors: Beautement Patrick , Broenner Christine
Published: December 2011

Rationale  People working in the health sector have been looking to complexity science to help them deal with the complex phenomena they encounter in their everyday working practice. While complexity science has assisted many in the field to look at the complex issues from a different viewpoint and explained the emergence of complex phenomena, however, practicable, pragmatic approaches and techniques have not been provided.

Aims and objectives  In this article, actual issues and challenges that these practitioners face and the needs they expressed during a workshop called ‘Putting Complexity to Work – Supporting the Practitioners’ are discussed.

Conclusion  As the nature of complexity offers no one single ultimate solution, the paper concludes that, for operationalizing the insights received from complexity science into their day‐to‐day work, practitioners in health care and other domains need to address a range of challenges that are outlined in the paper.
Development and validation of real‐time PCR for the detection of Yersinia ruckeri
Authors: Keeling S E , Johnston C , Wallis R , Brosnahan C L , Gudkovs N , McDonald W L
Published: December 2011

Yersiniosis (enteric red mouth disease) is a contagious bacterial disease caused by Yersinia ruckeri, which primarily affects salmonids. A real‐time PCR assay using a molecular beacon has been developed and validated to improve the detection of the causative biotypes of Y. ruckeri. The assay, which targets the glnA (glutamine synthetase) gene, proved to have 100% analytical specificity and analytical sensitivities of 5 fg and 3 × 103 CFU g−1 for DNA and seeded kidney tissue, respectively. The assay was highly repeatable with low % CV for intra‐ and inter‐run experiments, and the optimized parameters transferred easily between different real‐time PCR platforms. Following analytical validation, diagnostic specificity was determined using New Zealand farmed Chinook salmon (n = 750) from 10 farms during 2007/08. The real‐time PCR was run in parallel with the bacterial culture detection method, and all fish tested were found to be negative by both methods for Y. ruckeri, resulting in 100% diagnostic specificity (95% confidence interval). The molecular beacon real‐time PCR system is specific, sensitive, reproducible and a rapid method for the detection of Y. ruckeri and has the potential to be used for routine diagnostic testing, health certification and active surveillance programmes.
Comparative effects of four feed types on white spot disease susceptibility and skin immune parameters in rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Xueqin J , Kania P W , Buchmann K
Published: December 2011

The effects on rainbow trout, Oncorhynchus mykiss (Walbaum), immune parameters by differently formulated fish feed types containing immunostimulants have been tested in a double‐blind, duplicated and controlled study performed over 50 days. A total of 800 rainbow trout (10–12 g) were kept in eight duplicate fish tanks (each containing 100 fish) and fed at a daily feeding rate of 1.5% of the biomass. The feed types were (1) control feed (C) without additives, (2) feed containing beta‐glucan, nucleotides, manno‐oligosaccharides (MOS), vitamins C and E (GNMCE), (3) feed containing probiotic bacteria and plant extracts (PP) and (4) feed with nucleotides, manno‐oligosaccharides, vitamins C and E (NMCE). Plasma lysozyme activity was increased in fish fed two feed types (GNMCE and NMCE) but slightly depressed in fish fed PP. A non‐significant trend for a higher mucous cell density at days 30 and 50 was shown in all fish receiving feeds with additives compared to the control group. All fish became infected with Ichthyophthirius multifiliis when exposed, but fish fed GNMCE showed a significantly lower infection both at days 30 and 50. Expression of genes encoding C3 and MHCII was significantly up‐regulated in fish fed GNMCE for 50 days, and the expression of genes coding Hepcidin was significantly down‐regulated in fish fed NMCE for 50 days. Beta‐glucan was the single component, when used in combination with other feed ingredients, which was found associated with increased parasite resistance, increased lysozyme and immune gene up‐regulation.
Postnatal Overfeeding Leads to Obesity and Exacerbated Febrile Responses to Lipopolysaccharide Throughout Life
Authors: Clarke M. A. , Stefanidis A. , Spencer S. J.
Published: December 2011

The perinatal environment can be crucial for programming long‐term physiology, including the mechanisms regulating body weight, and postnatal overfeeding can lead to obesity throughout life. Inflammation‐related complications are of particular concern in the obese. However, little is known about how postnatal overfeeding contributes to changes in the ability to respond to inflammation. In the present study, we investigate changes in the febrile and neurochemical response to immune challenge with lipopolysaccharide (LPS), in juvenile and adult, male and female Wistar rats made obese by overfeeding during the postnatal period. We demonstrate that febrile responses to LPS are exacerbated in these rats, with peak core temperatures being up to 0.5 °C higher compared to those in controls, and this is associated with an enhanced pro‐inflammatory cytokine profile and enhanced hypothalamic‐pituitary‐adrenal (HPA) axis activation. Plasma pro‐inflammatory cytokines concentrations were approximately three‐fold greater in neonatally overfed rats after LPS and there were approximately twice as many neurones activated in the paraventricular nucleus of the hypothalamus as in controls, with a prolonged corticosterone response. We also observed elevated expression of toll‐like receptors (TLR) 2 and 4 in adipose tissue and greater inhibitory factor κB phosphorylation in these obese animals. Despite similar changes in expression of adipose TLR3, there was no corresponding alteration in the response to a viral mimetic that acts at this receptor. We suggest that an elevated febrile response to LPS therefore occurs in cases of obesity and this is associated with altered HPA axis function and enhanced TLR2/4 expression in adipose tissue and an up‐regulated downstream pro‐inflammatory cascade.
Characteristics of implant‐CAD/CAM abutment connections of two different internal connection systems
Authors: SUMI T. , BRAIAN M. , SHIMADA A. , SHIBATA N. , TAKESHITA K. , VANDEWEGHE S. , COELHO P.G. , WENNERBERG A. , JIMBO R.
Published: December 2011

Summary  Titanium or zirconium computer‐aided design/computer‐aided manufacturing abutments are now widely used for aesthetic implant treatments; however, information regarding microscopic structural differences that may influence the biological and mechanical outcomes of different implant systems is limited. Therefore, the characteristics of different connection systems were investigated. Optical microscopic observation and scanning electron microscopy showed different characteristics of two internal systems, namely the Astra Tech and the Replace Select system, and for different materials. The scanning electron microscopic observation showed for the Astra Tech that the implant–abutment interface seemed to be completely sealed for both titanium and zirconium abutments, both horizontally and sagittally; however, the first implant–abutment contact was below the fixture top, creating a microgap, and fixtures connected with titanium abutments showed significantly larger values (23·56 μm ± 5·44 in width, and 168·78 μm ± 30·39 in depth, P < 0·001). For Replace Select, scanning electron microscopy in the sagittal direction showed that the sealing of titanium and zirconium abutments differed. The seal between the implant–titanium and implant–zirconium abutments seemed to be complete at the butt‐joint interface; however, the displacement of the abutment in relation to the fixture in the lateral direction was evident for both abutments with no statistical differences (P > 0·70), creating an inverted microgap. Thus, microscopy evaluation of two commonly used internal systems connected to titanium or zirconium abutments showed that the implant–abutment interface was perfectly sealed under no‐loading conditions. However, an inverted microgap was seen in both systems, which may result in bacterial accumulation as well as alteration of stress distribution at the implant–abutment interface.
Propagule pressure and colony social organization are associated with the successful invasion and rapid range expansion of fire ants in China
Authors: YANG CHIN‐CHENG , ASCUNCE MARINA S. , LUO LI‐ZHI , SHAO JING‐GUO , SHIH CHENG‐JEN , SHOEMAKER DEWAYNE
Published: December 2011

We characterized patterns of genetic variation in populations of the fire ant Solenopsis invicta in China using mitochondrial DNA sequences and nuclear microsatellite loci to test predictions as to how propagule pressure and subsequent dispersal following establishment jointly shape the invasion success of this ant in this recently invaded area. Fire ants in Wuchuan (Guangdong Province) are genetically differentiated from those found in other large infested areas of China. The immediate source of ants in Wuchuan appears to be somewhere near Texas, which ranks first among the southern USA infested states in the exportation of goods to China. Most colonies from spatially distant, outlying areas in China are genetically similar to one another and appear to share a common source (Wuchuan, Guangdong Province), suggesting that long‐distance jump dispersal has been a prevalent means of recent spread of fire ants in China. Furthermore, most colonies at outlier sites are of the polygyne social form (featuring multiple egg‐laying queens per nest), reinforcing the important role of this social form in the successful invasion of new areas and subsequent range expansion following invasion. Several analyses consistently revealed characteristic signatures of genetic bottlenecks for S. invicta populations in China. The results of this study highlight the invasive potential of this pest ant, suggest that the magnitude of international trade may serve as a predictor of propagule pressure and indicate that rates and patterns of subsequent range expansion are partly determined by the interplay between species traits and the trade and transportation networks.
Thermal adaptation and ecological speciation
Authors: KELLER I. , SEEHAUSEN O.
Published: December 2011

Ecological speciation is defined as the emergence of reproductive isolation as a direct or indirect consequence of divergent ecological adaptation. Several empirical examples of ecological speciation have been reported in the literature which very often involve adaptation to biotic resources. In this review, we investigate whether adaptation to different thermal habitats could also promote speciation and try to assess the importance of such processes in nature. Our survey of the literature identified 16 animal and plant systems where divergent thermal adaptation may underlie (partial) reproductive isolation between populations or may allow the stable coexistence of sibling taxa. In many of the systems, the differentially adapted populations have a parapatric distribution along an environmental gradient. Isolation often involves extrinsic selection against locally maladapted parental or hybrid genotypes, and additional pre‐ or postzygotic barriers may be important. Together, the identified examples strongly suggest that divergent selection between thermal environments is often strong enough to maintain a bimodal genotype distribution upon secondary contact. What is less clear from the available data is whether it can also be strong enough to allow ecological speciation in the face of gene flow through reinforcement‐like processes. It is possible that intrinsic features of thermal gradients or the genetic basis of thermal adaptation make such reinforcement‐like processes unlikely but it is equally possible that pertinent systems are understudied. Overall, our literature survey highlights (once again) the dearth of studies that investigate similar incipient species along the continuum from initial divergence to full reproductive isolation and studies that investigate all possible reproductive barriers in a given system.
Rotavirus disease burden among children <5 years of age – Santa Rosa, Guatemala, 2007–2009
Authors: Cortes Jennifer , Arvelo Wences , Lopez Beatriz , Reyes Lissette , Kerin Tara , Gautam Rashi , Patel Manish , Parashar Umesh , Lindblade Kim A.
Published: December 2011

Objectives  To assess the burden of rotavirus disease in Guatemala, in view of the recent introduction of a national rotavirus vaccination programme.

Methods  We examined data from an active, facility‐based surveillance system in Santa Rosa, Guatemala, from October 2007 through September 2009 among children <5 years of age presenting to the hospital or ambulatory clinics with diarrhoea (≥3 loose stools in 24 h during the last 7 days). Demographic and epidemiological data were collected, and specimens were tested for rotavirus via enzyme immunoassay. Genotyping was performed via reverse transcriptase polymerase chain reaction.

Results  We enrolled 347 hospitalized patients <5 years of age with diarrhoea and 1215 from ambulatory clinics. Specimens from 275 (79%) hospitalized children and 662 (54%) from ambulatory visits were tested for rotavirus. Rotavirus accounted for 32% of hospitalizations and 9% of ambulatory visits for diarrhoea, resulting in adjusted annual rates of 36 hospitalizations and 372 ambulatory visits per 10 000 children. Ninety‐one per cent of hospitalizations and 81% of ambulatory visits for rotavirus diarrhoea occurred in children <2 years. G1P8 represented 71% and 95% of rotavirus genotypes for 2007–2008 and 2008–2009 rotavirus seasons, respectively.

Conclusions  Rotavirus is a major cause of diarrhoea in children <5 years of age in Santa Rosa, Guatemala, highlighting the potential health benefits of vaccination and the need for continued surveillance to assess impact and effectiveness of the rotavirus vaccination programme in Guatemala.
Stillbirths and early neonatal mortality in rural Northern Ghana
Authors: Engmann Cyril , Walega Paul , Aborigo Raymond A. , Adongo Philip , Moyer Cheryl A. , Lavasani Layla , Williams John , Bose Carl , Binka Fred , Hodgson Abraham
Published: December 2011

Objective  To calculate perinatal mortality (stillbirth and early neonatal death: END) rates in the Upper East region of Ghana and characterize community‐based stillbirths and END in terms of timing, cause of death, and maternal and infant risk factors.

Methods  Birth outcomes were obtained from the Navrongo Health and Demographic Surveillance System over a 7‐year period.

Results  Twenty thousand four hundred and ninty seven pregnant women were registered in the study. The perinatal mortality rate was 39 deaths/1000 deliveries, stillbirth rate 23/1000 deliveries and END rates 16/1000 live births. Most stillbirths were 31 weeks gestation or less. Prematurity, first‐time delivery and multiple gestation all significantly increased the odds of perinatal death. Approximately 70% of END occurred during the first 3 postnatal days, and the most common causes of death were birth asphyxia and injury, infections and prematurity.

Conclusion  Stillbirths and END remain a significant problem in Navrongo. The main causes of END occur during the first 3 days and may be modifiable with simple targeted perinatal policies.
Diagnostic value of hazelnut allergy tests including rCor a 1 spiking in double‐blind challenged children
Authors: Masthoff L. J. , Pasmans S. G. , van Hoffen E. , Knol M. J. , Bruijnzeel‐Koomen C. A. , Flinterman A. E. , Kentie P. , Knulst A. C. , Meijer Y.
Published: December 2011

Background

The diagnostic value of hazelnut allergy tests in double‐blind challenged children is largely unknown. The aim of this study was to analyze the performance of current diagnostic tests for hazelnut allergy in children and the effect of spiking.

Methods

Data of 151 children who underwent a double‐blind placebo‐controlled food challenge for hazelnut were analyzed. The positive predictive value and negative predictive value (PPV/NPV) of level of specific IgE (sIgE) for hazelnut, the influence of rCor a 1 spiking of the ImmunoCAP, and size of the skin prick test (SPT) for hazelnut were determined, also in relation to the severity of the hazelnut allergy. Reported accidental ingestion leading to an allergic reaction to hazelnut was also analyzed in relation to hazelnut allergy.

Results

Specific IgE ≥0.35 kUA/l for hazelnut was a moderate predictor for hazelnut allergy. The spiking decreased the PPV from 41% to 38% and increased the NPV from 91% to 100% for sIgE ≥0.35 kUA/l. The maximum reached PPV was 73% for sIgE cutoff of 26 kUA/l. Level of sIgE before spiking was significantly different between different grades of severity and was lost after spiking. Skin prick test was a better predictor for hazelnut allergy and severity than the level of sIgE. A history of accidental ingestion leading to an allergic reaction to hazelnut had a predictive value of 59% for hazelnut allergy.

Conclusions

This study showed a good NPV of diagnostic tests for hazelnut allergy in children which further improved by rCor a 1 spiking. However, the PPVs are moderate and decreased by spiking.
What does the nature of the MECP2 mutation tell us about parental origin and recurrence risk in Rett syndrome?
Authors: Zhang J , Bao X , Cao G , Jiang S , Zhu X , Lu H , Jia L , Pan H , Fehr S , Davis M , Leonard H , Ravine D , Wu X
Published: December 2011

Zhang J, Bao X, Cao G, Jiang S, Zhu X, Lu H, Jia L, Pan H, Fehr S, Davis M, Leonard H, Ravine D, Wu X. What does the nature of the MECP2 mutation tell us about parental origin and recurrence risk in Rett syndrome?

The MECP2 mutations occurring in the severe neurological disorder Rett syndrome are predominantly de novo, with rare familial cases. The aims of this study were to provide a precise estimate of the parental origin of MECP2 mutations using a large Chinese sample and to assess whether parental origin varied by mutation type. The parental origin was paternal in 84/88 [95.5%, (95% confidence interval 88.77–98.75)] of sporadic Chinese cases. However, in a pooled sample including data from the literature the spectrum of mutations occurring on maternally and paternally derived chromosomes differed significantly. The excess we found of ‘single base pair gains or losses' on maternally derived MECP2 gene alleles suggests that this mutational category is associated with an elevated risk of gonadal mosaicism, which has implications for genetic counseling.
Plant phytaspases and animal caspases: structurally unrelated death proteases with a common role and specificity
Authors: Chichkova Nina V. , Tuzhikov Alexander I. , Taliansky Michael , Vartapetian Andrey B.
Published: December 2011

Proteases with an aspartate cleavage specificity are known to contribute to programmed cell death (PCD) in animals and plants. In animal cells this proteolytic activity belongs to caspases, a well‐characterized family of cysteine‐dependent death proteases. Plants, however, lack caspase homologs and thus the origin of this type of proteolytic activity in planta was poorly understood. Here, we review recent data demonstrating that a plant serine‐dependent protease, phytaspase, shares cleavage specificity and a role in PCD analogous to that of caspases. However, unlike caspases, regulation of phytaspase‐mediated cleavage of intracellular target proteins appears to be attained not at the level of proenzyme processing/activation, which occurs, in the case of phytaspase, autocatalytically and constitutively. Rather, the mature phytaspase is excluded from healthy cells into the apoplast and is allowed to re‐enter cells upon the induction of PCD. Thus, PCD‐related proteases in animals and plants display both common features and important distinctions.
Organ transplantation from a donor colonized with a multidrug‐resistant organism: a case report
Authors: Goldberg E. , Bishara J. , Lev S. , Singer P. , Cohen J.
Published: December 2011

The number of intensive care unit patients with infections caused by multidrug‐resistant organisms is increasing in most developed countries. We report the case of a deceased multiorgan donor, who was an asymptomatic carrier of carbapenem‐resistant Klebsiella pneumoniae (CR‐KP) in the respiratory tract, a condition that was not diagnosed before organ harvesting and transplantation. The outcome of the 2 kidney recipients, the liver recipient, and 1 of the lung recipients was uneventful; in particular, no evidence of infection transmission or adverse graft outcomes was noted. The other lung recipient had a complicated postoperative course and, 4 weeks post transplantation, he developed a bacteremic pneumonia with CR‐KP from which he subsequently died. These results suggest that, in well defined conditions, organs from donors who are CR‐KP positive may be considered for transplantation.
Donor‐derived Coccidioides immitis fungemia in solid organ transplant recipients
Authors: Blodget E. , Jan Geiseler P. , Larsen R.A. , Stapfer M. , Qazi Y. , Petrovic L.M.
Published: December 2011

We report disseminated coccidioidomycosis in 3 transplant recipients from a donor in an endemic area found to have unrecognized meningeal coccidioidomycosis. All 3 transplant recipients presented within 3 weeks of receipt of their organ. Only 1 organ recipient survived the acute presentation of coccidioidomycosis. Serologic testing for Coccidioides immitis infection should be considered for organ donors residing in endemic areas.
Pulse cyclophosphamide induction treatment in Thai children with diffuse proliferative lupus nephritis
Authors: OPASTIRAKUL SAUWALAK , CHARTAPISAK WATTANA
Published: December 2011

Aim:  To report the effectiveness of pulse cyclophosphamide induction therapy and to identify predictors for unresponsiveness to treatment in Thai children.

Methods:  Children with biopsy‐proven diffuse proliferative lupus nephritis admitted to Chiang Mai University hospital between 2001 and 2006 were retrospectively studied. Patients received a test dose of 750 mg/m2 at the first month followed by six cycles of monthly cyclophosphamide (IVCY) at a dose of 1 g/m2 (maximum 1 g) as induction therapy. Responsiveness to treatment, defined as urinary protein to creatinine ratio of less than 0.3 with normalization of C3 level and clinical remission, was assessed at the end of the induction period. Gender, age at onset, duration of disease before treatment, hypertension, clinical nephrotic syndrome, amount of proteinuria, serum creatinine, creatinine clearance, serum C3 level and crescentic formation were compared between responsive and nonresponsive groups. Maintenance therapy with quarterly pulse IVCY or Azathioprine or Mycophenolate mofetil was given for 18–24 months after remission.

Results:  Twenty nine patients with a mean age of 10.3 ± 2.6 years were studied. Hypertension, microscopic haematuria and nephrotic‐range proteinuria were seen in 66%, 86% and 60% of the patients, respectively. Forty‐one per cent of biopsies showed cellular or fibrocellular crescents. Twenty patients (69%) achieved remission at the end of induction therapy. There were no significant differences in all parameters studied between responsive and nonresponsive groups. The relapse rate after maintenance therapy was 58.8%.

Conclusion:  Our results show that pulse cyclophosphamide is an effective regimen for induction therapy in children with diffuse proliferative glomerulonephritis. No definite predictor for unresponsiveness was detected in this study.
Change in accuracy of recognizing psychiatric disorders by non‐psychiatric physicians: Five‐year data from a psychiatric consultation–liaison service
Authors: Su Jian‐An , Tsai Ching‐Shu , Hung Tai‐Hsin , Chou Shih‐Yong
Published: December 2011

Aim:  Psychiatric disorders are easily underestimated and under‐recognized by physicians. The aim of the present study was to investigate the change in accuracy of recognizing psychiatric symptoms.

Methods:  Consecutive 5‐year consultation–liaison data were collected and patients with one of the five common psychiatric diagnoses, including depressive disorders, substance use disorders, delirium, anxiety disorders and psychotic disorders, were chosen for analysis. The primary care physician's initial impression of a psychiatric diagnosis was recorded based on their reason for referral on the referral sheets. Accurate recognition was defined as matching of the physician's initial impression with the psychiatrist's final diagnosis. Mentioning the core symptoms of psychiatric diagnostic criteria or common synonyms would be considered as correct recognition.

Results:  The overall accuracy of recognition was 41.5% and there was no significant change during this 5‐year period. Substance use disorders were the one diagnosis with the highest agreement, followed by delirium, depressive disorders, anxiety disorders, and psychotic disorders. As for the factors associated with accurate recognition, male patients or those with multiple physical illnesses were more likely to have their psychiatric symptoms recognized correctly.

Conclusions:  Without comprehensive postgraduate psychiatric education, the accuracy of recognizing psychiatric symptoms does not improve year by year. Education should focus on common psychiatric problems among medical inpatients, especially those easily misdiagnosed, such as depression and delirium.
Hyperhomocysteinemia in Tunisian bipolar I patients
Authors: Ezzaher Asma , Mouhamed Dhouha Haj , Mechri Anwar , Omezzine Asma , Neffati Fadoua , Douki Wahiba , Bouslama Ali , Gaha Lotfi , Najjar Mohamed Fadhel
Published: December 2011

Aims:  The aim of the present study was to investigate hyperhomocysteinemia in Tunisian bipolar I patients according to 5,10‐methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism.

Methods:  The subjects consisted of 92 patients with bipolar I disorder diagnosed according to DSM‐IV, and 170 controls. Plasma total homocysteine, folate and vitamin B12 were measured. MTHFR C677T polymorphism was determined by polymerase chain reaction–restriction fragment length polymorphism.

Results:  Compared with controls, patients had a significantly higher homocysteine level (16.4 ± 9.8 vs 9.6 ± 4.5 µmol/L; P < 0.001) and a significantly lower folate level (3.2 ± 0.9 vs 6.5 ± 3.2 µg/L; P < 0.001). C677T MTHFR polymorphism genotype frequencies were in Hardy–Weinberg equilibrium. After adjustment for MTHFR C677T genotypes, hypofolatemia, hypovitamin B12 and for potential confounding factors, the odds ratio (OR) of hyperhomocysteinemia associated with bipolar disorder remained significant (OR, 5.53; 95% confidence interval: 1.92–15.86; P = 0.001). In patients, there was no significant change in hyperhomocysteinemia, hypofolatemia and hypovitamin B12 with regard to the clinical and therapeutic characteristics, whereas the highest prevalence of hyperhomocysteinemia was found in depressive patients and when illness duration was >12 years. Hypofolatemia was seen in all patients on lithium and in the majority of patients on carbamazepine, and the highest prevalence of hypovitamin B12 was noted in patients taking carbamazepine.

Conclusion:  Hyperhomocysteinemia was more frequent in bipolar I patients independent of C677T polymorphism. Patients had reduced levels of folate, which modulates homocysteine metabolism. Indeed, this finding indicates that folate supplementation may be appropriate for bipolar patients with hyperhomocysteinemia.
Recognition of facial emotion and perceived parental bonding styles in healthy volunteers and personality disorder patients
Authors: Zheng Leilei , Chai Hao , Chen Wanzhen , Yu Rongrong , He Wei , Jiang Zhengyan , Yu Shaohua , Li Huichun , Wang Wei
Published: December 2011

Aims:  Early parental bonding experiences play a role in emotion recognition and expression in later adulthood, and patients with personality disorder frequently experience inappropriate parental bonding styles, therefore the aim of the present study was to explore whether parental bonding style is correlated with recognition of facial emotion in personality disorder patients.

Methods:  The Parental Bonding Instrument (PBI) and the Matsumoto and Ekman Japanese and Caucasian Facial Expressions of Emotion (JACFEE) photo set tests were carried out in 289 participants.

Results:  Patients scored lower on parental Care but higher on parental Freedom Control and Autonomy Denial subscales, and they displayed less accuracy when recognizing contempt, disgust and happiness than the healthy volunteers. In healthy volunteers, maternal Autonomy Denial significantly predicted accuracy when recognizing fear, and maternal Care predicted the accuracy of recognizing sadness. In patients, paternal Care negatively predicted the accuracy of recognizing anger, paternal Freedom Control predicted the perceived intensity of contempt, maternal Care predicted the accuracy of recognizing sadness, and the intensity of disgust.

Conclusions:  Parenting bonding styles have an impact on the decoding process and sensitivity when recognizing facial emotions, especially in personality disorder patients.
Views and experiences of mental health nurses working with undergraduate assistants in nursing in an acute mental health setting
Authors: Cleary Michelle , Horsfall Jan , O'Hara‐Aarons Maureen , Mannix Judy , Jackson Debra , Hunt Glenn E.
Published: December 2011

Undergraduate nurses are employed as assistants in nursing (AIN) in inpatient mental health settings; however, there is a paucity of published research exploring registered nurses' (RN) views about the AIN role in these settings. This qualitative study documents the views and experiences of RN working with undergraduate AIN. Fifty structured face‐to‐face interviews were analysed, and the results are discussed in three sections. The first section outlines RN perceptions of qualities and skills required of AIN in mental health, and the responses primarily focus on communication skills, initiative, and willingness to learn. The second section targets factors in the workplace that might enhance the interest of AIN in a mental health nursing career; the responses emphasize their need to work with experienced staff. The last section outlines RN expectations of AIN, most of which are met and involve physical observations and technical tasks; less fulfilled activities primarily cluster around interactions with patients. Findings highlight the advantages and disadvantages of drawing on undergraduate nursing students as AIN in mental health settings. Communication skills, personal initiative, safety training to prevent violence, and education to increase knowledge and awareness about mental illness, diagnosis, and mental status‐related skills were all important concerns articulated by RN.