bluuebunny/crossref_metadata_2025 huggingface dataset:
Maximizing patient adherence for optimal outcomes in psoriasis
Authors: Bewley A , Page B
Published: April 2011

Psoriasis is a chronic, disabling disease in which adherence to treatment is often poor. The aim of this article is to highlight the problem of adherence to long‐term treatment in psoriasis and the factors that contribute to it, and to discuss how adherence, and thus outcomes, can be improved. This article is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6–10 October, 2010, in Gothenburg, Sweden. Adherence to topical medication is a major problem in psoriasis. Not only are prescriptions not being filled by patients (primary adherence) but topical medications are not being used as recommended (secondary adherence). The issue is complex due to the many factors which affect adherence, including efficacy, ease of use and convenience of application, and the healthcare professional–patient relationship. Due to the nature of the disease, patients suffer poor self‐image and feel stigmatized, particularly when psoriasis is present on a visible part of the body. Consequently, the negative impact of psoriasis on patient quality of life underlies many adherence issues. It is therefore important for treatment to address the psychological aspects as well as the physical symptoms of psoriasis. Improvements in several areas of disease management may lead to benefits in medication adherence and hence clinical benefit. Prescribing therapy in line with patient preference for treatment vehicle and improving the healthcare professional–patient relationship may be key factors. Nurses have an important role in educating patients and delivering long‐term care. This individualized, personal, approach may help improve treatment adherence, outcomes, and the quality of life for patients with psoriasis.
What is new in topical therapy for psoriasis?
Authors: Reich K , Bewley A
Published: April 2011

This article describes a recent development in topical therapies for psoriasis and is based on a presentation given by the authors at a satellite symposium convened during the 19th Congress of the European Academy of Dermatology and Venereology, 6–10 October 2010, in Gothenburg, Sweden. Topical therapies are the mainstay of treatment for psoriasis; however, for optimal outcomes to be achieved, medications need to be used as prescribed. Patients with psoriasis often report low treatment adherence rates; the reasons for this are multifactorial, but can include specific aspects of the treatments themselves. For example, physical properties, ease of use and the vehicle in which the active ingredients are dissolved can all play a role in an individual patient’s adherence to treatment. Of the available topical therapies, corticosteroids and vitamin D analogues are the treatment of choice, with combined efficacy that is superior to monotherapy with either agent. To permit simultaneous once‐daily dosing, an ointment was formulated that allowed calcipotriol and betamethasone dipropionate to be delivered together; this two‐compound ointment had an improved efficacy and tolerability profile vs. either compound alone. To provide an alternative for patients who may dislike ointments, but still want to benefit from the high efficacy of combination therapy, a two‐compound (calcipotriol/betamethasone dipropionate) gel has recently been developed; data from phase 2 and phase 3 studies show that it is more effective than the comparators it was tested against, with fewer adverse events, and a rapid onset of action. In a series of one‐to‐one interviews recently conducted with 150 patients with psoriasis, gel and cream formulations were preferred for ease of use and cosmetic acceptability compared with ointment. The availability of this new gel thus increases patient choice. Ultimately, treatment should always be tailored to match individual patients’ needs.
Modulation of plant growth by HD‐Zip class I and II transcription factors in response to environmental stimuli
Authors: Harris John C. , Hrmova Maria , Lopato Sergiy , Langridge Peter
Published: April 2011

Plant development is adapted to changing environmental conditions for optimizing growth. This developmental adaptation is influenced by signals from the environment, which act as stimuli and may include submergence and fluctuations in water status, light conditions, nutrient status, temperature and the concentrations of toxic compounds. The homeodomain‐leucine zipper (HD‐Zip) I and HD‐Zip II transcription factor networks regulate these plant growth adaptation responses through integration of developmental and environmental cues. Evidence is emerging that these transcription factors are integrated with phytohormone‐regulated developmental networks, enabling environmental stimuli to influence the genetically preprogrammed developmental progression. Dependent on the prevailing conditions, adaptation of mature and nascent organs is controlled by HD‐Zip I and HD‐Zip II transcription factors through suppression or promotion of cell multiplication, differentiation and expansion to regulate targeted growth. In vitro assays have shown that, within family I or family II, homo‐ and/or heterodimerization between leucine zipper domains is a prerequisite for DNA binding. Further, both families bind similar 9‐bp pseudopalindromic cis elements, CAATNATTG, under in vitro conditions. However, the mechanisms that regulate the transcriptional activity of HD‐Zip I and HD‐Zip II transcription factors in vivo are largely unknown. The in planta implications of these protein–protein associations and the similarities in cis element binding are not clear.

Contents

Summary
823

I.
Introduction
824

II.
The role of HD‐Zip transcription factors in plant growth adaptation to environmental changes and the phytohormone network
825

III.
Dissecting the common cis element, dimerization and cell specificity of HD‐Zip I and HD‐Zip II transcription factors
830

IV.
Conclusions
834

Acknowledgements
834

References
834
This ought to be good: Brain activity accompanying positive and negative expectations and outcomes
Authors: Liao Yu , Gramann Klaus , Feng Wenfeng , DeáK Gedeon O. , Li Hong
Published: April 2011

The current study employed a modified gambling task, in which probabilistic cues were provided to elicit positive or negative expectations. Event‐related potentials (ERPs) to “final outcome” and “probabilistic cues” were analyzed. Difference waves between the negative condition and the corresponding positive condition were examined. The results confirm that feedback related negativity (FRN) amplitude is modulated by the interaction of outcome valence and expectancy by showing larger FRN difference waves for unexpected than expected outcomes. More interestingly, the difference wave between ERPs elicited by positive and negative expectations showed a negative deflection, with a frontal midline source density around 280 ms after onset of the predictive cue. Negative expectations were associated with larger FRN amplitudes than positive expectations. This suggests that FRN is elicited by probabilistic cues to pending outcomes.
High mitochondrial DNA diversity of an introduced alien carnivore: comparison of feral and ranch American mink Neovison vison in Poland
Authors: Zalewski Andrzej , Michalska‐Parda Aleksandra , Ratkiewicz Mirosław , Kozakiewicz Michał , Bartoszewicz Magdalena , Brzeziński Marcin
Published: April 2011

Aim  Invasive alien species usually exhibit very high adaptation and rapid evolution in a new environment, but they often have low levels of genetic diversity (invasive species paradox). Genetic variation and population genetic structure of feral American mink, Neovison vison, in Poland was investigated to explain the invasion paradox and to assess current gene flow. Furthermore, the influence of mink farming on adaptation of the feral population was evaluated by comparing the genetic structure of feral and ranch mink.

Location  Samples from feral mink were collected in 11 study areas in northern and central Poland and from ranch mink at 10 farms distributed throughout the country.

Methods  A 373‐bp‐long mtDNA control region fragment was amplified from 276 feral and 166 ranch mink.

Results  Overall, 31 haplotypes, belonging to two groups from genetically diverse sources, were detected: 11 only in feral mink, 12 only in ranch mink and eight in both. The genetic differentiation of feral mink from the trapping sites was high, while that among ranch mink from various farms was moderate. There was no significant relationship between genetic and geographic distance. The number of trapping sites where given haplotypes occurred correlated with the number of farms with these haplotypes. The mink from two sites were the most divergent, both from all other feral mink and from ranch mink. Comparison of mtDNA and microsatellite differentiation suggests male‐biased dispersal in this species.

Main conclusions  American mink in Poland exhibit high genetic diversity and originate from different source populations of their native range. The process of colonization was triggered by numerous escapees from various farms and by immigrants from Belarus. The genetic structure of local feral mink populations was shaped by the founder effect and multiple introductions. The genomic admixture that occurred during mixing of different populations might have increased the fitness of individuals and accelerated the invasiveness of this species.
Prognostic value of regional lymph node status in canine mammary carcinomas
Authors: Szczubiał M. , Łopuszynski W.
Published: April 2011

In this study, we have determined the prognostic value of the presence of the micrometastases and metastases greater than 2 mm in the regional lymph nodes for bitches with mammary carcinomas. The study involved 51 dogs diagnosed with a single malignant epithelial tumour in the 4th or 5th mammary gland. All animals underwent regional mastectomy; the 4th and 5th mammary glands were removed together with the inguinal lymph node. The lymph nodes were examined immunohistochemically using the anti‐cytokeratin antibody, clone AE1/AE3. The bitches were followed up every 6 months for 2 years after surgery to determine the disease‐free survival (DFS) and overall survival (OS). The Kaplan–Meier analysis showed a statistically significant difference in DFS and OS only between the group of bitches without metastases and the group with lymph node metastases greater than 2 mm. No significant differences between these two groups versus bitches with lymph node micrometastases were found.
Radiotherapy in the management of localized mucocutaneous oral lymphoma in dogs: 14 cases
Authors: Berlato D. , Schrempp D. , Van Den Steen N. , Murphy S.
Published: April 2011

Oral mucocutaneous lymphoma is rare in dogs. Surgery and chemotherapy do not usually provide effective long‐term control. The objective of this study was to retrospectively evaluate survival of dogs with localized oral lymphoma treated with radiation therapy. The medical database of three institutions was searched for dogs with diagnosis of oral lymphoma treated with radiotherapy. Dogs with evidence of systemic disease were excluded. Survival was calculated with the Kaplan–Meier method and prognostic variables analysed with log‐rank test. Fourteen dogs were included in the study. Mean survival was 1129 days [95% confidence interval (CI) 711–1546] with median survival of 770 days. The overall response of radiotherapy was 67% (five complete and three partial responses). A survival advantage was seen in dogs with no evidence of lymph node metastasis (P= 0.002) and that achieved a complete response to radiation therapy (P= 0.013). Radiation therapy was a well‐tolerated and effective treatment for localized oral lymphoma.
The influence of interleukin‐4 on ligament healing
Authors: Chamberlain Connie S. , Leiferman Ellen M. , Frisch Kayt E. , Wang Sijian , Yang Xipei , Brickson Stacey L. , Vanderby Ray
Published: April 2011

Despite a complex cascade of cellular events to reconstruct the damaged extracellular matrix, ligament healing results in a mechanically inferior scarred ligament. During normal healing, granulation tissue expands into any residual normal ligamentous tissue (creeping substitution), resulting in a larger region of healing, greater mechanical compromise and an inefficient repair process. To control creeping substitution and possibly enhance the repair process, the antiinflammatory cytokine, interleukin‐4 (IL‐4), was administered to rats before and after rupture of their medial collateral ligaments. In vitro experiments showed a time‐dependent effect on fibroblast proliferation after IL‐4 treatment. In vivo treatments with IL‐4 (100 ng/mL IV) for 5 days resulted in decreased wound size and type III collagen and increased type I procollagen, indicating a more regenerative early healing in response to the IL‐4 treatment. However, continued treatment of IL‐4 to day 11 antagonized this early benefit and slowed healing. Together, these results suggest that IL‐4 not only influences the macrophages and T lymphocytes but also stimulates fibroblasts associated with the proliferative phase of healing in a dose‐, cell‐, and time‐dependent manner. Although treatment significantly influenced healing in the first week after injury, IL‐4 alone was unable to maintain this early regenerative response.
Concurrent validation and reliability of digital image analysis of granulation tissue color for clinical pressure ulcers
Authors: Iizaka Shinji , Sugama Junko , Nakagami Gojiro , Kaitani Toshiko , Naito Ayumi , Koyanagi Hiroe , Matsuo Junko , Kadono Takafumi , Konya Chizuko , Sanada Hiromi
Published: April 2011

Granulation tissue color is one indicator for pressure ulcer (PU) assessment. However, it entails a subjective evaluation only, and quantitative methods have not been established. We developed color indicators from digital image analysis and investigated their concurrent validity and reliability for clinical PUs. A cross‐sectional study was conducted on 47 patients with 55 full‐thickness PUs. After color calibration, a wound photograph was converted into three images representing red color: erythema index (EI), modified erythema index with additional color calibration (granulation red index [GRI]), and , which represents the artificially created red–green axis of L*a*b* color space. The mean intensity of the granulation tissue region and the percentage of pixels exceeding the optimal cutoff intensity (% intensity) were calculated. Mean GRI (ρ=0.39, p=0.007) and (ρ=0.55, p<0.001), as well as their % intensity indicators, showed positive correlations with a* measured by tristimulus colorimeter, but erythema index did not. They were correlated with hydroxyproline concentration in wound fluid, healthy granulation tissue area, and blood hemoglobin level. Intra‐ and interrater reliability of the indicator calculation using both GRI and had an intraclass correlation coefficient >0.9. GRI and from digital image analysis can quantitatively evaluate granulation tissue color of clinical PUs.
Effects of different pedalling techniques on muscle fatigue and mechanical efficiency during prolonged cycling
Authors: Theurel J. , Crepin M. , Foissac M. , Temprado J. J.
Published: April 2011

The present study aimed to test the influence of the pedalling technique on the occurrence of muscular fatigue and on the energetic demand during prolonged constant‐load cycling exercise. Subjects performed two prolonged (45 min) cycling sessions at constant intensity (75% of maximal aerobic power). In a random order, participants cycled either with their preferred technique (PT) during one session or were helped by a visual force‐feedback to modify their pedalling pattern during the other one (FB). Index of pedalling effectiveness was significantly (P<0.05) improved during FB (41.4±5.5%); compared with PT (36.6±4.1%). Prolonged cycling induced a significant reduction of maximal power output, which was greater after PT (−15±9%) than after FB (−7±12%). During steady‐state FB, vastus lateralis muscle activity was significantly (P<0.05) reduced, whereas biceps femoris muscles activities increased compared with PT. Gross efficiency (GE) did not significantly differ between the two sessions, except during the first 15 min of exercise (FB: 19.0±1.9% vs PT: 20.2±1.9%). Although changes in muscular coordination pattern with feedback did not seem to influence GE, it could be mainly responsible for the reduction of muscle fatigue after prolonged cycling.
Differences in the surface and subsurface reflection characteristics of facial skin by age group
Authors: Matsubara Akira
Published: April 2011

Background/purpose: The age‐dependent changes of facial skin imperfections such as spot or wrinkles have been investigated repeatedly by means of various objective measurements. However, the age‐dependent changes in the optical‐reflection characteristics that create a perception of a shine or a glow of the skin have received little attention. We evaluated the age dependence of the optical‐reflection characteristics of the surface and subsurface facial skin layers of three age groups.

Methodology: The facial skin of 83 Japanese females ranging in age from 20 to 49 years was examined using a high‐resolution digital camera equipped with a linear polarizing filter under polarized illumination. Surface and subsurface reflection components were extracted by means of an image‐processing technique. In addition to the reflection characteristics, skin hydration, the melanin index, and the hemoglobin index were also measured.

Results: Significant age‐dependent changes were found in the evenness of the surface reflection and in the intensity of the subsurface reflection. In contrast, no difference was observed in the intensity of the surface reflection or in the evenness of the subsurface reflection. The melanin index showed a significant age‐dependent difference, with a trend similar to that of the subsurface reflection intensity, but the skin hydration and hemoglobin index showed no difference by age group.

Conclusion: Surface and subsurface reflection characteristics show age‐dependent changes. Younger skin has a greater subsurface reflectivity and a more even surface reflectivity. These optical characteristics of the skin might be related to the perception of consumers that younger skin is brighter and more radiant with an internal glow, whereas aged skin is shinier or glossier.
Tolerance of low‐frequency ultrasound sonophoresis: a double‐blind randomized study on humans
Authors: Maruani Annabel , Vierron Emilie , Machet Laurent , Giraudeau Bruno , Halimi Jean‐Michel , Boucaud Alain
Published: April 2011

Background: Sonophoresis [low‐frequency ultrasound (US)] has been used in animals and in vitro to investigate enhanced percutaneous absorption of drugs. No study focused on its clinical human tolerance has been published as yet.

Methods: We aimed to assess the bioeffects of low‐frequency US in vivo on human skin in a double‐blind randomized‐controlled study. We applied pulse‐mode US at 36 kHz for 5 min in a step procedure of increasing dosage, from 1.57 to 3.50 W/cm2, and placebo. The primary outcome was toxic effects of the procedure, defined as a pain score >40 on a 0–100 mm visual analogue scale or necrosis. Erythema (scored from 0 to 3 in severity) was also evaluated. The secondary outcomes were measurements of skin thickness by high‐resolution skin imaging, of skin capacitance and temperature.

Results: We included 34 healthy volunteers. We found no pain score >38 and no skin necrosis with either US or placebo. Erythema was systematically observed immediately after US application, but after 1 day, we observed three cases in the knee group. The most frequent adverse effect was tinnitus. We observed no marked increase in temperature or cutaneous thickness after US or placebo. Cutaneous capacitance increased immediately after both applications.

Conclusion: Such data demonstrating good tolerance of sonophoresis can be useful before the initiation of a clinical trial of the therapeutic use of low‐frequency sonophoresis in humans.
Thermography study of skin response due to whole‐body cryotherapy
Authors: Cholewka Armand , Stanek Agata , Sieroń Aleksander , Drzazga Zofia
Published: April 2011

Purpose: Thermography and contact thermometry were used to study the influence of body mass index (BMI) on the lowering of skin temperature caused by whole‐body cryotherapy.

Methods: The study was performed using the Thermovision Camera AGEMA Type 470 and A40. The thermograms of the chosen regions of interests were performed before and immediately after whole‐body cryotherapy in a research room outside a cryogenic chamber where the temperature was stabilized. As an additional measurement technique during whole‐body cryotherapy, contact thermometry was performed using thermocouples Ni–Cr–Ni–Al stacked to the skin surface.

Results: The results obtained showed differences in the decrease of skin temperature of predetermined body parts. The largest temperature decrease was observed on the lower extremities. Some differences in the thermal response of similar body parts influenced by the extremely low temperature, with regard to the BMI of volunteers, were observed. This was also found in the results of contact thermometry studies. The statistical analysis confirmed the results of thermography and thermometry studies.

Conclusion: The magnitude of skin temperature decrease due to the extremely low temperature used in whole‐body cryotherapy may be connected to a patient's BMI.
Cerebral Resistance Index is less predictive in hypothermic encephalopathic newborns
Authors: Elstad Maja , Whitelaw Andrew , Thoresen Marianne
Published: April 2011

Aim:  Neonatal hypoxic‐ischaemic encephalopathy (HIE), if severe, may involve cerebral vasoparalysis. In HIE, Pourcelot’s cerebral vascular resistance index (RI) below 0.55 (by Doppler ultrasound) from published literature at normothermia predicted poor outcome with a positive predictive value (PPV) of 84%. The aim of this study was to re‐assess RI as a predictor of outcome in HIE during hypothermia.

Methods:  One hundred and twenty‐five infants with HIE treated with hypothermia with outcome data and at least one measurement of RI at 24 h or later were included. Poor outcome was defined as death or severe disability.

Results:  Positive predictive value of low RI (≤0.55) was 60% (95% CI 45%, 74%), while the negative predictive value (NPV) was 78% (95% CI: 67%, 86%). The PPV during hypothermia is significantly lower than the pooled PPV of 84% (95% CI 73%, 91%) from all published studies of RI at normothermia. NPV during hypothermia and normothermia was similar [76%, (95% CI 69%, 82%)].

Conclusion:  Low RI is significantly less predictive of poor outcome during hypothermia than normothermia. The lower PPV may be because hypothermia affects cerebral vasculature or protects the brain solely at a molecular and cellular level. Infants, who would have been predicted from their RI to have poorer outcome at normothermia, have better outcome when cooled.
Low thymic size in preterm infants in the neonatal intensive care unit, a possible marker of infection? A prospective study from birth to 1 year of age
Authors: Jeppesen DL , Ersbøll AK , Nielsen SD , Hoppe TU , Valerius NH
Published: April 2011

Aim:  To study the growth of the thymus in preterm infants.

Methods:  Ultrasonographic thymic size (Ti) was studied in 80 preterm infants (gestational age 24–36 weeks) from birth to discharge from the neonatal intensive care unit (NICU). Thirty‐three of these infants were followed to 1 year of age.

Results:  At birth, the median Ti was 5.2 compared with 11.8 in term infants. At discharge, the median Ti was 10.0 and not significantly different from Ti in term infants at birth (p = 0.22). The size of the thymus was significantly associated with postmenstrual age and weight (both p < 0.01). Infections during admission were negatively associated with the size of the thymus (p < 0.01). During the first 3 months after discharge, preterm infants had a significantly higher frequency of infections than did term infants (p = 0.002); hereafter, the preterm infants had significantly fewer infections than term infants (p = 0.002). The median Ti in preterm infants and term infants at 1 year of age was 21.1 and 17.3, respectively. This difference was not statistically significant (p = 0.41).

Conclusions:  Growth of thymus was not compromised by preterm birth. Ti is negatively associated with the frequency of infections in preterm neonates submitted to NICU.
Hypothesis‐driven species distribution models for tree species in the Bavarian Alps
Authors: Mellert K. H. , Fensterer V. , Küchenhoff H. , Reger B. , Kölling C. , Klemmt H. J. , Ewald J.
Published: April 2011

Question: What are the main drivers for tree species distribution in the Bavarian Alps? What are the species‐specific habitat requirements? Are predictions in accordance with expert knowledge?

Location: Bavarian Alps (Southern Germany).

Methods: To describe tree species–environment relationships, we established species distribution models for the 14 most common tree species of the region. We combined tree species occurrence data from forest inventories and a vegetation database with environmental data from a digital elevation model, climate maps and soil maps. For modelling, we used generalized additive models (GAM) combined with techniques to account for spatial autocorrelation and uneven coverage of environmental gradients. We developed parsimonious models to judge whether statistical models correspond to models based on expert knowledge.

Results: Conceptual models were generally in accordance with expectations. Variables based on average temperatures were the most important predictors in most models. Proxies for soil properties such as water and nutrient availability were statistically significant and generally plausible, but appeared largely redundant for model performance. Altitudinal limits of tree species were generally well represented by models. Most species responded differently to summer and January temperatures, indicating that temperature variables are proxies not only for energy balance, but also for frost damage and drought. Although model building benefits considerably from collation with expert knowledge, there are limitations.

Conclusions: Meaningful species distribution models can be obtained from noisy data sets covering only a small fraction of species ranges. Models calibrated with such data sets benefit from hypothesis‐driven model building rather than strict data‐driven model building. Hence, misleading explanations and predictions can be avoided and uncertainties identified. Nevertheless, projections based on climate scenarios can be substantially improved only with models calibrated on a wider data set. Ideally, environmental gradients should cover the whole niche space of a species, or at least include regions with analogous climate.
Self‐perception of oral health in non‐institutionalised elderly of Piracicaba city, Brazil
Authors: Esmeriz Cláudia E. C. , Meneghim Marcelo C. , Ambrosano Gláucia M. B.
Published: April 2011

doi: 10.1111/j.1741‐2358.2011.00464.x
 
Self‐perception of oral health in non‐institutionalised elderly of Piracicaba city, Brazil

Objectives:  To associate the self‐perception of oral health with sociodemographic, clinical, quality of life and geriatric depression, evaluating what influence in the self‐perception of the elderly and the importance to the oral health.

Background:  The current demographic transition and poor oral health of the elderly deserves particular attention, especially the impact of oral health on the quality of life.

Methods:  In this cross‐sectional study, we evaluated 371 elderly, aged 60 years or more, adscript to Health Family Units, Piracicaba city, Brazil. Clinically, the indexes decayed missing filled teeth (DMFT), CPI and Use/Need of Prosthesis (WHO/99) were used and evaluated by means of instruments such as the self‐perceived oral health [geriatric oral health assessment index (GOHAI)], quality of life (SF‐36) and geriatric depression (Geriatric Depression Scale). The statistical analyses were carried out by means of univariate analysis of chi‐square and Fisher’s exact (α = 0.05) and multiple logistic regression analysis.

Results:  The mean age was 67.35 (2.8), with a mean DMFT of 28.5 (4.8) and a positive GOHAI score (>30). Most were women (63.3%), between 60 and 70 years (72.2%), married (60.4%), had just the elementary school (75.5%) education. Around 80% used some removable prosthetic. The results were associated with characteristics of self‐perception of oral health and were significative of schooling (OR = 2.46) and the emotional aspects of quality of life (OR = 0.30). Over 20% of the sample had traits of depression, and these results were statistically significant (OR = 1.65) when associated with the GOHAI scores.

Conclusion:  Educational and emotional aspects and geriatric depression are factors that influence the positive self‐perception of oral health of elderly people of Piracicaba USFs. These results represent that education, feelings and behaviours deserve special attention in their oral health, thereby approaching the self‐perception of real dental condition.
The patient journey of adults with hearing impairment: the patients’ views
Authors: Manchaiah V.K.C. , Stephens D. , Meredith R.
Published: April 2011

Clin. Otolaryngol. 2011, 36, 227–234

Objective:  The term ‘patient journey’ refers to the experiences and processes the patient goes through during the course of a disease and its treatment. The study explores the perspectives of adults with acquired hearing impairment and to further develop the patient journey template based on the Ida model.

Design:  Qualitative approach using thematic analysis and process mapping.

Setting:  Support groups of people with hearing impairment.

Participants:  Thirty‐two adults with acquired hearing impairment from two hearing impaired groups in Wales. All were hearing aid users.

Main outcome measure:  Participants worked in small groups to describe their experiences through hearing loss. These data were used to develop a template of the patients’ perspective of the journey. This was then compared with the perspective of professionals, and a ‘patient journey template for adults with acquired hearing impairment’ was developed.

Results:  This template identifies seven main phases as follows: (i) pre‐awareness; (ii) awareness; (iii) movement; (iv) diagnostics; (v) rehabilitation; (vi) self‐evaluation; and (vii) resolution. The study identified a number of new components. The self‐evaluation component was not defined by professionals and reflects the need for patients to consider the costs, benefits and alternatives to the approach provided by audiologists. It is important for audiologists to be aware of this.

Conclusion:  The study highlighted the differences and commonalities in perspectives of professionals and patients. Use of the patient journey can help clinicians to understand the unique experiences their patients go through help them to develop patient‐centred treatment.
Cardiac and Vascular Consequences of Pre‐Hypertension in Youth
Authors: Urbina Elaine M. , Khoury Philip R. , McCoy Connie , Daniels Stephen R. , Kimball Thomas R. , Dolan Lawrence M.
Published: April 2011

Hypertension is associated with increased left ventricular mass (LVM) and carotid intima‐media thickness (cIMT), which predict cardiovascular (CV) events in adults. Whether target organ damage is found in pre‐hypertensive youth is not known. The authors measured body mass index, blood pressure, fasting glucose, insulin, lipids and C‐reactive protein, LVM/height2.7 (LVM index), diastolic function, cIMT, carotid stiffness, augmentation index, brachial artery distensibility, and pulse wave velocity (PWV) in 723 patients aged 10 to 23 years (29% with type 2 diabetes mellitus). Patients were stratified by blood pressure level (normotensive: 531, pre‐hypertensive: 65, hypertensive: 127). Adiposity and CV risk factors worsened across blood pressure group. There was a graded increase in cIMT, arterial stiffness, and LVM index and decrease in diastolic function from normotension to pre‐hypertension to hypertension. In multivariable models adjusted for CV risk factors, status as pre‐hypertension or hypertension remained an independent determinant of target organ damage for LVM, diastolic function, internal cIMT, and carotid and arterial stiffness. Pre‐hypertension is associated with cardiovascular target organ damage in adolescents and young adults.

J Clin Hypertens (Greenwich). 2011;13:332–342. ©2011 Wiley Periodicals, Inc.
Oxygen saturation in branch retinal vein occlusion
Authors: Hardarson Sveinn Hakon , Stefánsson Einar
Published: April 2011

Purpose:  The aim of this study was to test whether oxygen saturation in retinal blood vessels is affected by branch retinal vein occlusion (BRVO).

Methods:  The spectrophotometric retinal oximeter is based on a fundus camera. It simultaneously captures images of the retina at 586 and 605 nm and calculates optical density (absorbance) of retinal vessels at both wavelengths. The ratio of the two optical densities is approximately linearly related to haemoglobin oxygen saturation. Relative oxygen saturation was measured in retinal blood vessels in 24 patients with BRVO. Friedman’s test and Dunn’s post test were used for statistical analyses.

Results:  Oxygen saturation in occluded venules ranged from 12% to 93%. The median oxygen saturation was 59% (range 12–93%, n = 22) in affected retinal venules, 63% (23–80%) in unaffected venules in the BRVO eye and 55% (39–80%) in venules in the fellow eye (p = 0.66). Corresponding values for arterioles were 101% (89–115%, n = 18), 95% (85–104%) (p < 0.05) and 98% (84–109%).

Conclusions:  Venular saturation in BRVO is highly variable between patients. Hypoxia is seen in some eyes but not in others. This may reflect variable severity of disease, degree of occlusion, recanalization, collateral circulation, tissue atrophy, arteriovenous diffusion or vitreal transport of oxygen.
Measuring the temporal structure in serially sampled phylogenies
Authors: Gray Rebecca R. , Pybus Oliver G. , Salemi Marco
Published: April 2011

1. Nucleotide sequences sampled at different times (serially sampled sequences) allow researchers to study the rate of evolutionary change and the demographic history of populations. Some phylogenies inferred from serially sampled sequences are described as having strong ‘temporal clustering’, such that sequences from the same sampling time tend to cluster together and to be the direct ancestors of sequences from the following sampling time. The degree to which phylogenies exhibit these properties is thought to reflect interesting biological processes, such as positive selection or deviation from the molecular clock hypothesis.

2. Here, we introduce the temporal clustering (TC) statistic, which is the first quantitative measure of the degree of topological ‘temporal clustering’ in a serially sampled phylogeny. The TC statistic represents the expected deviation of an observed phylogeny from the null hypothesis of no temporal clustering, as a proportion of the range of possible values, and can therefore be compared among phylogenies of different sizes.

3. We apply the TC statistic to a range of serially sampled sequence data sets, which represent both rapidly evolving viruses and ancient mitochondrial DNA. In addition, the TC statistic was calculated for phylogenies simulated under a neutral coalescent process.

4. Our results indicate significant TC in many empirical data sets. However, we also find that such clustering is exhibited by trees simulated under a neutral coalescent process; hence, the observation of significant ‘temporal clustering’ cannot unambiguously indicate the presence of strong positive selection in a population.

5. Quantifying topological structure in this manner will provide new insights into the evolution of measurably evolving populations.
Effects of Fan Speed on Rotating Stall Inception and Recovery
Authors: Choi Minsuk , Vahdati Mehdi , Imregun Mehmet
Published: April 2011

An implicit, time-accurate 3D compressible Reynolds-averaged Navier-Stokes (RANS) solver is used to simulate rotating stall inception and recovery, the so-called rotating stall hysteresis, in the case of a modern fan geometry. In the first instance, rotating stall was simulated for 70%, 80%, and 90% fan speeds using a whole-annulus fan model with a variable-area nozzle downstream. As the fan speed is increased, the stall cells also increase in size but their number decreases. One large stall cell is predicted to rotate along the annulus at 80% and 90% speeds, while there are three smaller cells at 70% speed. In all cases, the reverse flow is confined to the near-tip region and the rotating stall does not develop into a full-span stall because of the fan blade’s high-aspect ratio. To simulate stall recovery, the nozzle area was increased gradually at 70% and 90% speeds and the flow was seen to recover from rotating stall to reach an unstalled operating condition. The recovery process was found to be affected by the fan speed. At 70% speed, the large disturbances decay first to form almost symmetric stall cells. Thereafter, the stall cells shrink into smaller ones as the mass flow rate increases further. At 90% fan speed, a single stall cell rotates along the annulus, the disappearance of which results in recovery. An attempt has been made to explain the dependence of the stall inception and recovery patterns on the fan speed.
Revealing the Gamma-Ray Jet in a Black Hole Binary
Authors: Hardcastle Martin J.
Published: April 2011

New techniques in polarization measurement allow gamma-ray emission from a black hole binary in the Milky Way to be associated with a jet.
How Science Eluded the Budget Ax—For Now
Authors: Mervis Jeffrey
Published: April 2011

When details of the 11th-hour budget compromise that kept the U.S. government running emerged last week, it became clear that science programs fared relatively well.
Spate of Suicides Roils University, Jeopardizing Academic Reforms
Authors: Normile Dennis
Published: April 2011

Aggressive measures to improve education quality at the Korea Advanced Institute of Science and Technology, South Korea's equivalent of the Massachusetts Institute of Technology, are being blamed in part for the suicide of a sophomore on 7 April.
Serotypes of Streptococcus pneumoniae Isolates from Children with Invasive Pneumococcal Disease in Turkey: Baseline Evaluation of the Introduction of the Pneumococcal Conjugate Vaccine Nationwide
Authors: Ceyhan Mehmet , Gurler Nezahat , Yaman Akgun , Ozturk Candan , Oksuz Lutfiye , Ozkan Sengul , Keser Melike , Salman Nuran , Alhan Emre , Esel Duygu , Gultekin Meral , Camcioglu Yildiz , Gul Mustafa , Sorguc Yelda , Aydemir Sohret , Gunaydin Murat , Yakupogullari Yusuf , Kizirgil Ahmet
Published: April 2011

Before use of the pneumococcal conjugate vaccine PCV7 became widespread in Turkey, 202 invasive pneumococcus isolates were analyzed. The most common serotypes were 19F and 6B. In children ≤2 years of age, the potential coverage rate of PCV7 was 69.5%. The most frequent non-PCV7 serotypes were 19A, 3, 1, 6A, and 8.
Adjuvant Activity of the Catalytic A1 Domain of Cholera Toxin for Retroviral Antigens Delivered by GeneGun
Authors: Bagley Kenneth C. , Lewis George K. , Fouts Timothy R.
Published: April 2011

Most DNA-encoded adjuvants enhance immune responses to DNA vaccines in small animals but are less effective in primates. Here, we characterize the adjuvant activity of the catalytic A1 domain of cholera toxin (CTA1) for human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV) antigens in mice and macaques delivered by GeneGun. The inclusion of CTA1 with SIVmac239 Gag dramatically enhanced anti-Gag antibody responses in mice. The adjuvant effects of CTA1 for the secreted antigen HIV gp120 were much less pronounced than those for Gag, as the responses to gp120 were high in the absence of an adjuvant. CTA1 was a stronger adjuvant for Gag than was granulocyte-macrophage colony-stimulating factor (GM-CSF), and it also displayed a wider dose range than GM-CSF in mice. In macaques, CTA1 modestly enhanced the antibody responses to SIV Gag but potently primed for a recombinant Gag protein boost. The results of this study show that CTA1 is a potent adjuvant for SIV Gag when delivered by GeneGun in mice and that CTA1 provides a potent GeneGun-mediated DNA prime for a heterologous protein boost in macaques.
Actinobaculum schaalii Causing Fournier's Gangrene
Authors: Vanden Bempt Isabelle , Van Trappen Stefanie , Cleenwerck Ilse , De Vos Paul , Camps Kim , Celens Annemie , Van De Vyvere Martine
Published: April 2011

Actinobaculum schaalii
, which belongs to the group of Gram-positive rods, is difficult to culture. Using molecular genetics,
Actinobaculum schaalii
could be identified as a causing microorganism in a case of Fournier's gangrene.
Cytochrome
b
Gene Quantitative PCR for Diagnosing Plasmodium falciparum Infection in Travelers
Authors: Farrugia Cécile , Cabaret Odile , Botterel Françoise , Bories Christian , Foulet Françoise , Costa Jean-Marc , Bretagne Stéphane
Published: April 2011

A cytochrome
b
(
cytb
) gene quantitative PCR (qPCR) assay was developed to diagnose malaria in travelers. First, manual and automated DNA extractions were compared and automated DNA extraction of 400 μl of blood was found to be more efficient. Sensitivity was estimated using the WHO international standard for
Plasmodium falciparum
DNA and compared to that of a previously published qPCR targeting the 18S rRNA coding gene (18S qPCR). The limit of detection of the
cytb
qPCR assay was 20 DNA copies (i.e., 1 parasite equivalent) per 400 μl of extracted whole blood and was comparable for the two qPCR assays. Both qPCR assays were used on blood samples from 265 consecutive patients seen for suspicion of malaria. There were no microscopy-positive and qPCR-negative samples. Positive
cytb
qPCR results were observed for 51 samples, and all but 1 were also 18S qPCR positive. Eight (16%) of these 51 samples were negative by microscopic examination. The 8
cytb
qPCR-positive and microscopy-negative samples were from African patients, 3 of whom had received antimalarial drugs. Three non-
P. falciparum
infections were correctly identified using an additional qPCR assay. The absence of PCR inhibitors was tested for by the use of an internal control of mouse DNA to allow reliable quantification of circulating DNA. The high analytical sensitivity of both qPCR assays combined with automated DNA extraction supports its use as a laboratory tool for diagnosis and parasitemia determination in emergencies. Whether to treat qPCR-positive and microscopy-negative patients remains to be determined.
Vitamin B12and folate deficiency and elevated plasma total homocysteine in workers with chronic exposure to chromate
Authors: Wang Tian-Cheng , Jia Guang , Zhang Ji , Ma Yan-Hui , Liu Lan-Zheng , Zhang Ning , Feng Wei-Yue , Zhou Jing-Wen , Song Yan-Shuang , Yan Lei , Du Xian-Mei
Published: April 2011

Objectives

Chronic occupational exposure to chromium can result in a broad range of adverse effects including multiple organ damage, genotoxicity and carcinogenesis. However, the metabolic consequences of chromium exposure have not been fully investigated. This study was designed to examine vitamin B12, folate and homocysteine metabolic changes in workers chronically exposed to chromate. The potential association between metabolic alteration and renal impairment induced by chromate exposure was also assessed.

Methods

The level of chromium exposure was evaluated by measuring chromium concentrations in red blood cells (RBC-Cr) and urine (U-Cr). Renal impairment was assessed with serum cystatin C (Cys-C) and urinary β2-microglobulin (β2M). Serum vitamin B12, folate and plasma total homocysteine (tHcy) were measured and correlations analysed.

Results

Significant increases in RBC-Cr, U-Cr, serum Cys-C, plasma tHcy and urinary β2M concentrations were observed in workers chronically exposed to chromate compared to controls. In the exposed workers, serum vitamin B12and folate levels were decreased and significantly inversely correlated with RBC-Cr concentrations, and increased plasma tHcy concentrations were mirrored by decreased serum vitamin B12and folate levels. Elevated plasma tHcy concentrations were positively related to serum Cys-C concentrations.

Conclusions

Hyperhomocysteinemia in chronically exposed workers was primarily induced by vitamin B12and folate deficiency. This metabolic change might be associated with renal dysfunction in chromate processing workers after long term exposure.
Working patterns and vitamin D status in mid-life: a cross-sectional study of the 1958 British birth cohort
Authors: Ward Maria , Berry Diane J , Power Chris , Hyppönen Elina
Published: April 2011

Objectives

To assess the association between working patterns and vitamin D status in men and women and to determine the potential influence of related lifestyle and socioeconomic factors.

Methods

The authors used data from the 1958 British birth cohort (aged 45 years) and 6154 participants, who were in full-time work, were included in current analyses. Vitamin D status was measured by circulating concentrations of 25-hydroxyvitamin D (25(OH)D). Information on working patterns and lifestyle factors was obtained using a structured questionnaire administered at 45 years.

Results

Manual social class was strongly associated with vitamin D-related lifestyle factors, with those in manual classes not only spending more time outdoors, but also spending more time watching TV/using PC, consuming less supplements and oily fish. Associations between working patterns and vitamin D-related lifestyles were less clear: night work was not strongly associated with lifestyles in either gender, while working hours were associated with time spent outside, PC/TV leisure time and use of supplements in men but not in women. In men, working patterns were not associated with lower 25(OH)D concentrations. In women, 25(OH)D concentrations were 8% lower (95% CI 15% to 2%) in night workers compared with others, while women working less than 35 h/week had 5% higher concentrations of 25(OH)D (95% CI 1% to 8%) compared with those working 35–40 h/week after adjustment for season, social class and body mass index (BMI).

Conclusions

Women working nights and longer hours may be vulnerable to deficits in vitamin D status and associated health hazards.
FAST INTERACTIVE QUANTIFICATION OF SYNAPSES IN THE CEREBRAL CORTEX
Authors: MORALES JUAN , ALONSO-NANCLARES LIDIA , RODRÍGUEZ JOSÉ-RODRIGO , MERCHÁN-PÉREZ ÁNGEL , DEFELIPE JAVIER , RODRÍGUEZ ÁNGEL
Published: April 2011

Synapses are key elements in the organization of neuronal circuits. To analyse these structures, it is now possible to obtain serial images from large samples of nervous tissue in an automated manner through combined focused ion beam milling and scanning electron microscopy. However, the identification, 3D reconstruction and quantification of synapses within these samples are labor intensive procedures that require continuous user intervention. We have developed a software tool to achieve the segmentation of synapses in a reconstructed 3D volume of the cerebral cortex, thereby greatly facilitating and accelerating these processes. The tool is interactive, allowing the user to supervise the segmentation process, to modify the appropriate parameters and to validate the results. Some experimental results obtained with our tool in the rat cerebral cortex are also presented.