bluuebunny/crossref_metadata_2025 huggingface dataset:
Does routine psychological screening of newly diagnosed rural cancer patients lead to better patient outcomes? Results of a pilot study
Authors: Thewes Belinda , Butow Phyllis , Stuart‐Harris Robin ,   the Greater Southern Area Health Service Screening Collaborative Group
Published: November 2009

Background:  Few studies have reported on the impact of screening on patient outcomes or clinical practice and research describing the implementation of psychosocial screening in rural services is scarce.

Aims:  This study investigated the feasibility and utility of a psychological screening program in Australian rural oncology clinics.

Subjects & methods:  A total of 83 newly diagnosed adult cancer patients, seen at one of three rural outpatient oncology clinics participated in this study.

Results:  Nineteen of forty‐three (44%) participants in the screening phase scored above cut‐off score on the Distress Thermometer (DT), a validated screening tool for distress in cancer patients. The DT had acceptable sensitivity (86%) and specificity (77%) as a screening tool using another validated self‐report measure of psychological symptoms, the Psychological Symptoms Subscale of the Somatic and Psychological Health Report Short form, as a‘gold standard’. Screening with the DT did not significantly increase the rate of referrals to psychosocial staff of distressed individuals. However, screening with the DT reduced time to referral. The screened group reported significantly greater unmet needs in univariate (P = 0.01) and multivariate analyses (P = 0.01).

Conclusions:  Psychological screening did not increase rates of referral to psychosocial support staff for patients with psychological morbidity. However, given the methodological limitations of this pilot study, the results should be interpreted with caution. The DT was found to have acceptable sensitivity and specificity to detect likely cases of psychological morbidity. Barriers to implementation of psychological screening in rural clinics and recommendations for future psychological screening programs at outpatient oncology clinics are discussed.
A seven‐year retrospective analysis of students entering medicine via a Rural Student Recruitment program in Western Australia
Authors: Emery Ashleigh , Hurley Sarah , Williams Jasmine , Pougnault Sue , Mercer Annette , Tennant Marc
Published: November 2009

Objective:  This research aimed to evaluate the effectiveness of the Rural Student Recruitment (RSR) program. This program was an initiative to address the low number of rural students enrolled in medicine at the University of Western Australia. RSR identifies students throughout rural and remote areas of Australia interested in pursuing a career in medicine. The program provides support to these students through the various stages of the selection process and subsequently through the course.

Setting:  Medical School, the University of Western Australia.

Participants:  Rural students enrolled in medicine at the University of Western Australia.

Results:  Of the 1591 participants in the RSR program, 11.6% have been successful in being offered a place. Participation was consistently higher for women, although men were proportionately more successful at gaining entry (14.5% versus 10.4%). It was found that the distribution of successful students in the RSR program generally reflects population density across rural Western Australia, with the majority of students coming from the South West, and the minority from the Pilbara and Kimberley. However, over the last three years (2006–2008) an increase in access from very remote regions was noted. This has been associated with a modification to the entry process that now includes a remoteness weighting for the secondary school attended.

Conclusions:  The conclusion from this analysis was that the RSR program in concert with refinements in entry criteria has been effective in increasing the number of medical students from a rural background.
Promoting positive coping skills for rural youth: Benefits for at‐risk young people
Authors: Eacott Chelsea , Frydenberg Erica
Published: November 2009

Objective:  To explore the effects of a coping skills program long term and to assess the utility of providing booster intervention. Young people at high risk for depression were of particular interest.

Design:  Mixed method.

Setting:  Rural Victoria (approximately 200 km from Melbourne).

Participants:  A total of 159 year 10 students (76 male and 83 female) from a Catholic Secondary school.

Main outcome measures:  Adolescent Coping Scale and the Kessler Psychological Distress Scale.

Results:  Following initial coping skills training (with the Best of Coping program) students at risk for depression had significantly reduced their reliance on non‐productive coping (P < 0.05). This decrease was not maintained at 12‐month follow up but was improved through exposure to a booster program. Results suggest the high‐risk group are likely to benefit from further intervention. At the 12‐month follow up all students were involved in booster coping skills training (with the Coping for Success program) that significantly increased their likelihood of referring to others to assist in solving problems (P < 0.05). These findings were supported by qualitative interview data.

Conclusions:  Positive program effects for young people at risk of depression and beneficial outcomes of booster intervention for the general student population were achieved in a rural setting.
Factors associated with nutritional status in liver transplant patients who survived the first year after transplantation
Authors: De Carvalho Luciana , Parise Edison Roberto , Samuel Didier
Published: November 2009

Background and Aims:  Most studies published focus on the evaluation of the impact of nutritional status on the morbidity and mortality during the immediate postoperative period or on the short‐term evolution of liver transplant patients. The aim of the study was to evaluate long‐term trends in nutritional status.

Methods:  Seventy patients consecutively submitted to liver transplantation were studied. Nutritional assessment was performed the day before transplantation and the 45, 90, 180 and 365 days after transplantation, consisting of determination of dietary intake, anthropometric and biochemical analysis.

Results:  Sixty‐nine percent of the patients presented with malnutrition on the day before liver transplantation, decreasing to 44% at end of the first year. The prevalence of protein–calorie malnutrition (PCM) was 63% at 90 days post‐transplant. A significant difference of PCM was observed between patients with cirrhosis and non‐cirrhotic disease (53.6% × 100%) at 90 days post‐transplant. The pre‐transplant nutritional diagnosis and 90‐day calorie intake were identified as variables independently associated with nutritional status at 90 days post‐transplant. The variables independently associated with nutritional status in the 1‐year assessment were pre‐transplant PCM and 365‐day calorie requirements.

Conclusion:  No influence on nutritional status was observed for peri‐ or postoperative factors after 3 or 12 months of follow up. As expected, dietary factors, especially adequate calorie intake, were always associated with nutritional status during all periods analyzed.
Naturally occurring K vitamins inhibit pancreatic cancer cell survival through a caspase‐dependent pathway
Authors: Showalter Shayna L , Wang Ziqiu , Costantino Christina L , Witkiewicz Agnieszka K , Yeo Charles J , Brody Jonathan R , Carr Brian I
Published: November 2009

Background and Aims:  Available medical therapies against pancreatic cancer are largely ineffective and have many side‐effects. Physiologically, vitamins K1 and K2 (VK) act as co‐factors for γ‐carboxylation of prothrombin and other coagulation factors. In previous studies, VK analogs have been found to have potent negative effects on the survival of various cancer cells. We hypothesized that the well‐tolerated and naturally occurring VK1 and VK2 may be used to inhibit pancreatic cancer cell survival.

Methods:  Four pancreas cancer cell lines were tested. Two of these (MiaPaCa2 and PL5) were found to be sensitive to VK1 and VK2 (IC50 values ≤150 µM). To address the mechanisms of this effect on cell survival, we performed cell cycle and apoptosis studies using VK2 (the more potent compound).

Results:  We found that VK induced caspase‐dependent apoptosis in over 60% of cells in the sensitive lines at the half maximal inhibitory concentration (IC50) range. Further, this induction in apoptosis was antagonized by a caspase inhibitor. Accompanying apoptosis, a dose‐ and time‐dependent induction of extracellular signal‐regulated kinase (ERK) phosphorylation occurred when sensitive lines were treated with either VK1 or VK2 at inhibitory doses. Simultaneous co‐treatment of cells with a MEK1 inhibitor and VK prevented both the induction of ERK phosphorylation and the apoptosis, showing that the mitogen‐activated protein (MAP) kinase pathway is central for VK‐mediated apoptosis in pancreatic cancer cells.

Conclusion:  These data show that naturally‐occurring, non‐toxic K vitamins can inhibit the survival of some pancreatic cancer cell lines. These novel, safe and clinically‐utilized agents initiate a caspase‐dependent apoptosis via the MAP kinase pathway and could potentially benefit patients with pancreatic cancer either as a single agent or in combination with chemotherapy for treatment, or for prevention of recurrence of pancreas cancer post resection.
Endoplasmic reticulum stress involved in the course of lipogenesis in fatty acids‐induced hepatic steatosis
Authors: Liu Jiang , Jin Xi , Yu Chao‐Hui , Chen Shao‐Hua , Li Wei‐Ping , Li You‐Ming
Published: November 2009

Background and Aims:  The aim of the present study is to elucidate whether endoplasmic reticulum stress involved in the course of lipogenesis in fatty acids induced hepatic steatosis and the potential effect of metformin on endoplasmic reticulum stress.

Methods:  HepG2 cells were exposed to different types of culture media. After incubation for 24 h, cells were harvested to evaluate cell survival rate and lipid level among different groups. Moreover, reverse transcriptase polymerase chain reaction and western blot for glucose‐regulated protein‐78 (GRP78), sterol response element‐binding protein‐1c (SREBP1c) and fatty acid synthase (FAS) were applied.

Results:  The levels of triglyceride (TG), mRNA of FAS, mRNA and protein of GRP78 and SREBP1c significantly increased in the free fatty acids (FFA)‐induced hepatic steatosis group. Then, HepG2 cells with hepatic steatosis induced by FFA were treated by metformin, levels of TG, GRP78 mRNA, SREBP1c mRNA and FAS mRNA as well as GRP78 and SREBP1 protein levels were partially decreased but without significant differences.

Conclusion:  Endoplasmic reticulum stress might be involved in lipogenesis in fatty acids‐induced hepatic steatosis. Therefore, endoplasmic reticulum stress might serve as a novel target in the pathogenesis and therapy of non‐ alcoholic fatty liver disease.
Progesterone and allopregnanolone enhance the miniature synaptic release of glycine in the rat hypoglossal nucleus
Authors: Chesnoy‐Marchais Dominique
Published: November 2009

It is well known that progesterone is synthesised and metabolised within the nervous system, and that one of its metabolites, allopregnanolone, potentiates the activity of GABA receptor anionic channels and modulates GABAergic neurotransmission. Progesterone is now under clinical trial for its neuroprotective properties, but its possible effects on neurotransmission have not yet been fully explored. The present study investigated acute effects of progesterone on the other major type of synaptic inhibition, glycinergic neurotransmission. Spontaneous glycinergic miniature currents were recorded in hypoglossal motoneurons, using the whole‐cell patch‐clamp technique in rat brainstem slices. A 20‐min superfusion with progesterone (1 μm) triggered an increase in the frequency of glycinergic miniatures, whereas no effect of progesterone was observed after block with finasteride (5 μm) of 5α ‐reductase, the first enzymatic step leading from progesterone to allopregnanolone. The effect of progesterone could be mimicked by superfusion with allopregnanolone (0.3 μm), whereas no effect was induced by epiallopregnanolone. Thus, progesterone can increase the synaptic miniature release of glycine and this effect appears to be indirect, resulting from its metabolism into 5α‐reduced derivatives, in particular into allopregnanolone. A low concentration of an exogenous GABAAagonist can also increase the frequency of inhibitory miniature currents in hypoglossal motoneurons. Thus, the effects of progesterone and allopregnanolone on glycine release can be at least partly explained by the potentiation of the activity of depolarizing presynaptic GABA receptor channels. The increase in the tonic synaptic release of a major inhibitory neurotransmitter should reduce the excitability of the neurons and contribute to their protection against excitotoxicity.
Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis
Authors: Kapoor Rakesh , Muruganandham Kaliyaperumal , Gulia Anil Kumar , Singla Manish , Agrawal Saurabh , Mandhani Anil , Ansari M.S. , Srivastava Aneesh
Published: November 2009

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To analyse the factors predicting the mortality and need for nephrectomy in patients with emphysematous pyelonephritis (EPN).

PATIENTS AND METHODS

Clinical features, laboratory variables, imaging studies, management strategy and the final outcomes were analysed in 39 consecutive patients with EPN. The mean (sd) age was 57 (7.2) years and the male to female ratio was 2:11. The baseline risk factors (clinical, laboratory and radiological) were compared among three groups; group 1, survived with renal salvage (26); group 2, survived after nephrectomy (eight); and group 3, died (five).

RESULTS

The overall survival rate was 87% (34/39) and the kidney was salvaged in 67% (26) patients at a median follow‐up of 18 months. Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation were significantly associated with mortality rate. There was no significant difference in final outcome based on radiological classification. Extensive renal parenchymal destruction of >50% (based on computed tomography) significantly predicted the need for nephrectomy (P < 0.001) and death (P = 0.02). Early (<1 week) nephrectomy resulted in a higher mortality rate (three of seven patients) than initial conservative management. There were no deaths in selected patients who received antibiotics alone or had delayed nephrectomy (four patients each). Of 24 patients who had minimally invasive treatment alone, two (8%) died. Minimally invasive treatment resulted in high renal salvage (22/24, 92%).

CONCLUSION

Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation are associated with higher mortality rates, whereas extensive renal parenchymal destruction is associated with a need for nephrectomy. Early nephrectomy is associated with higher mortality rates than is initial conservative management.
Pathological findings and prostate‐specific antigen outcomes after laparoscopic radical prostatectomy for high‐risk prostate cancer
Authors: Ploussard Guillaume , Salomon Laurent , Allory Yves , Terry Stéphane , Vordos Dimitri , Hoznek Andreas , Abbou Claude‐Clément , Vacherot Francis , De La Taille Alexandre
Published: November 2009

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To review the biochemical recurrence‐free survival (RFS) rates of laparoscopic radical prostatectomy (LRP) in patients with a high risk of disease progression as defined by preoperative criteria of D’Amico et al.

PATIENTS AND METHODS

Between October 2000 and May 2008, 110 patients had extraperitoneal LRP and bilateral pelvic lymph node sampling for high‐risk prostate cancer in our department. High‐risk prostate cancer was defined as a prostate‐specific antigen (PSA) level of >20 ng/mL, and/or a biopsy Gleason score ≥8, and/or a clinical stage of T2c–T4 stage. The median follow‐up was 37.6 months. Risk factors for time to biochemical recurrence were tested using log‐rank survivorship analysis and Cox proportional hazards regression.

RESULTS

Prostate cancer was organ‐confined in 36% of patients; the Overall RFS was 79.4% and 69.8% at 1 and 3 years, respectively. The 3‐year RFS rates for organ‐confined cancer vs extracapsular extension were 100% and 54.3%, respectively (P < 0.001). The 3‐year RFS rates for tumour‐free seminal vesicle vs seminal vesicle invasion were 81.8% and 33.6%, respectively (P < 0.001). The 3‐year RFS rates for negative surgical margins vs positive were 85.2% and 47.3%, respectively (P = 0.001). Compared with men with any single pathological risk factor or any two risk factors, men with all three risk factors had a significantly shorter time to PSA failure after LRP (log‐rank test, P < 0.001).

CONCLUSION

Among patients at increased risk of disease progression as defined by preoperative criteria, a third of men with organ‐confined disease have a favourable prognosis. Men at high risk for early PSA failure could be better identified by pathological assessment of RP specimens, and selected for phase III randomized trials investigating adjuvant systemic treatment.
Relational Self‐Worth: Differences in Perceived Worth as a Person across Interpersonal Contexts among Adolescents
Authors: Harter Susan , Waters Patricia , Whitesell Nancy R.
Published: November 2009

The present study investigated the hypothesis that in addition to perceptions of one's global self‐worth as a person, individuals evaluate their self‐worth differently across relational contexts. Perceptions of self‐worth among adolescents were examined in 4 such contexts: with parents, teachers, male classmates, and female classmates. The factor pattern revealed a clear, 4‐factor solution with negligible cross‐loadings. Approximately three‐fourths of the participants reported differences in self‐worth, ranging from small to large, across contexts. To examine the basis for differences and similarities across relationships, self‐worth in each context was predicted by the validation support reported by adolescents in that context. Support in a given context was significantly more highly correlated with relational self‐worth in the corresponding context than in any of the other contexts. Adolescents could be divided into subgroups based upon the high correlation between self‐worth in one particular context and global self‐worth. These findings suggest that how an individual evaluates the self in certain relationships is critical to his or her overall sense of worth as a person.
IMMIGRATION, TRANSNATIONALISM AND ‘FLEXIBLE CITIZENSHIP’ IN CANADA: AN EXAMINATION OF ONG'S THESIS TEN YEARS ON
Authors: WATERS JOHANNA L.
Published: November 2009

This paper examines the relationship between transnationalism and belonging, with particular reference to Ong's concept of ‘flexible citizenship’, ten years after it was first articulated. It asks ‘to what extent is Ong's work still relevant for the contemporary experiences of transnational migrants?’ With a focus on research in Canada, I argue that, contrary to their ‘flexible’ intentions, transnational immigrants often demonstrate a high level of local civic involvement and a localised sense of identity in the ‘new’ country, even when continuing to practice transnationalism on a daily basis. In addition, the paper contributes to debates around the relationship between transnationalism and integration over time. It draws upon an indepth qualitative study of immigrant women over eight years to examine the extent of their transnational activities and feelings of belonging. It concludes that while the notion of flexible citizenship would in many cases seem to describe accurately the objectives of Chinese immigrants to Canada, it is perhaps less salient in relation to some of their experiences.
ARGUMENTS FROM NOTHING: GOD AND QUANTUM COSMOLOGY
Authors: Cahoone Lawrence
Published: November 2009

This essay explores a simple argument for a Ground of Being, objections to it, and limitations on it. It is nonsensical to refer to Nothing in the sense of utter absence, hence nothing can be claimed to come from Nothing. If, as it seems, the universe, or any physical ensemble containing it, is past‐finite, it must be caused by an uncaused Ground. Speculative many‐worlds, pocket universes and multiverses do not affect this argument, but the quantum cosmologies of Alex Vilenkin, and J. B. Hartle and Stephen Hawking, which claim that the universe came from literally nothing, would. I argue that their novel project cannot work for reasons both physical (their “nothing” is actually a vacuum state governed by eternal physical laws) and methodological (physical theory cannot explain the emergence of the physical per se). Thus my argument stands. However, as David Hume showed, a posteriori arguments like mine infer a creation, and Creator, of a certain character, namely, a stochastic concept of creation and a panentheistic, partly physical Creator lacking omniscience and omnipotence. Rather than undermining the cosmological argument, as Hume intended, these limitations liberate the concept of the Ground from unnecessary problems, as Hartshorne suggested.
BIOTECHNOTHEOLOGY AND DEMYTHOLOGIZATION OF STEM‐CELL RESEARCH
Authors: Strehovec Tadej
Published: November 2009

Biotechnology deals not only with new types of therapies for preventing and curing diseases but also with the creation of new technologies for the production of human flesh. Its ultimate aim is to create a new human body, a new person. Biotechnology wears the cloak not only of a new scientific paradigm but also of a kind of messianic religion. To develop new therapies, to destroy illnesses, to transform the human body into a nonmortal one—these are some of the promises it makes. In time, many of these promises will undoubtedly prove to be illusory, but they will nevertheless continue to have a significant impact on the way people think. Through a process that I call biotechnotheological analysis I show that biotechnology could eventually become not only a type of secular religion but even a type of mythic para‐Christian religion, one that incorporates the two most significant processes at work in every mythical religion: the process of mimesis and the ritual of the scapegoat. The essay is an attempt to understand biotechnological achievements, especially in stem‐cell research, in this new biotechnotheological way.
ON EVOLUTION AND CREATION: PROBLEM SOLVED? THE POLISH EXAMPLE
Authors: Tomczyk Jacek , Bugajak Grzegorz
Published: November 2009

We present the results of research carried out as a part of the project Current Controversies about Human Origins: Between Anthropology and the Bible, which focused on the supposed conflict between natural sciences and some branches of the humanities, notably philosophy and theology, with regard to human origins. One way to tackle the issue was to distribute a questionnaire among students and teachers of the relevant disciplines. Teachers of religion and the natural sciences (biology, chemistry, and physics) and students of theology, philosophy, and the natural sciences (specializing in biology and/or anthropology) were asked to answer eleven questions concerning the perception of the conflict between evolutionism and creationism, the definitions of creation and evolution, the existence of a human spiritual element, and the ways of interpreting the Bible, especially the first chapters of the book of Genesis. We present selected results of this questionnaire.
THERE'S MORE TO TIME THAN TICKING AWAY
Authors: Raman Varadaraja V.
Published: November 2009

Time is an element that each of us experiences in the core of our being. Yet it also is one of the great mysteries in our conceptual grasp of reality. The notion of time has therefore been reflected upon and explored by thinkers and scientists since ancient times. In this essay I relate the multiple ways in which Antje's Jackelén's scholarly and stimulating work Time and Eternity analyzes the historical, philosophical, theological, and scientific perspectives on the notion of time lived and its relation to the conceptual endless time that we call eternity, and offer some of my own contextual reflections on the topic.
THE RHYTHM OF GOD'S ETERNAL MUSIC: ON ANTJE JACKELÉN'S TIME AND ETERNITY
Authors: Meisinger Hubert
Published: November 2009

Antje Jackelén's book Time and Eternity is a thorough and carefully presented theology of time and, by its very essence, an incomplete and open thought model because time will always be dynamic and relational. This approach is an excellent example for the dialogue between science and religion because it uses resources not tapped in the dialogue so far: hymn‐books stemming from Germany, Sweden, and the English‐speaking world published between 1975 and 1995. They are taken as resources for a critical investigation on the meaning and importance of the notion of eternity for the interdisciplinary dialogue, which is characterized not as a synthesis but as holding a beneficial tension, or “eutonia.” I suggest that this approach can be taken even further by merging it with a model of time developed by the German mathematician A. M. Klaus Müller: The crossing over of time modes in a relational matrix of time also gives clear insights into the time of God not only as futurum—time as extrapolation of the past and present—but also as adventus—time which is to come.
TIME AND ETERNITY: HYMNIC, BIBLICAL, SCIENTIFIC, AND THEOLOGICAL VIEWS
Authors: Albright John R.
Published: November 2009

The book Time and Eternity, the English version of Zeit und Ewigkeit, by Antje Jackelén, contains scientific and theological treatments of these two topics, starting with the usage of such ideas in German, Swedish, and English hymns. This essay describes her work and explains how the scientific ideas provide a coherent framework for understanding the place of time.
Efficacy of narrowband UVB vs. PUVA in patients with early‐stage mycosis fungoides
Authors: Ponte P , Serrão V , Apetato M
Published: November 2009

Introduction  Mycosis fungoides (MF) is a non‐Hodgkin’s T‐cell lymphoma of the skin that often begins as limited patches and plaques with slow progression to systemic involvement. Narrowband ultraviolet (UV) B therapy has been proven to be an effective short‐term treatment modality for clearing patch‐stage MF. The effect of psoralen plus long‐wave ultraviolet A (PUVA) in the treatment of patch‐ and plaque‐type MF has also been thoroughly documented.

Objectives  The purpose of this study was to compare the efficacy and safety of narrowband UVB and PUVA in patients with early‐stage MF.

Methods  We analysed the response to treatment, relapse‐free survival and irradiation dose in 114 patients with histologically confirmed early‐stage MF (stage IA, IB and IIA).

Results  A total of 95 patients were treated with PUVA (83.3%) and 19 with narrowband UVB (16.7%). With PUVA, 59 patients (62.1%) had a complete response (CR), 24 (25.3%) had a partial response (PR) and 12 (12.6%) had a failed response. Narrowband UVB led to CR in 12 (68.4%) patients, PR in 5 (26.3%) patients and a failed response in 1 (5.3%) patient. There were no differences in terms of time to relapse between patients treated with PUVA and those treated with narrowband UVB (11.5 vs. 14.0 months respectively; P = 0.816). No major adverse reactions were attributed to the treatment.

Conclusions  Our results confirm that phototherapy is a safe, effective and well‐tolerated, first‐line therapy in patients with early‐stage cutaneous T‐cell lymphoma, with prolonged disease‐free remissions being achieved. It suggests that narrowband UVB is at least as effective as PUVA for treatment of early‐stage MF.
ORIGINAL ARTICLE: Making a difference. Visual health needs of people with a learning disability
Authors: McGlade Anne , Bickerstaff David , Lindsay Jennifer , McConkey Roy , Jackson Jonathan
Published: November 2009

Accessible summary

We wanted to find out if having an eye test helped people with a learning disability see better.

People with a learning disability and their family carers helped in the design of the study.

The findings showed that good eye sight is important to people with a learning disability.

People told us that when they got their glasses it helped them to do simple daily things.

These things were watching television, seeing the football score, seeing the computer, going to the park and seeing small print to read.

People told us that being able to see better helps them to feel better.

This article discusses the findings from a study to assess the impact of corrective eye treatment in adults with a learning disability. The Special Visual Assessment Clinic (SVAC) is an optometry led multi professional service delivered in a Resource Centre in Belfast, Northern Ireland. The study, which included user and carer input in its design, involved people with a learning disability (15), their family carers (21) and staff (12) in interviews, group discussions, completion of checklists and clinical audit. Findings revealed that prior to the SVAC taking place there was limited awareness of vision related problems amongst all these groups. Following assessment and corrective treatment which, in the main included the provision of glasses, there was a heightened awareness of visual needs and of the benefits of eye examinations which included some tentative links to quality of life.
Alien invaders and reptile traders: what drives the live animal trade in South Africa?
Authors: Van Wilgen N. J. , Wilson J. R. U. , Elith J. , Wintle B. A. , Richardson D. M.
Published: November 2009

The global trade in reptiles for pets has grown rapidly in recent decades. Some species introduced by the pet trade have established and become invasive, for example the Burmese python in Florida. Although there are currently no invasive alien reptiles in South Africa, the last 30 years has seen an exponential increase in the number of introductions of an increasing number of species from an increasing number of countries. We determine and analyse the presence and abundance of species in the South African reptile trade. This serves as a background to efforts to overhaul the management and regulation of this trade, particularly given the need for increasingly objective risk‐assessment protocols. We show that introduced species tend to come from specific families including Boidae, Chameleonidae, Elapidae, Pythonidae, Testudinidae and Viperidae. Moreover, within specific families (e.g. chameleons), species of larger body size are more likely to be introduced. As the risk of a species becoming invasive may be increased by higher propagule pressure, it is also important to characterize the volume of trade. Here we analyse data on the abundance of reptiles in South Africa using generalized, additive models and show that venomous and expensive species are traded in low numbers, whereas species that are easy to breed and handle or are large, colourful or patterned are preferred. These human imposed preferences have the potential to cause significant taxonomic changes to the reptile fauna of South Africa, which still largely reflects natural biogeographic and evolutionary processes. Elucidation of import and trade patterns enables us to estimate the probable propagule pressure of any particular species. Because the dispersal pathway defined by trade influences the likelihood of invasion, this information is important for informing policy development and directing management efforts.
Attributing Hardy‐Weinberg Disequilibrium to Population Stratification and Genetic Association in Case‐Control Studies
Authors: Grover Vaneeta K. , Cole David E. C. , Hamilton David C.
Published: November 2009

Loci exhibiting Hardy‐Weinberg disequilibrium (HWD) are often excluded from association studies, because HWD may indicate genotyping error, population stratification or selection bias. For case‐control studies, HWD can result from a genetic effect at the locus. We extend the modelling to accommodate both stratification and genetic effects. Theoretical genotype frequencies and HWD coefficients are derived under a general genetic model for a population with two strata. Maximum likelihood is used to estimate model parameters and a test for lack of fit identifies the models most consistent with the data. Simulations were used to assess the method.

The technique was applied to a group of ethnically and clinically heterogeneous kidney stone formers and controls, both exhibiting HWD for the R990G SNP of the CASR gene. Results indicate the best fitting model incorporates both stratification and genetic association. The ability of our method to apportion HWD to stratification and genetic effects may well be a significant advance in dealing with heterogeneity in case‐control genetic association studies.
Adolescents' Triangulation in Marital Conflict and Peer Relations
Authors: Buehler Cheryl , Franck Karen L. , Cook Emily C.
Published: November 2009

This study examined the association between youths' triangulation in marital conflict and three aspects of their peer relations in 416 families during early adolescence. A 4‐wave, longitudinal research design was used. As hypothesized, triangulation was associated negatively with perceived support from friends and positively with perceived peer rejection. Triangulation was a risk factor for both sons and daughters. Adolescent problem behavior did not mediate the significant association between triangulation and perceived friendship support. Adolescent problem behavior, particularly internalizing problems, completely me diated the association between triangulation and adolescents' perceptions of peer rejection, suggesting the important developmental role of adolescents' anxiety, depressive affect, and withdrawal. The implications of these findings are discussed in terms of Bowen's multigenerational family systems theory and social learning principles.
Attachment Style With Mother, Father, Best Friend, and Romantic Partner During Adolescence
Authors: Doyle Anna Beth , Lawford Heather , Markiewicz Dorothy
Published: November 2009

Self‐reported attachment styles with mother, father, best friend, and romantic partner were assessed longitudinally across adolescence. Three cohorts (ages 13, 16, and 19 years; N=373) from a community sample were followed across 2 years. There was only one change in attachment styles with age: the oldest adolescents were more dismissive than the younger. Adolescents were more secure with mother than with father, and most dismissive and fearful with father. Boys were more dismissing than girls, who were more fearful with a romantic partner (n=158). Across time, attachment insecurity with father was associated with insecurity with a best friend. Attachment insecurity with a romantic partner was associated primarily with insecurity with friend, but changes over time tended to be associated with insecurity with mother. Results support the view of a differentiated hierarchy of attachment figures in adolescence, with the quality of parental attachment contributing to close extra‐familial relationships.
A Cross‐Cultural Study of Adolescent Procrastination
Authors: Klassen Robert M. , Ang Rebecca P. , Chong Wan Har , Krawchuk Lindsey L. , Huan Vivien S. , Wong Isabella Y. F. , Yeo Lay See
Published: November 2009

In this study, we explore academic procrastination and associated motivation variables in 612 adolescents from Canada and Singapore. Few studies have explored adolescent procrastination and no previous studies have investigated adolescent procrastination using a cross‐cultural framework. Singaporean adolescents reported higher levels of procrastination and lower levels of self‐efficacy for self‐regulation than Canadian adolescents. Males across settings reported higher levels of procrastination and lower levels of self‐efficacy for self‐regulation than females. Bivariate relationships between procrastination and the motivation variables showed similar patterns in Singapore and Canada. Multigroup structural equation modeling revealed that self‐efficacy for self‐regulation showed the strongest multivariate relationship with procrastination for adolescents in both settings. The article concludes with implications for practitioners and researchers.
BLOOD COMPONENTS: Meta‐analysis of clinical studies of the purported deleterious effects of “old” (versus “fresh”) red blood cells: are we at equipoise?
Authors: Vamvakas Eleftherios C.
Published: November 2009

BACKGROUND: A meta‐analysis examined whether the available data support an adequate suspicion that transfusion of old red blood cells (RBCs) is associated with increased mortality, organ failure, infection, prolonged mechanical ventilation, and prolonged stay in the hospital or the intensive care unit. Such suspicion is required for intentionally exposing patients enrolled in randomized controlled trials (RCTs) to the known or probable—but rare—risks of old RBCs, to document (and prevent) purported common adverse effects of old RBCs.

STUDY DESIGN AND METHODS: Observational studies presenting adjusted results were eligible for analysis if the adequacy of the adjustment for confounding factors could be assessed. Three RCTs and 24 observational studies were retrieved. Medically and statistically homogeneous studies were integrated by fixed‐effects methods. Otherwise homogeneous studies conducted in different clinical settings were integrated by random‐effects methods.

RESULTS: Based on “as‐treated” analysis, transfusion of old RBCs was associated with a significant reduction in mortality (summary odds ratio, 0.38; 95% confidence interval, 0.14‐0.99; p < 0.05) across two small RCTs. Integration of adjusted findings on the same outcome, from observational studies conducted in the same setting, produced summary results that were either negative (in six analyses) or impossible to evaluate owing to uncontrolled confounding by the number of transfused RBCs (in two analyses).

CONCLUSION: The available data do not support an adequate suspicion that old RBCs may be associated with common adverse morbidity and/or mortality outcomes, so as to justify exposing experimental subjects to the other known or probable—but rare—risks of old RBCs.
Efficacy and safety of exchange transfusion as an adjunct therapy for severe Plasmodium falciparum malaria in nonimmune travelers: a 10‐year single‐center experience with a standardized treatment protocol
Authors: Van Genderen Perry J.J. , Hesselink Dennis A. , Bezemer Jacob M. , Wismans Pieter J. , Overbosch David
Published: November 2009

BACKGROUND: Even in circumstances where optimal antimalarial and supportive treatment is available, severe Plasmodium falciparum malaria is still associated with a significant case fatality. Although exchange transfusion (ET) has been considered as a controversial adjunct therapy, we have not encountered any case fatality since ET was introduced as a standard adjunct therapy for patients with severe malaria.

STUDY DESIGN AND METHODS: In this retrospective cohort study of 25 patients with severe malaria, the efficacy and safety of ET as an adjunct to parenteral antimalarial treatment (which was implemented in our hospital starting in 1998) were evaluated and compared with 31 historical control patients who were treated with conventional parenteral antimalarial treatment in the period before ET was added to the standard of care for severe malaria (generally before 1997).

RESULTS: The parasite clearance times (PCT)25%, PCT50%, PCT75% and PCT90% were all significantly shorter for patients treated with ET than for patients treated with parenteral quinine only. The shorter PCTs in the ET group were the result of a more rapid parasite clearance in the early phases after initiation of ET.

CONCLUSION: No case fatalities were observed in the ET group. The complications that were observed with ET were more likely related either to the multiorgan dysfunction associated with severe malaria or to side effects of parenteral quinine rather than to the ET procedure. ET may be safely executed in a setting with intensive care facilities and availability of safe blood products and should be considered as a beneficial adjunct treatment to parenteral antimalarial therapy.
Risk behaviors in volunteer blood donors who seroconverted for HIV, Abidjan, Côte d'Ivoire 1997 to 2005
Authors: Minga Albert , Dohoun Lambert , Abo Yao , Coulibaly Ali , Konaté Seidou , Ouattara Hervé Penan , N'Guessan Bath K. , Dabis François , Salamon Roger , Lewden Charlotte
Published: November 2009

BACKGROUND: The residual risk of human immunodeficiency virus (HIV) transmission from blood products in the Abidjan National Blood Transfusion Center was estimated to be 1 in 5780 blood donations over the period 2002 through 2004. We aimed at describing risk behaviors in blood donors who seroconverted for HIV in Abidjan to improve the pre–blood donation selection.

STUDY DESIGN AND METHODS: We investigated the behavioral profile of HIV seroconverters assessed before their HIV diagnosis, during the blood donation selection at the blood bank of Abidjan, and compared it to the profile documented after this HIV diagnosis, at enrollment in the PRIMO‐CI cohort. Since 1997, enrollment in this cohort is offered to every blood donor whose delay since HIV seroconversion was 36 months or less.

RESULTS: Among the 418 blood donors who seroconverted for HIV between 1997 and 2005, 241 were enrolled in the cohort. Median age was 28 years and 63% were men. The median time between the last HIV‐negative test and the first positive test was 7 months. Since the last blood donation, 29% of donors reported unprotected sexual intercourse with multiple casual sexual partners, 55% unprotected sexual intercourse with one casual sexual partner, and 36% sharing of nail clippers. During the pre–blood donation questionnaire, 69% of HIV seroconverters had reported unprotected sexual intercourse since the last blood donation (vs. 89% reported after donation), and 7% had had multiple casual sexual partners (vs. 32%).

CONCLUSION: Volunteer blood donors who seroconverted for HIV in Abidjan reported a high proportion of unprotected sexual intercourse with casual sexual partners.
Effects of strength and endurance training on metabolic risk factors in healthy 40–65‐year‐old men
Authors: Sillanpää E. , Häkkinen A. , Punnonen K. , Häkkinen K. , Laaksonen D. E.
Published: November 2009

This study compared 21 weeks of combined high‐intensity strength and endurance training with endurance or strength training only on metabolic risk factors in 40–65‐year‐old men. The healthy men (n=63) were randomized into endurance (E), strength (S), combined strength and endurance training (SE) and control (C) groups. S and E trained two times a week and SE 2+2 times a week. Systolic (SBP) and diastolic blood pressure decreased significantly both in E (−6±8 and −4±6 mmHg) and in S (−9±8 and −5±7 mmHg), but not in SE or C (P=0.003 for the difference in the changes of SBP between the groups). The changes in serum glucose and insulin during an oral glucose tolerance test did not differ between the groups. Only E decreased serum fasting insulin levels (−17±27%, P=0.013). Minor changes were observed in blood lipids and lipoproteins in all groups. Both endurance and strength training can modestly improve metabolic health even in relatively lean older men with normal glucose tolerance. Combined strength and endurance training did not produce complementary benefits on metabolic risk factors. Combined training is effective in improving body composition and cardiorespiratory and muscular fitness, however, which is likely to decrease the risk of future metabolic and cardiovascular disease.
Injuries among male and female elite football players
Authors: Hägglund M. , Waldén M. , Ekstrand J.
Published: November 2009

All 12 female football clubs (228 players) and 11 of 14 male clubs (239 players) in the Swedish premier league were followed prospectively during the 2005 season. Individual exposure (playing time), injuries (time loss), and injury severity (days lost due to injury) were recorded by the team medical staffs. Injury incidence was higher for male players during both training (4.7 vs 3.8 injuries/1000 h, P=0.018) and match play (28.1 vs 16.1, P<0.001). However, no difference was found in the incidence of severe injury (absence >4 weeks) (0.7/1000 h in both groups). The thigh, especially the hamstrings, was the overall most commonly injured region in both sexes, while the hip/groin was more commonly injured in male players and the knee in female players. Knee ligament injuries accounted for 31% and 37% of the total time lost from football for male and female players, respectively. In conclusion, male elite players had a higher injury incidence than their female counterparts although no difference was observed in the incidence of moderate to severe injury. We recommend that preventive measures should be focused on hamstring and knee ligament injury in order to reduce the overall injury burden.
Education to promote verbal communication by caregivers in geriatric care facilities
Authors: FUKAYA Yasuko , KOYAMA Sachiyo , KIMURA Yusuke , KITAMURA Takanori
Published: November 2009

Aim:  Our previous study divided the verbal communication between caregivers and elderly residents at geriatric care facilities into Type I communication (to elicit activities of daily living) and Type II communication (conversation that occurs in normal social life) and found that Type II communication promotes utterances by elderly residents. This study conducted an education intervention to promote Type II talking by caregivers and evaluated the results.

Methods:  At three geriatric care facilities, 243 caregivers who might care for 36 elderly residents experienced training involving lectures and group discussion to understand the importance of Type II talking and how to apply it to their daily work. A statistical comparison was applied to the changes in Type II talking duration from before the intervention, 1 week after the intervention, and 3 months after the intervention to evaluate the effect of the educational intervention.

Results:  At two facilities, the Type II talking duration increased significantly from before the educational intervention to 1 week after the intervention and remained higher after 3 months. However, the educational intervention's effect was not clear at one facility. There was no significant difference in the elderly persons' total utterance duration, but it increased from before the intervention to 1 week after the intervention.

Conclusion:  After the educational intervention, the amount of Type II talking by the caregivers increased significantly 1 week after the intervention for two facilities, but although the amount of Type II talking was higher at 3 months than before the intervention, it was not as high as 1 week after the intervention.