bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Methicillin-ResistantStaphylococcus aureusColonization Among Older Residents of Care Homes in the United Kingdom
Authors: Barr Benjamin , Wilcox Mark H. , Brady Angela , Parnell Peter , Darby Bob , Tompkins David
Published: June 2007

Objective.

To determine the prevalence of methicillin-resistantStaphylococcus aureus(MRSA) colonization among older residents of care homes in Leeds, United Kingdom, and to identify resident and care home risk factors for carriage.

Design.

We conducted a cross-sectional prevalence survey of 715 residents from 39 care homes. All participants were tested for nasal colonization with S.aureus,including MRSA. A short questionnaire was completed about each participant and each care home. A multivariable model was used to determine which risk factors were independently associated with MRSA colonization.

Setting.

Care homes for older residents in Leeds, United Kingdom.

Participants.

All residents in participating homes who were able to give informed consent.

Results.

A total of 159 of 715 residents tested positive for MRSA, for a prevalence of 22% (95% confidence interval, 18%—27%) The resultant multivariate model showed that residence in a home with a low ratio of nurses to beds, residence in a care home in a deprived area, male sex, presence of an invasive device, and a hospitalization duration of more than 10 days during the previous 2 years were independently associated with MRSA colonization.

Conclusions.

This study found a large reservoir of MRSA within the care home population. Control strategies need to be coordinated between care homes and hospitals. Increasing the ratio of nurses to beds, reducing the duration of hospitalization, and improving the management of invasive devices could help reduce the prevalence of MRSA colonization. Further research is required to ascertain the potential health benefits of reducing the rate of MRSA colonization among care home residents.
Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand
Authors: Apisarnthanarak Anucha , Thongphubeth Kanokporn , Sirinvaravong Sirinaj , Kitkangvan Danai , Yuekyen Chananart , Warachan Boonyasit , Warren David K. , Fraser Victoria J.
Published: June 2007

Objective.

To evaluate the efficacy of a multifaceted hospitalwide quality improvement program that featured an intervention to remind physicians to remove unnecessary urinary catheters.

Methods.

A hospitalwide preintervention-postintervention study was conducted over 2 years (July 1, 2004, through June 30, 2006). The intervention consisted of nurse-generated daily reminders that were used by an intervention team to remind physicians to remove unnecessary urinary catheters, beginning 3 days after insertion. Clinical, microbiological, pharmaceutical, and cost data were collected.

Results.

A total of 2,412 patients were enrolled in the study. No differences were found in the demographic and/or clinical characteristics of patients between the preintervention and postintervention periods. After the intervention, reductions were found in the rate of inappropriate urinary catheterization (mean rate, preintervention vs postintervention, 20.4% vs 11% [P = .04]), the rate of catheter-associated urinary tract infection (CA-UTI) (mean rate, 21.5 vs 5.2 infections per 1,000 catheter-days [P <.001]), the duration of urinary catheterization (mean, 11 vs 3 days [P < .001]), and the total length of hospitalization (mean, 16 vs 5 days [P < .001]). A linear relationship was seen between the monthly average duration of catheterization and the rate of CA-UTI (r = 0.89; P < .001). The intervention had the greatest impact on the rate of CA-UTI in the intensive care units (mean rate, preintervention vs postintervention, 23.4 vs 3.5 infections per 1,000 catheter-days [P = .01]). The monthly hospital costs for antibiotics to treat CA-UTI were reduced by 63% (mean, $3,739 vs $1,378 [P < .001]), and the hospitalization cost for each patient during the intervention was reduced by 58% (mean, $366 vs $154 [P < .001]).

Conclusions.

This study suggests that a multifaceted intervention to remind physicians to remove unnecessary urinary catheters can significantly reduced the duration of urinary catheterization and the CA-UTI rate in a hospital in a developing country.
Outbreak of Healthcare-Associated Infection and Colonization With Multidrug-ResistantSalmonella entericaSerovar Senftenberg in Florida
Authors: Kay Robyn S. , Vandevelde Alexander G. , Fiorella Paul D. , Crouse Rebecca , Blackmore Carina , Sanderson Roger , Bailey Christina L. , Sands Michael L.
Published: June 2007

Background.

In July 1999, a rare strain of multidrug-resistantSalmonella entericaserovar Senftenberg was isolated from the sputum of a trauma patient. Over a 6-year period (1999-2005) in northeast Florida, thisSalmonellaserovar spread to 66 other patients in 16 different healthcare facilities as a result of frequent transfers of patients among institutions. To our knowledge, this is the first outbreak of healthcare-associated infection and colonization with a fluoroquinolone-resistant strain of S. Senftenberg in the United States.

Objectives.

To investigate an outbreak of infection and colonization with an unusual strain of S. Senftenberg and assist with infection control measures.

Design.

A case series, outbreak investigation, and microbiological study of all samples positive forS.Senftenberg on culture.

Setting.

Cases ofS.Senftenberg infection and colonization occurred in hospitals and long-term care facilities in 2 counties in northeast Florida.

Results.

The affected patients were mostly elderly persons with multiple medical conditions. They were frequently transferred between healthcare facilities. ThisSalmonellaserovar was capable of long-term colonization of chronically ill patients. AllS.Senftenberg isolates tested shared a similar pulsed-field gel electrophoresis (PFGE) pattern.

Conclusion.

A prolonged outbreak of infection and colonization with multidrug-resistantS.Senftenberg was identified in several healthcare facilities throughout the Jacksonville, Florida, area and became established when infection control measures failed. The bacterial agent was capable of long-term colonization in chronically ill patients. Because the dispersal pattern of this strain suggested a breakdown of infection control practices, a multipronged intervention approach was undertaken that included intense education of personnel in the different institutions, interinstitutional cooperation, and transfer paperwork notification.
Underresourced Hospital Infection Control and Prevention Programs: Penny Wise, Pound Foolish?
Authors: Anderson Deverick J. , Kirkland Kathryn B. , Kaye Keith S. , Thacker Paul A. , Kanafani Zeina A. , Auten Grace , Sexton Daniel J.
Published: June 2007

Objectives.

To estimate the cost of healthcare-associated infections (HAIs) in a network of 28 community hospitals and to compare this sum to the amount budgeted for infection control programs at each institution and for the entire network.

Design.

We reviewed literature published since 1985 to estimate costs for specific HAIs. Using these estimates, we determined the costs attributable to specific HAIs in a network of 28 hospitals during a 1-year period (January 1 through December 31, 2004). Cost-saving models based on reductions in HAIs were calculated.

Setting.

Twenty-eight community hospitals in the southeastern region of the United States.

Results.

The weight-adjusted mean cost estimates for HAIs were $25,072 per episode of ventilator-associated pneumonia, $23,242 per nosocomial blood stream infection, $10,443 per surgical site infection, and $758 per catheter-associated urinary tract infection. The median annual cost of HAIs per hospital was $594,683 (interquartile range [IQR], $299,057-$l,287,499). The total annual cost of HAIs for the 28 hospitals was greater than $26 million. Hospitals budgeted a median of $129,000 (IQR, $92,500-$200,000) for infection control; the median annual cost of HAIs was 4.6 (IQR, 3.4-8.0) times the amount budgeted for infection control. An annual reduction in HAIs of 25% could save each hospital a median of $148,667 (IQR, $74,763-$296,861) and could save the group of hospitals more than $6.5 million.

Conclusions.

The economic cost of HAIs in our group of 28 study hospitals was enormous. In the modern age of infection control and patient safety, the cost-control ratio will become the key component of successful infection control programs.
Prevalence of Antimicrobial Resistance in Acinetobacter calcoaceticus-baumannii Complex in a Saudi Arabian Hospital
Authors: Al-Tawfiq Jaffar A. , Mohandhas Thangiah X.
Published: June 2007

During the period from 1998 through 2004, a total of 476 isolates of Acinetobacter calcoaceticus-baumannii complex were recovered. The organism showed high rates of resistance to ampicillin (86% of isolates), cefoxitin (89%), and nitrofurantoin (89%). The rate of resistance to imipenem was 3%; to ticarcillin-clavulanic acid, 16.5%; to gentamicin, 26%; and to ceftazidime, 38%. Multidrug resistance was observed in 14%-35.8% of Acinetobacter species isolates.
213Bi‐radioimmunotherapy defeats early‐stage disseminated gastric cancer in nude mice
Authors: Beck Roswitha , Seidl Christof , Pfost Birgit , Morgenstern Alfred , Bruchertseifer Frank , Baum Hannsjörg , Schwaiger Markus , Senekowitsch‐Schmidtke Reingard
Published: June 2007

The α‐emitter 213Bi is characterized by a high relative biological effectiveness. 213Bi‐immunoconjugates targeting tumor‐specific d9‐E‐cadherin have been proven to effectively kill tumor cells in a murine peritoneal carcinomatosis model. The aim of the present study was to optimize the efficacy of 213Bi‐radioimmunotherapy for disseminated gastric cancer in a mouse model of early‐ and advanced‐stage disease and to evaluate the long‐term toxicity of 213Bi‐immunoconjugates. For that purpose, nude mice were treated with different activities of 213Bi‐d9 monoclonal antibody (MAb) targeting d9‐E‐cadherin or unspecific 213Bi‐d8MAb at days 1 or 8 after inoculation of HSC45‐M2 gastric cancer cells expressing mutant d9‐E‐cadherin. Therapeutic efficacy was evaluated by monitoring survival for up to 300 days. Long‐term toxicity was evaluated by the survival of tumor‐free mice injected with 213Bi‐immunoconjugates, kidney function parameters and histopathological examination of kidneys. We showed that survival was significantly prolonged following treatment of mice with 213Bi‐immunoconjugates (0.37–22.2 MBq) at day 1 after tumor cell inoculation (P < 0.002). Therapy with 1.85 MBq of 213Bi‐d9MAb was most successful, defeating early‐stage disease in 87% of all cases. Treatment at day 8 after tumor cell inoculation was less efficient. Long‐term nephrotoxicity could only be observed following application of 22.2 MBq of 213Bi‐d9MAb, the highest activity applied in the therapy trials. As treatment with 1.85 MBq 213Bi‐d9MAb showed excellent therapeutic efficacy without any signs of acute or chronic toxicity, radioimmunotherapy with the α‐emitter 213Bi is a promising concept for treatment of early peritoneal carcinomatosis. (Cancer Sci 2007; 98: 1215–1222)
Management of cold haemolytic syndrome
Authors: Gertz Morie A.
Published: June 2007

Most haemolytic disease is mediated by immunoglobulin G (IgG) antibodies and leads to red blood cell destruction outside of the circulatory system. However, rare syndromes, such as paroxysmal cold haemoglobinuria, show IgG antibodies causing intravascular destruction. Haemolysis may also occur because of immunoglobulin M antibodies. Historically, these antibodies have been termed ‘cold agglutinins’ because they cause agglutination of red blood cells at 3°C. Cold agglutinin haemolytic anaemia has been associated with a number of autoimmune and lymphoproliferative disorders, and its management differs substantially from warm antibody‐mediated haemolytic anaemia. This review of cold haemolytic syndromes describes new therapies and clinical strategies to determine a correct diagnosis.
Protein metabolism in Turner syndrome and the impact of hormone replacement therapy
Authors: Gravholt Claus Højbjerg , Riis Anne Lene , Møller Niels , Christiansen Jens Sandahl
Published: June 2007

Background  Studies have documented an altered body composition in Turner syndrome (TS). Body fat is increased and muscle mass is decreased. Ovarian failure necessitates substitution with female hormone replacement therapy (HRT), and HRT induces favourable changes in body composition. It is unknown how HRT affects protein metabolism.

Aim  To test whether alterations in body composition before and after HRT in TS are a result of altered protein metabolism.

Design  We performed a randomized crossover study with active treatment (HRT in TS and oral contraceptives in controls) or no treatment.

Materials and methods  We studied eight women (age 29·7 ± 5·6 (mean ± SD) years) with TS, verified by karyotype, and eight age‐matched controls (age 27·3 ± 4·9 years). All subjects underwent a 3‐h study in the postabsorptive state. Protein dynamics of the whole body and of the forearm muscles were measured by an amino acid tracer dilution technique using [15N]phenylalanine and [2H4]tyrosine. Substrate metabolism was examined by indirect calorimetry.

Results  Energy expenditure was comparable among TS and controls, and did not change during active treatment. Whole‐body phenylalanine and tyrosine fluxes were similar in the untreated situations, and did not change during active treatment. Amino acid degradation and protein synthesis were similar in all situations. Muscle protein breakdown was similar among groups, and was not affected by treatment. Muscle protein synthesis rate and forearm blood flow did not differ among groups or due to treatment.

Conclusion  Protein metabolism in TS is comparable to controls, and is not affected by HRT.
Inherited lipodystrophies and the metabolic syndrome
Authors: Monajemi Houshang , Stroes Erik , Hegele Robert A. , Fliers Eric
Published: June 2007

Lipodystrophies represent a heterogeneous group of diseases characterized by an abnormal subcutaneous fat distribution, the extent of which can vary from localized, to partial, to generalized lipoatrophy. Whereas partial and generalized lipodystrophies are each associated with metabolic abnormalities, the localized form is not. These metabolic changes include insulin resistance with type 2 diabetes, acanthosis nigricans, dyslipidaemia predominantly consisting of hypertriglyceridaemia (associated with the onset of pancreatitis) and depressed HDL cholesterol, liver steatosis and hypertension. Affected women are often hirsute and this can be associated with the presence of polycystic ovarian syndrome (PCOS). Most of these clinical features are present to some extent in patients with the common metabolic syndrome. As the prevalence of metabolic syndrome far outweighs that of lipodystrophy, the diagnosis of this rare disorder may often be overlooked with the affected patient diagnosed as merely being ‘yet’ another case of metabolic syndrome. In this article, we draw attention to the importance of recognizing patients with lipodystrophy who present with metabolic abnormalities, as both the diagnostic as well as the therapeutic approach of these patients differ profoundly from patients with the metabolic syndrome.
Long‐term effects of growth hormone (GH) treatment on body composition and bone mineral density in short children born small‐for‐gestational‐age: six‐year follow‐up of a randomized controlled GH trial
Authors: Willemsen Ruben H. , Arends Nicolette J. T. , Bakker‐van Waarde Willie M. , Jansen Maarten , Van Mil Edgar G. A. H. , Mulder Jaap , Odink Roelof J. , Reeser Maarten , Rongen‐Westerlaken Ciska , Stokvis‐Brantsma Wilhelmina H. , Waelkens Johan J. J. , Hokken‐Koelega Anita C. S.
Published: June 2007

Context  Alterations in the GH‐IGF‐I axis in short small‐for‐gestational‐age (SGA) children might be associated with abnormalities in bone mineral density (BMD) and body composition. In addition, birth weight has been inversely associated with diabetes and cardiovascular disease in adult life. Data on detailed body composition in short SGA children and long‐term effects of GH treatment are very scarce.

Objective  To investigate effects of long‐term GH treatment on body composition and BMD by dual energy X‐ray absorptiometry (DXA) in short SGA children.

Design  Longitudinal 6‐year GH study with a randomized controlled part for 3 years.

Results  At baseline, fat percentage standard deviation score (SDS) and lumbar spine BMD SDS corrected for height (BMADLS SDS) were significantly lower than zero. Lean body mass (LBM) SDS adjusted for age was also reduced, but LBM adjusted for height (LBM SDSheight) was not decreased. GH treatment induced a decrease in fat percentage SDS and an increase in BMADLS SDS. LBM SDSheight remained similar in GH‐treated children, but deteriorated in untreated controls. When these untreated controls subsequently started GH treatment, their LBM SDSheight rapidly normalized to values comparable with zero.

Conclusion  During long‐term GH treatment in short SGA children, fat percentage SDS decreased and BMADLS SDS increased. These effects of GH treatment were most prominent in children who started treatment at a younger age and in those with greater height gain during GH treatment. LBM SDSheight remained around 0 SDS in GH‐treated children, but declined to low normal values in untreated controls.
Determining the dilation factor in 4D monitoring of compacting reservoirs by rock‐physics models
Authors: Carcione José M. , Landrø Martin , Gangi Anthony F. , Cavallini Fabio
Published: June 2007

Hydrocarbon depletion and fluid injection cause compaction and stretching of the reservoir and overburden layers. 4D prestack seismic data can be used to detect these changes because compaction/stretching causes changes in traveltimes and seismic velocities. We show that, by using two different petro‐elastic models at varying effective pressures, a good approximation is to assume that the fractional changes in layer thickness, ΔL/L, and seismic velocity, Δv/v, are related by a linear function of ΔL/L. The slope of this function (the dilation factor, α= (Δv/v)/(ΔL/L)) is negative and its absolute value generally decreases (shale, low porosity) or increases (sandstone, high porosity) with increasing layer thickness and decreasing effective pressure. The analysis is mainly performed for isotropic deformations. The dilation factor for uniaxial deformations is smaller in absolute value.

The dilation factor, which can be calculated from time‐lapse data, can be used to predict reservoir compaction/stretching as a function of depth and surface subsidence.
Detection of preferential infiltration pathways in sinkholes using joint inversion of self‐potential and EM‐34 conductivity data
Authors: Jardani A. , Revil A. , Santos F. , Fauchard C. , Dupont J.P.
Published: June 2007

The percolation of water in the ground is responsible for measurable electric potentials called self‐potentials. These potentials are influenced by the distribution of the electrical conductivity of the ground. Because sinkholes are associated both with self‐potential and electrical conductivity anomalies, a joint inversion of EM‐34 conductivity and self‐potential data is proposed as a way of delineating the location of these features. Self‐potential and EM conductivity data were obtained at a test site in Normandy (France) where sinkholes and crypto‐sinkholes are present over a karstic area in a chalk substratum overlain by clay‐with‐flint and loess covers. The presence of sinkholes and crypto‐sinkholes is associated with negative self‐potential anomalies with respect to a reference electrode located outside the area where the sinkholes are clustered. The sinkholes also have a conductivity signature identified by the EM‐34 conductivity data. We used the simulated‐annealing method, which is a global optimization technique, to invert jointly EM‐34 conductivity and self‐potential data. Self‐potential and electrical conductivity provide clear complementary information to determine the interface between the loess and clay‐with‐flint formations. The sinkholes and crypto‐sinkholes are marked by depressions in this interface, focusing the groundwater flow towards the aquifer contained in the chalk substratum.
Understanding the changing value of natural resources: an integrated palaeoecological–historical investigation into grazing–woodland interactions by Loch Awe, Western Highlands of Scotland
Authors: Davies Althea L. , Watson Fiona
Published: June 2007

Aim  We aim to compare fine resolution pollen data from a former seasonal pasture with historical evidence for grazing and woodland use. We discuss the complexities and benefits of integrating qualitative and quantitative information, and the implications for studies of past wood–grazing interactions and their relevance to current conservation management.

Location  Corries is an abandoned farm township in Scotland's Western Highlands.

Methods  Two sources were used: (1) pollen evidence from a former seasonal pasture, analysed at c. 20‐year intervals and dated using 14C and 210Pb, provides a c. 1100‐year local vegetation and land‐use history; (2) written sources document resource regulation and changing socio‐economic circumstances at local to national scales over the last c. 400 years.

Results  Each source records woodland and livestock management at different spatial and temporal scales: written evidence provides a clearer understanding of general (estate) rather than farm‐scale changes, while small pollen basins record localized woodland–grazing dynamics, which can be difficult to extrapolate to the landscape scale. Both sources indicate a dynamic wood–grazing balance and together provide clearer evidence for incentives and drivers controlling this relationship. The first palynological phase of woodland incursion (adc. 1210–1490) pre‐dates the surviving written records, but a second (adc. 1680–1760) occurs during a period of increasing market value for cattle, when farmers may have increased grazing despite regulations to protect woods. The site is not representative of grazing intensification associated with the introduction of extensive sheep farming because the farmer protected the woods (adc. 1760–1880) until they were cleared (adc. 1880–1920) for quarrying (ad 1885–1904), which accounts for the limited palynological evidence for grazing.

Main conclusions  Written evidence for past stocking levels is too fragmentary and ambiguous to allow long‐term quantitative analysis, but a local historical context is important for interpreting local pollen records. Management decisions that determined grazing–woodland interactions were shaped by changing values, markets, agricultural practices and regulatory structures, which can result in nonlinear relationships between stocking levels and woodland continuity. Many woods were managed for multiple purposes in the past and promoting natural processes or pursuing pre‐anthropogenic baselines will result in the erosion of cultural features that have shaped present landscape values.
Mechanism of chloride corrosion of dental amalgam
Authors: FINKELSTEIN G. F. , GREENER E. H.
Published: June 2007

Polarization of conventional dental amalgam in Ringer's solution produces a dissolution of the γ2 phase at –250 mV (SCE) and formation of Sn—Cl and Sn—O—Cl. This study was undertaken to determine the electrochemical nature of these reactions. Potentiostatic polarization scans were run at 4, 37 and 50°C in several dilutions of aerated Ringer's solution. Manipulation of reactant concentrations and electrolyte temperature produced shifts in the potentiostatic profiles. At 50°C, a γ2 dissolution peak shift to —300 mV was observed, and at 4°C the peak shifted to—200 mV. Dilution of Ringer's solution with respect to [Cl−] over three orders of magnitude produced a linear shift in the noble direction of 500 mV. Cathodic polarization appears to be limited by the oxygen half cell reaction. Changes of [Cl−] affect the shape of the peak, round out its approach to the current maximum. Shifts in peak potential due to temperature and concentration changes agreed with calculations based on critical pitting potential for γ2 dissolution due to a chloride reaction. Polarization profiles in pooled saliva agreed with calculated potentials based on known saliva [Cl−].
Relationship of the preferred vertical dimension of occlusion to the height of the complete dentures in use
Authors: BROEKHUIJSEN M. L. , VAN WILLIGEN J. D. , WRIGHT SUSAN M.
Published: June 2007

The dependence of the preferred vertical dimension of occlusion (PVDO) of edentulous subjects on the height of the complete dentures the subjects were wearing was investigated. Two experiments were carried out. Experiment I tested whether PVDO is influenced by a change in the vertical dimension of occlusion of the dentures. Experiment II compared PVDO values before and after insertion of dentures that had been constructed with an occlusal vertical dimension equal to PVDO. It is concluded that PVDO is independent of the height of the complete dentures the subject is wearing. Clinical implications are discussed.
Pharmacokinetics and bioavailability of imidocarb dipropionate in swine
Authors: SU D. , LI X. B. , WANG Z. J. , WANG L. , WU W. X. , XU J. Q.
Published: June 2007

A two‐way crossover study was performed in eight healthy young pigs to determine the pharmacokinetics of imidocarb dipropionate (IMDP) following intravenous (2 mg/kg b.w.) and intramuscular (2 mg/kg b.w.) administrations. Each animal received one intravenous and one intramuscular injection with a 30‐day washout period between the two‐treatments. Plasma concentrations were measured by high‐performance liquid chromatography (HPLC) assay with UV detector at regular intervals for up to 24 h post‐injection. Intravenous plasma concentration profiles best fit a three‐compartmental model yielding a mean system clearance (Cl(s)) of 558 mL/kg·h and a mean half‐life of 13.91 h. Mean imidocarb AUC(0−∞) (μg·h/mL), Vc (L/kg), Vd(area)(L/kg) and MRT(0‐t) (h) values were 3.58, 0.11, 14.36 and 1.46, respectively. Compartmental modeling of imidocarb, after intramuscular administration produced best fit for two‐compartmental model yielding mean Kα (h−1), Cmax (μg/mL), tmax (h), and bioavailability (%) of 3.89, 2.02, 0.54, and 86.57 for the 2 mg/kg dose level. The present studies showed that IMDP was rapidly absorbed, widely distributed, and slowly eliminated. No adverse effects were observed in any of the pigs after i.v. and i.m. administrations of IMDP. The favorable PK behavior, such as the long half‐life, acceptable bioavailability indicated that it is likely to be effective in pigs.
Large deletions in the CFTR gene: clinics and genetics in Swiss patients with CF
Authors: Schneider M , Hirt C , Casaulta C , Barben J , Spinas R , Bühlmann U , Spalinger J , Schwizer B , Chevalier‐Porst F , Gallati S
Published: June 2007

Cystic fibrosis (CF) is the most common life‐shortening autosomal recessive disorder in Caucasians, and is associated with at least one mutation on each CF transmembrane conductance regulator (CFTR) allele. Some patients, however, with only one identifiable point mutation carry on the other allele, a large deletion that is not detected by conventional screening methods. The overall frequency of large deletions in patients with CF is estimated to be 1–3%. Using the CFTR Multiplex Ligation dependent Probe Amplification® Kit (MRC‐Holland, Amsterdam, Netherlands) that allows the exact detection of copy numbers from all 27 exons in the CFTR gene, we screened 50 patients with only one identified mutation for large deletions in the CFTR gene. Each detected deletion was confirmed using our real‐time polymerase chain reaction (PCR) assay and deletion‐specific PCR reactions using junction fragment primers. We detected large deletions in eight patients (16%). These eight CF alleles belong to four different deletion types (CFTRindel2, CFTRdele14b–17b, CFTRdele17a–17b and CFTRdele 2–9) whereof the last is novel. Comparing detailed clinical data of all these patients with CF and the molecular genetic findings, we were able to elaborate criteria for deletion screenings and possible genotype–phenotype associations. In conclusion, we agree with other authors that deletion screenings should be implemented in routine genetic diagnostics of CF.
Hypothalamic‐pituitary‐adrenal axis suppression in asthmatic children on inhaled corticosteroids: Part 1. Which test should be used?
Authors: Zöllner Ekkehard Werner
Published: June 2007

The effect of inhaled corticosteroids (ICS) on the hypothalamic‐pituitary‐adrenal axis (HPA) has been regarded as a ‘benign physiological response’. A recent survey suggests that adrenal crisis might be more common in asthmatic children on ICS than previously thought. The clinical features of adrenal insufficiency are non‐specific and can easily be missed. Accurate biochemical assessment of the axis is therefore mandatory. A review of the literature determined that all basal adrenal function tests, including plasma cortisol profiles, cannot identify which children can respond to stress. There is no evidence to suggests that the degree of the physiological adjustment of the HPA to ICS predicts clinically significant HPA suppression. Only gold standard adrenal function tests can assess the integrity of the whole axis. Of the two available tests, the correctly performed overnight metyrapone test (with ACTH levels) is safe and better by far. The use of cortisol profiles should only be used to demonstrate differences in systemic activity of various ICS and delivery devices. Regulatory bodies should insist on trials that evaluate the HPA with a gold standard adrenal function test before it is declared safe and allowed to be marketed. A re‐analysis of studies that have utilized gold standard adrenal function tests only might identify the lowest safe dose and duration of ICS.
Dietary prevention of allergic disease in children: Are current recommendations really based on good evidence?
Authors: Brand Paul L. P. , Vlieg‐Boerstra Berber J. , Dubois Anthony E. J.
Published: June 2007

We provide a critical appraisal of the literature on the effects of dietary prevention of atopic disease in children. In our view, currently available studies suffer from lack of blinding which is a major problem if the primary end point is subjective (such as the diagnosis of eczema). In addition, long‐term follow‐up suggests that atopic symptoms are delayed rather than truly prevented, and that only the mildest cases are prevented (or delayed). Although it has been reported that cow's milk allergy is truly prevented by dietary interventions in early life, this has never been demonstrated by double‐blind placebo‐controlled food challenges. No studies to date have shown effects of hypoallergenic formulae on objective markers of atopic sensitization, such as specific IgE levels. Finally, there is no universally accepted pathophysiological mechanism which could explain the usefulness of hypoallergenic formulae in allergy prevention. In conclusion, we feel that the currently available evidence on the allergy preventive effects of hypoallergenic formulae is insufficient to justify blanket advice being given to ‘high risk’ families. Such advice gives parents the hope that they can actually prevent allergy in their children which may not be justified. A cautious approach in advising interventions with hypoallergenic formulae to prevent allergy in high‐risk infants is warranted.
Is breast feeding a risk factor for eczema during the first year of life?
Authors: Sariachvili Manana , Droste Jos , Dom Sandra , Wieringa Marjan , Vellinga Akke , Hagendorens Margo , Bridts Chris , Stevens Wim , Sprundel Marc Van , Desager Kristine , Weyler Joost
Published: June 2007

Breast feeding (BF) provides many advantages to the offspring; however, at present there is an ongoing debate as to whether or not it prevents allergic diseases. The aim of the current study was to investigate the effect of duration of BF on eczema in the first year of life. A birth cohort of 1128 infants was followed prospectively from 5 months of pregnancy. Data were collected using questionnaires, a medical examination and blood tests for allergy at the age of 1 yr. Breast feeding was not statistically significant associated with eczema in the first year of life [adj ORs with 95% CIs: 0.8 (0.4–1.3), 0.8 (0.5–1.3) and 1.0 (0.6–1.5) for BF duration of 1–6 wk, 7–12 wk and ≥13 wk, respectively]. Eczema was positively associated with atopy and educational level of the mother, use of antibiotics in pregnancy and passive smoking by the child during the first 12 months. Regular postnatal contact of the infants with dogs was inversely associated with eczema. Breast feeding was positively associated with eczema among children with non‐atopic parents [adj ORs with 95% CIs: 2.1 (0.4–10.6), 2.2 (0.4–11.3) and 1.9 (0.4–8.5) for BF duration of 1–6 wk, 7–12 wk and ≥13 wk, respectively], whereas an inverse association was found among children with atopic parents [adj ORs with 95% CIs: 0.6 (0.3–1.3), 0.7 (0.3–1.4) and 0.9 (0.5–1.7) for the same BF durations]. However, these associations were not statistically significant. Breast feeding has no significant effect on the prevalence of eczema in the first year of life. The effect of BF on eczema in children depends on parental atopy.
Safety of levocetirizine treatment in young atopic children: An 18‐month study
Authors: Simons F. Estelle R. ,   on Behalf of the Early Prevention of Asthma in Atopic Children (EPAAC) Study Group*
Published: June 2007

There are more than 40 H1‐antihistamines available worldwide. Most of these medications have never been optimally studied in prospective, randomized, double‐masked, placebo‐controlled trials in children. The aim was to perform a long‐term study of levocetirizine safety in young atopic children. In the randomized, double‐masked Early Prevention of Asthma in Atopic Children Study, 510 atopic children who were age 12–24 months at entry received either levocetirizine 0.125 mg/kg or placebo twice daily for 18 months. Safety was assessed by: reporting of adverse events, numbers of children discontinuing the study because of adverse events, height and body mass measurements, assessment of developmental milestones, and hematology and biochemistry tests. The population evaluated for safety consisted of 255 children given levocetirizine and 255 children given placebo. The treatment groups were similar demographically, and with regard to number of children with: one or more adverse events (levocetirizine, 96.9%; placebo, 95.7%); serious adverse events (levocetirizine, 12.2%; placebo, 14.5%); medication‐attributed adverse events (levocetirizine, 5.1%; placebo, 6.3%); and adverse events that led to permanent discontinuation of study medication (levocetirizine, 2.0%; placebo, 1.2%). The most frequent adverse events related to: upper respiratory tract infections, transient gastroenteritis symptoms, or exacerbations of allergic diseases. There were no significant differences between the treatment groups in height, mass, attainment of developmental milestones, and hematology and biochemistry tests. The long‐term safety of levocetirizine has been confirmed in young atopic children.
Global warming and the disruption of plant–pollinator interactions
Authors: Memmott Jane , Craze Paul G. , Waser Nickolas M. , Price Mary V.
Published: June 2007

Anthropogenic climate change is widely expected to drive species extinct by hampering individual survival and reproduction, by reducing the amount and accessibility of suitable habitat, or by eliminating other organisms that are essential to the species in question. Less well appreciated is the likelihood that climate change will directly disrupt or eliminate mutually beneficial (mutualistic) ecological interactions between species even before extinctions occur. We explored the potential disruption of a ubiquitous mutualistic interaction of terrestrial habitats, that between plants and their animal pollinators, via climate change. We used a highly resolved empirical network of interactions between 1420 pollinator and 429 plant species to simulate consequences of the phenological shifts that can be expected with a doubling of atmospheric CO2. Depending on model assumptions, phenological shifts reduced the floral resources available to 17–50% of all pollinator species, causing as much as half of the ancestral activity period of the animals to fall at times when no food plants were available. Reduced overlap between plants and pollinators also decreased diet breadth of the pollinators. The predicted result of these disruptions is the extinction of pollinators, plants and their crucial interactions.
Adaptive social and maternal induction of antipredator dorsal patterns in a lizard with alternative social strategies
Authors: Lancaster Lesley T. , McAdam Andrew G. , Wingfield John C. , Sinervo Barry R.
Published: June 2007

Maternal effects facilitate adaptation to changing environments because they alter individual offspring traits to match current conditions. We show that maternal effects can also resolve context‐dependent, correlational selection on multiple offspring traits, promoting adaptation to more complex environments. In side‐blotched lizards (Uta stansburiana), two alternative pathways of dorsal pattern induction involve maternal oestradiol and alleles for throat colouration (∼social strategy). In one pathway, females increased yolk oestradiol when mated to yellow‐throated sires; oestradiol induced dorsal barring in yellow‐throated progeny of both sexes. In another pathway, females elevated yolk oestradiol in response to a high frequency of orange alleles in experimental social neighbourhoods. When the sire lacked yellow alleles, this secondary pathway resulted in striped, orange sons and striped, non‐orange daughters. All maternally induced types had high fitness in the wild. These results illustrate a (previously undescribed) mechanism for females to simultaneously resolve differing correlational selection pressures on different progeny.
The relationship between dispersal ability and geographic range size
Authors: Lester Sarah E. , Ruttenberg Benjamin I. , Gaines Steven D. , Kinlan Brian P.
Published: June 2007

There are a variety of proposed evolutionary and ecological explanations for why some species have more extensive geographical ranges than others. One of the most common explanations is variation in species’ dispersal ability. However, the purported relationship between dispersal distance and range size has been subjected to few theoretical investigations, and empirical tests reach conflicting conclusions. We attempt to reconcile the equivocal results of previous studies by reviewing and synthesizing quantitative dispersal data, examining the relationship between average dispersal ability and range size for different spatial scales, regions and taxonomic groups. We use extensive data from marine taxa whose average dispersal varies by seven orders of magnitude. Our results suggest dispersal is not a general determinant of range size, but can play an important role in some circumstances. We also review the mechanistic theories proposed to explain a positive relationship between range size and dispersal and explore their underlying rationales and supporting or refuting evidence. Despite numerous studies assuminga priorithat dispersal influences range size, this is the first comprehensive conceptual evaluation of these ideas. Overall, our results indicate that although dispersal can be an important process moderating species’ distributions, increased attention should be paid to other processes responsible for range size variation.
Marine extinctions revisited
Authors: Monte‐Luna Pablo del , Lluch‐Belda Daniel , Serviere‐Zaragoza Elisa , Carmona Roberto , Reyes‐Bonilla Héctor , Aurioles‐Gamboa David , Castro‐Aguirre José Luis , Próo Sergio A. Guzmán del , Trujillo‐Millán Oscar , Brook Barry W.
Published: June 2007

In recent years, more than 130 extinctions have been estimated to have occurred in the marine realm. Here we review this body of evidence and show that this figure may actually be overestimated by as much as 50%. We argue that previous estimates have not fully taken into account critical uncertainties such as naturally variable geographical distributions, and have misinterpreted documentary evidence. However, current evidence indicates that some sharks, rays and reef‐associated species, although not necessarily geographically restricted, are particularly vulnerable to anthropogenic impacts and now occur in very low numbers. Overestimating extinctions is of concern because it could reduce confidence in the credibility of the ‘extinct’ category in threatened species lists and, ultimately, be used to question the integrity of conservation and management policies. We suggest that when integrating future checklists of marine extinct species, there needs to be a more rigorous use of the terminology of extinction, and participation by specialists in each of the particular taxonomic groups involved.
Landings, logbooks and observer surveys: improving the protocols for sampling commercial fisheries
Authors: Cotter A J R , Pilling G M
Published: June 2007

The sampling of commercial marine fisheries for management purposes often displays a key weakness in the form of poor documentation of the scientific basis of sampling and estimation, the assumptions made, and the practical constraints. This paper reviews systematically the theoretical and practical options that can remedy this situation and recommends that decisions be archived in regularly updated ‘Sampling Approach and Modifications’ (SAM) documents. Defining the target population, the observable population (usually a subset of the target), and the assumed links between them is important, along with the distinction between design‐ and model‐based sampling approaches. Fleet‐targeted and stock‐targeted sampling strategies are contrasted, the latter being much harder to implement. Sampling protocols aimed at estimating quantities of fish landed and discarded, length–frequency distributions, length‐related variables such as age, weight and maturity, and ratio variables such as catch per unit of effort and the proportions of discards are discussed, together with the raising of estimates to fleet and/or stock levels. The ideas are summarized in the specific contexts of landings sampling, logbook schemes and sea‐going observer surveys. SAMs are commended for enhancing the scientific value of fishery sampling, and for encouraging methodological discussions among users and producers of the data.
Keeping watch on the unwatchable: technological solutions for the problems generated by ecosystem‐based management
Authors: McShane Paul E. , Broadhurst Matt K. , Williams Alan
Published: June 2007

Ecosystem‐based management is an emerging paradigm influencing the management of commercial fisheries. Increasingly, developed nations are adopting explicit legislation and policy governing the assessment and management of their fisheries against criteria of ecological sustainability. Yet the ability to evaluate ecosystem impacts of fisheries is compromised by a general lack of understanding of marine ecosystem function (beyond the population level) and a lack of robust and practical indicators for ecosystem health and management. Recent technological advances can assist in developing criteria, including structural analyses of seafloor communities potentially impacted by fishing gears (e.g. demersal trawling). Similarly, advances in fishing gear technology, including improved selectivity and the development of gears which have a more benign environmental impact, can mitigate some of the ecological impacts of fishing. Such technological advances are summarized in the context of contemporary fisheries management.
Distributional Effects of FDI: How the Interaction of FDI and Economic Policy Affects Poor Households in Bolivia
Authors: Nunnenkamp Peter , Schweickert Rainer , Wiebelt Manfred
Published: June 2007

This article provides a CGE analysis of the medium to long‐run impact of FDI inflows on poverty and income distribution in Bolivia. The simulation results suggest that FDI inflows enhance economic growth and reduce poverty. However, the income distribution typically becomes more unequal. In particular, FDI widens disparities between urban and rural areas. The Bolivian government may promote the growth‐enhancing and poverty‐alleviating effects by overcoming labour‐market segmentation and providing complementary public investment in infrastructure. But simulated policy reforms or alternative productivity scenarios are hardly effective in reducing the economic divide.
The Bangladesh Health SWAp: Experience of a New Aid Instrument in Practice
Authors: White Howard
Published: June 2007

Sector‐wide approaches are being widely adopted as a new aid modality, incorporating government ownership, partnership and a move from project to programme support. The literature to date on their performance in practice is, at best, mixed. This article reviews these issues in the light of the experience of arguably the world's oldest and largest SWAp, the Bangladesh health sector programme. A positive picture emerges of an evolutionary institutional adaptation towards a programme approach, with positive systemic effects on government processes and a reduction in transaction costs in dealing with donors. There are, however, negative aspects, notably, donor dominance in ‘dialogue’, though with limited influence on the government's actual strategy.
Flexible SWAps for Strategic Policy‐making: Reflections on the Zambian Experience
Authors: Van Donge Jan Kees
Published: June 2007

This article offers an alternative view on the emergence of new forms of development co‐operation by analysing the emergence of SWAps in Zambia since the early 1990s. SWAps in Zambia emerged not as part of a grand design but in response to the changing environment in which aid agencies were operating. An examination of the relative success of the health and education SWAps and the spectacular failure of the agriculture SWAp suggests that a flexible approach is more effective than the imposition of a planning template. Furthermore, the failure of the agricultural SWAp has been followed by significant new forms of public/private partnership.
The Equity and Poverty Impacts of Aquaculture: Insights from the Philippines
Authors: Irz Xavier , Stevenson James R. , Tanoy Arnold , Villarante Portia , Morissens Pierre
Published: June 2007

Recent literature is sceptical about the ability of aquaculture development to enhance equity and reduce poverty. This article investigates the issue empirically by surveying 148 households randomly selected in five coastal communities of the Philippines. There is overwhelming evidence that aquaculture benefits the poor in important ways and that it is perceived very positively by poor and non‐poor alike. In particular, the poor derive a relatively larger share of their income from it than the rich, and a lowering of the poverty line only reinforces this result. A Gini decomposition exercise also shows unambiguously that aquaculture represents an inequality‐reducing source of income, providing employment to a large number of unskilled workers in communities characterised by large labour surpluses.
Private Crop Insurers and the Reinsurance Fund Allocation Decision
Authors: Coble Keith H. , Dismukes Robert , Glauber Joseph W.
Published: June 2007

This research investigates the strategic behavior of private crop insurance firms reinsured by the USDA through the Standard Reinsurance Agreement. This arrangement allows the private firm to strategically allocate individual policies into different risk‐sharing arrangements. Thus, firm earnings are conditioned upon accurately forecasting policy loss experience. Our analysis begins with models investigating the characteristics explaining the placement of policies into the assigned risk fund. Then a simulation model of the SRA is used to compare the post‐SRA returns of actual firm allocations to two alternative allocation strategies based on a aggregate models and a policy‐level econometric forecasting model.