bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of psychological factors on placebo responses in a randomized controlled trial comparing sham device to dummy pill
Authors: Bertisch Suzanne M. , Legedza Anna R. T. , Phillips Russell S. , Davis Roger B. , Stason William B. , Goldman Rose H. , Kaptchuk Ted J.
Published: February 2009

Objectives  To explore to what extent psychological factors such as expectation, depression, anxiety and belief in alternative medicine impact placebo response and differential responses to separate placebo interventions.

Methods  We analysed data from a randomized controlled trial designed to compare the clinical response of two distinct placebo treatments (sham acupuncture device and placebo pill) in 119 participants with persistent distal upper arm pain due to repetitive stress injury. We used a multivariable linear regression model to identify potential correlates of self‐reported upper extremity pain at the end of treatment in both placebo arms of the study combined. We also performed stratified analyses by placebo treatment.

Results  We did not find any of the psychological factors of interest to be associated with pain at the end of treatment in our combined analysis. We found higher baseline pain score and pain for longer than 1 year's duration to be significantly associated with higher pain scores at the end of treatment for the placebo treatments combined. In stratified analyses, for the sham acupuncture group, we found higher baseline depression score, higher baseline pain score and younger age to be independently correlated with higher pain score at the end of treatment. For the placebo pill group, only baseline pain was significantly correlated to pain score at the end of treatment.

Conclusion  In this trial, neither expectancy nor psychological states were associated with response to placebo, with the exception of baseline depression score for the sham acupuncture arm.
Towards quantifying the aesthetic outcomes of breast cancer treatment: comparison of clinical photography and colorimetry
Authors: Kim Min Soon , Rodney William N. , Cooper Tara , Kite Chris , Reece Gregory P. , Markey Mia K.
Published: February 2009

Rationale, aims and objectives  Scarring is a significant cause of dissatisfaction for women who undergo breast surgery. Scar tissue may be clinically distinguished from normal skin by aberrant colour, rough surface texture, increased thickness (hypertrophy) and firmness. Colorimeters or spectrophotometers can be used to quantitatively assess scar colour, but they require direct patient interaction and can cost thousands of dollars. By comparison, digital photography is already in widespread use to document clinical outcomes and requires less patient interaction. Thus, assessment of scar coloration by digital photography is an attractive alternative. The goal of this study was to compare colour measurements obtained by digital photography and colorimetry.

Methods  Agreements between photographic and colorimetric measurements of colour were evaluated. Experimental conditions were controlled by performing measurements on artificial scars created by a make‐up artist. The colorimetric measurements of the artificial scars were compared with those reported in the literature for real scars in order to confirm the validity of this approach. We assessed the agreement between the colorimetric and photographic measurements of colour using a hypothesis test for equivalence, the intraclass correlation coefficient and the Bland–Altman method.

Results  Overall, good agreement was obtained for three parameters (L*a*b*) measured by colorimetry and photography from the results of three statistical analyses.

Conclusion  Colour measurements obtained by digital photography were equivalent to those obtained using colorimetry. Thus, digital photography is a reliable, cost‐effective measurement method of skin colour and should be further investigated for quantitative analysis of surgical outcomes.
Predictive model for progression of hearing loss: meta‐analysis of multi‐state outcome
Authors: Chao Ting‐Kuang , Chen Tony Hsiu‐Hsi
Published: February 2009

Rationale, aims and objectives  To develop a multi‐state Markov model to predict multi‐state progression of age‐related hearing loss (ARHL).

Method  A systematic searching of literature from Medline (1966–2005) was performed. The disease process for hearing loss was modelled as a four‐state continuous‐time Markov process. We estimated the progression rates for each study separately, then calculated weighted averages over all studies across age groups, weighting for each study by the inverse of variance. The pooled estimates were obtained and transition probabilities between states were illustrated.

Results  The progression of hearing loss increased with the ascending frequencies across all age groups. Men had significantly faster progression rates in all frequencies and age groups except for the age group of 90 years or older. In comparison between ears, the progression of hearing would be slightly faster in left ears initially in early elder life and did not show any difference in further ageing and later hearing declines. With the pooled estimates of progression rates, the probabilities of hearing deterioration could be obtained.

Conclusions  The multi‐state model can quantify the nature course of hearing progression in ARHL. Predictions of hearing status can be simulated either at population or individual level with this model.
Appropriateness of colonoscopy in a digestive endoscopy unit: a prospective study using ASGE guidelines
Authors: Suriani Renzo , Rizzetto Mario , Mazzucco Dario , Grosso Silvia , Gastaldi Paola , Marino Maria , Sanseverinati Sabina , Venturini Ivo , Borghi Athos , Zeneroli Maria Luisa
Published: February 2009

Rationale, aims and objectives  Appropriate indications for colonoscopy (C) are essential for a rational use of resources. The aim of this study is to evaluate the appropriateness of indication for C according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines and to evaluate whether appropriate use was correlated with the diagnostic yield of C.

Methods  We analysed 677 consecutive C performed over an 11‐month period in a digestive endoscopy unit with an open access system.

Results  The rate of ‘generally indicated’ C was 77% and ‘generally not indicated’ C was 18%. The rate of indication not listed in the ASGE guidelines was 5%. The percentage of generally not indicated C requested by gastroenterologists for outpatients was lower than that requested by primary care surgeons or doctors (9.5%, 29%, 25.3%, respectively). In 38 (7.3%) and in 111 (21.3%) of 520 patients with appropriate C, cancer and polyps larger than 5 mm were found, respectively. Twenty polyps greater than 5 mm were detected in 15 cases (12%) of 122 inappropriate C, with only one case of intramucosal carcinoma; four (12%) polyps measuring over 5 mm were found in C not listed in ASGE guidelines. No advanced stage cancer was detected in the inappropriate group and in C not listed in ASGE guidelines.

Conclusions  Our results showed the high rate of inappropriate procedures, according to ASGE guidelines, requested by surgeons, internists and primary care doctors for both outpatients and inpatients. The proportion of not indicated endoscopic procedures requested by gastroenterologists must be reduced through more carefully application of ASGE guidelines. Endoscopic findings were more stringent in appropriate C.
Diagnostic accuracy of clinical criteria for identifying systolic and diastolic heart failure: cross‐sectional study
Authors: Maestre Ana , Gil Vicente , Gallego Javier , Aznar José , Mora Antonia , Martín‐Hidalgo Alberto
Published: February 2009

Objective  To determine the validity and clinical usefulness of clinical criteria in the diagnosis of systolic and diastolic heart failure.

Design  Cross‐sectional diagnostic study.

Methods  216 patients admitted consecutively to the cardiology section of an academic hospital with a suspected diagnosis of heart failure in a period of 12 months. A definite diagnosis of heart failure (echocardiographic diagnostic criteria of left ventricular dysfunction) was cross‐matched with the results obtained using the test under investigation (Framingham clinical diagnostic criteria for heart failure). Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive test result (LR+) and likelihood ratio for negative test result (LR−) were calculated and used to construct clinical decision‐making diagrams.

Results  The Framingham clinical criteria are very sensitive (92%) and moderately specific (79%). The diagnosis of heart failure was ruled out with a good LR− (0.1) but the diagnosis was confirmed with only a low level of evidence as the LR+ was 4.3. The main difference found between systolic and diastolic heart failure is that in the case of systolic failure the disease is ruled out conclusively (0.04), whereas in the case of diastolic failure the change in probability generated is at the borderline between conclusive and moderate (0.1).

Conclusion  The absence of the Framingham clinical criteria rules out the diagnosis of heart failure, particularly in the case of systolic heart failure. However, the presence of these criteria do not necessarily confirm the diagnosis, which may be based in echocardiography.
Knowledge, practice and faith on Total Quality Management principles among workers in the Health Care System: Evidence from an Italian investigation
Authors: Gregori Dario , Napolitano Giampaolo , Scarinzi Cecilia , Semeraro Arianna , Rosato Rosalba , Pagano Eva , Zigon Giulia , Gabassi Piergiorgio
Published: February 2009

Background  The implementation of Total Quality Management (TQM) principles in the sanitary field, in order to be effective, requires a radical change in management practice as well as the organizational culture and its philosophy. The need to monitor such a transformation emerges too.

Objectives  This study surveys how well TQM principles are known and understood by health care professionals from the employees' point of view and the factors affecting it.

Research design and subjects  The Health Care System in Trieste was surveyed.

Measures  The Total Quality Test was used, a novel and quick instrument aimed at routine assessment of the penetration and interiorization of TQM principles within the health care structure.

Results  Direct exposure to public, job role and time spent working within the same structure have been proved related to the penetration of TQM principles, whereas previous formative intervention did not prove to be associated with the penetration of TQM principles.

Conclusions  The implementation of a quick and simple instrument to monitor the TQM implementation highlighted several critical areas for intervention.
Can individuals with a significant risk for cardiovascular disease be adequately identified by combination of several risk factors? Modelling study based on the Norwegian HUNT 2 population
Authors: Petursson Halfdan , Getz Linn , Sigurdsson Johann A. , Hetlevik Irene
Published: February 2009

Rationale, aims and objectives  Clinicians are generally advised to consider several risk factors when evaluating patients' cardiovascular disease (CVD) risk. Our aim was to study whether combined assessment of five traditional risk factors might help doctors demarcate a relatively distinct and manageable group of high‐risk individuals. We selected five modifiable risk factors and estimated the proportion of a well‐defined population with ‘unfavourable’ levels of at least two of them, as defined by four internationally renowned guidelines. The impact of including so‐called ‘prehypertension’ among the risk factors was specifically addressed, and the results are discussed in a wider perspective.

Material and methods  Guideline implementation was modelled on data from a cross‐sectional Norwegian population study comprising 62 104 adults aged 20–79 years (The Nord‐Tröndelag Health Study 1995–7). Total, age‐ and gender‐specific point prevalences of individuals with zero, one, two, three or more factors, in addition to established disease, were calculated.

Results  One single CVD risk factor was exhibited by 12.4% of the population; two factors by 21.5%; and three or more by 49.7%. Established CVD or diabetes mellitus was reported by 12.5%. In total, 83.7% of the population exhibited a risk or disease profile with at least two factors, if prehypertension was included.

Conclusions  If guideline recommendations are literally applied, as many as 84% of adults in Norway could exhibit two or more CVD or risk factors and thus be considered in need of individual, clinical attention. This challenges the widely held presumption that ‘the net will close’ around a manageable group of individuals‐at‐risk if several risk factors are jointly considered. As the finding of this study arises in one of the world's most long‐ and healthy‐living populations, it raises several practical as well as ethical questions.
Paediatric experiences with work‐hour limitations
Authors: Fortuna Robert J. , Palfrey Judith S. , Shelov Steven P. , Samuels Ronald C.
Published: February 2009

Objectives  To evaluate the perceived impact of work‐hour limitations on paediatric residency training programmes and to determine the various strategies used to accommodate these restrictions.

Methods  A three‐page pre‐tested survey was administered to programme directors at the 2004 Association of Paediatric Programme Directors meeting. The impact of work‐hours was evaluated with Likert‐type questions and the methods used to meet work‐hour requirements were compared between large programmes (≥30 residents) and small programmes.

Results  Surveys were received from 53 programme directors. The majority responded that work‐hour limitations negatively impacted inpatient continuity, time for education, schedule flexibility and attending staff satisfaction. Supervision by attending staff was the only aspect to significantly improve. Perceived resident satisfaction was neutral. To accommodate work‐hour limitations, 64% of programmes increased clinical responsibility to existing non‐resident staff, 36% hired more non‐resident staff and 17% increased the number of residents. Only one programme hired additional non‐clinical staff. Large programmes were more likely to use more total methods on the inpatient wards (P < 0.01) and in the intensive care units (P < 0.05) to accommodate work‐hour limitations.

Conclusions  Programme directors perceived a negative impact of work‐hours on most aspects of training without a perceived difference in resident satisfaction. While a variety of methods are used to accommodate work‐hour limitations, programmes are not widely utilizing non‐clinical staff to alleviate clerical burdens.
Comparison of QuantiFERON TB‐G‐test to TST for detecting latent tuberculosis infection in a high‐incidence area containing BCG‐vaccinated population
Authors: Kariminia Amina , Sharifnia Zarin , Aghakhani Arezoo , Banifazl Mohammad , Eslamifar Ali , Hazrati Mahboob , Ramezani Amitis
Published: February 2009

Objective  Until recently, the only tool for detection of latent tuberculosis infection (LTBI) was the tuberculin skin test (TST). QuantiFERON‐TB Gold In‐Tube test (QFT) is a promising in vitro diagnostic test for LTBI that has potential advantages over the TST. In this study we aimed to compare QFT with TST for diagnosis of LTBI.

Patients and methods  A total of 186 BCG‐vaccinated subjects enrolled in study. They underwent TST and QFT assay. They divided in two groups. Group 1 includes individuals who were at low risk for exposure to M. tuberculosis (LRG) and Group 2 includes individuals who were likely to have been exposed to M. tuberculosis infections (HRG).

Results  Overall agreement between QFT and TST was 89.3% (kappa = 0.052). In LRG, agreement between the two tests was 52.6% (95% confidence interval, 44–60%) with κ‐values of 0.019. In HRG agreement between the two tests was 63.2% (95% confidence interval, 42–84%) with κ‐values of 0.28.

Conclusion  In conclusion, the QFT assay showed acceptable results for determining latent M. tuberculosis infection in vaccinated population. The decision to select QFT over TST will depend on the population, purpose of testing and resource availability.
Prehospital pain treatment: an economic productivity factor in emergency medicine?
Authors: Hubert Hervé , Guinhouya Comlavi , Ricard‐Hibon Agnès , Wiel Eric , Durocher Alain , Goldstein Patrick
Published: February 2009

Rationale and objectives  Analgesia is a recommended practice for pain treatment in prehospital emergency medicine, but all experts note suboptimal pain relief or oligoanalgesia. The increase in the Care Workload (CW) and the Medical Treatment Duration (MTD) linked to analgesia are two explanatory factors, and they are representative of the unavailability of a prehospital team. The unavailability of a team is an opportunity cost which is probably the most important cost within the framework of prehospital emergency. The aim of this study was to analyse the influence of analgesia use on the availability of prehospital emergency teams.

Methods  This study was a prospective, multicentre cohort study conducted in 10 French Mobile Emergency and Resuscitation Services (MERS) between September 2001 and June 2003. A case–control study was performed including 568 case patients who received analgesia matched with controls based on diagnosis and severity. The pairs were compared for MTD and CW.

Results  No significant difference between cases and controls was found concerning MTD (P = 0.134). Conversely, a difference was found for CW (P < 10−4), with a mean value of 53.7 Project Recherche Nursing (PRN) points for the cases and 45.8 PRN points for the controls.

Conclusions  This study shows that analgesia generates an additional CW without increasing the MTD, and does not hinder the MERS teams' availability. This economic result should improve adherence to these clinical practice guidelines. Thus, analgesia appears to be a factor of productivity in the current context of economic pressures in terms of the funding of the healthcare system.
MRI algorithm for medical necessity for auto accident injured patients
Authors: Chen Shande , Laughlin James E
Published: February 2009

Rationale  Magnetic resonance imaging (MRI) is often used as a diagnostic test to evaluate personal injury. However, it increases the health care cost. Therefore, it is important to study the necessity for using MRI.

Objective  To examine the percentages of MRI ordering between orthopaedic surgeon and non‐surgeon referring health care providers, and to propose an MRI an algorithm to reduce unnecessary MRI for patients with personal injuries.

Methods  This is a retrospective study. A total of 2000 patients that received a soft tissue injury and did not require surgery between 1 January 2000 and 31 December 2004, were examined. Among them, 1000 patients came directly to one of the authors, an orthopaedic surgeon, and other 1000 were referred to the same surgeon. The percentages of MRI ordered by the author and the referring health care providers are examined. For referred patients, the orthopaedic author re‐examined each patient to determine whether he thought the MRI was necessary. The Chi‐square test and McNemar's test are used for comparisons for the percentages, and confidence intervals are reported. The study examines the overall MRI ordering, and MRI ordering separately for body regions.

Conclusions  We found that there was a great disparity between the percentages of MRI ordering between the orthopaedic surgeon and the non‐surgeon referring doctors, the orthopaedic surgeon ordered significantly less MRI (P‐values < 0.001). Adopting the proposed algorithm of medical necessity for ordering MRI or considering early referral to an orthopaedic surgeon prior to ordering MRI can significantly reduce the medical cost for these patients.
Evaluating the effect of change on change: a different viewpoint
Authors: Shahar Eyal
Published: February 2009

Rationale  When a causal variable and its presumed effect are measured at two time points in a cohort study, most researchers prefer to fit some type of a change model. Many of them believe that such an analysis is superior to a cross‐sectional analysis ‘because change models estimate the effect of change on change’, which sounds epistemologically stronger than ‘estimating a cross‐sectional association’.

Methods  In this paper I trace two commonly used regression models of change to their cross‐sectional origin and describe these models from the perspectives of time‐stable confounders, effect modification, and causal diagrams. In addition, I cite three viewpoints from the statistical literature.

Results  The so‐called change models do not estimate anything conceptually different from cross‐sectional models. A change model is superior to a cross‐sectional model mainly because it corresponds to a self‐matched design. Statistical viewpoints markedly differ about the appropriate parameterization and interpretation of such data.

Conclusion  Contrary to prevailing thought, a model of changes between two time points does not estimate any special causal idea called ‘longitudinal effect’. The main advantage of regressing ‘change on change’ is complete control of time‐stable confounders, a key concern in observational studies. Many analysts fail to realize that that important advantage is usually lost when they fit a random effects model.
Goal attainment for multiple cardiovascular risk factors in community‐based clinical practice (a Canadian experience)
Authors: Farahani Pendar , Levine Mitchell
Published: February 2009

Background  The primary goal in the clinical management of atherosclerotic cardiovascular (CV) disease is to reduce major CV risk factors. A single risk factor approach has been traditionally used for demonstrating effectiveness of therapeutic interventions designed to reduce CV risk in clinical trials, but a global CV risk reduction approach should be adopted when assessing effectiveness in the clinical practice setting.

Objectives  To explore combined goal achievement for low‐density lipoprotein cholesterol (LDL‐C), fasting plasma glucose and systolic‐diastolic blood pressure, in patients with dyslipidemia on pharmacotherapy in community‐based clinical practices across Canada.

Methods  In a cross‐sectional study, patients filling a prescription for any antihyperlipidemia therapy in selected pharmacies in Ontario, Quebec, British Columbia and Nova Scotia were recruited. Family physicians of the participating patients were requested to provide information from the patient's medical record. Ten‐year CV risk was identified for each patient according to the Framingham criteria.

Results  High‐risk patients comprised 52% of the patient population; 34% were moderate‐risk and 14% were low‐risk. Patients had a mean of 2.8 CV risk factors; high‐risk 3.7, moderate‐risk 2.3 and low‐risk 1.2. LDL‐C goal attainment was observed in 62%, 79% and 96% of patients in high‐risk, moderate‐risk and low‐risk strata respectively. BP goal was achieved in high‐risk patients 58%, moderate‐risk 83% and low‐risk 95%. Glucose levels were below the threshold in 91% of patients. Complete global CV risk reduction was achieved in only 21%, 66% and 92% of high‐risk, moderate‐risk and low‐risk strata respectively.

Conclusion  This study illustrates that many patients with dyslipidemia in the Canadian population, and in particular the high‐risk patients, did not meet the therapeutic targets for specific CV risk factors according to the Canadian guidelines. Overall, 54% of patients failed to achieve a state of complete global CV risk reduction.
A short course of add‐on adefovir dipivoxil treatment in lamivudine‐resistant chronic hepatitis B patients
Authors: Idilman R. , Kaymakoglu S. , Oguz Onder F. , Ahishali E. , Bektas M. , Cinar K. , Pınarbasi B. , Karayalcin S. , Badur S. , Cakaloglu Y. , Mithat Bozdayi A. , Bozkaya H. , Ökten A. , Yurdaydin C.
Published: February 2009

Summary.  The aims of the study were to investigate the efficacy of rescue therapy with lamivudine (LAM) and adefovir (ADV) combination for 6 months followed by ADV monotherapy in lamivudine‐resistant chronic hepatitis B (LAM‐R CHB) patients, and to analyze the frequency of ADV resistance mutant development in such patients. A total of 170 consecutive LAM‐R CHB patients (male/female: 130/40, mean age: 42.9 ± 13.4 years) with viral breakthrough under LAM therapy were analyzed. A total of 68 had HBeAg‐positive. Patients received rescue therapy with LAM [100 mg (qd)]+ADV [10 mg (qd)] for 6 months after which LAM was discontinued. HBV‐DNA was assessed with the HBV‐DNA 3.0 bDNA assay. ADV‐resistant mutations were identified by sequencing the reverse transcriptase region. The median duration of rescue therapy was 24 months. Cumulative probability of becoming HBV‐DNA undetectable was 33.8%, 59.6% and 68.2% after 24, 48 and 96 weeks of treatment, respectively. These figures were 43.2%, 58.0% and 73.1% for ALT normalization. Among 68 HBeAg‐positive CHB patients, 10 patients had an e‐antigen seroconversion. Low baseline HBV‐DNA level (<107 copies/mL) was a significant predictor of response to ADV treatment (P < 0.01). Cumulative probability of ADV resistance was 1.2%, 15.1% and 37.3% at 12, 24 and 36 months of therapy, respectively. By multivariate analysis, baseline high viral load and primary nonresponse to treatment at week 24 predicted ADV resistance. The data indicate that a time limited add‐on strategy does not provide benefit over the switch strategy with respect emergence of ADV resistant mutants in LAM‐R CHB patients.
Influence of biotope on the distribution and peak activity of questing ixodid ticks in Hungary
Authors: HORNOK S. , FARKAS R.
Published: February 2009

Abstract In order to update the occurrence of hard tick species in Hungary, 3442 questing ticks were collected from the vegetation by the dragging/flagging method in 37 different places in the country, between March and June of 2007. Ixodes ricinus (L.) turned out to be ubiquitous. Dermacentor marginatus (Schulzer) was absent from sampling sites in the southwestern part of the country, but in most places was concomitant and contemporaneous with Dermacentor reticulatus (Fabricius). These two species, as well as I. ricinus, occurred up to an altitude of 900–1000 m a.s.l. Haemaphysalis inermis (Birula) and Haemaphysalis concinna (Koch) were not confined to any parts of the country, unlike Haemaphysalis punctata (Canestrini & Fanzago) which was found in only one region. The local prevalence of the latter species was also significantly lower than those of the former two in the same habitat (fringes of meadows, paths in forests). Dermacentor spp. and H. inermis were represented only by adults. In most species females were collected more frequently than males, except in H. concinna and H. punctata. Temporal differences between the peak activity of I. ricinus and Dermacentor spp. on dry pastures appeared to equalize on meadows in mountain forests, and a similar phenomenon was observed for the three Haemaphysalis spp. when collected along forest paths with fresh, green vegetation.
Effects of intraspecific larval competition on adult longevity in the mosquitoesAedes aegyptiandAedes albopictus
Authors: REISKIND M. H. , LOUNIBOS L. P.
Published: February 2009

AbstractLarval competition is common in container‐breeding mosquitoes. The impact of competition on larval growth has been thoroughly examined and findings that larval competition can lead to density‐dependent effects on adult body size have been documented. The effects of larval competition on adult longevity have been less well explored. The effects of intraspecific larval densities on the longevity of adults maintained under relatively harsh environmental conditions were tested in the laboratory by measuring the longevity of adultAedes aegypti(L.) andAedes albopictus(Skuse) (Diptera: Culicidae) that had been reared under a range of larval densities and subsequently maintained in high‐ or low‐humidity regimes (85% or 35% relative humidity [RH], respectively) as adults. We found significant negative effects of competition on adult longevity inAe. aegypti, but not inAe. albopictus. Multivariate analysis of variance suggested that the negative effect of the larval environment on the longevity ofAe. aegyptiadults was most strongly associated with increased development time and decreased wing length as adults. Understanding how larval competition affects adult longevity under a range of environmental conditions is important in establishing the relationship between models of mosquito population regulation and epidemiological models of vector‐borne disease transmission.
Modelling the ecology of the coastal mosquitoes Aedes vigilax and Aedes camptorhynchus at Port Pirie, South Australia
Authors: KOKKINN M. J. , DUVAL D. J. , WILLIAMS C. R.
Published: February 2009

Abstract Two mosquito species, Aedes camptorhynchus (Thomson) and Aedes vigilax (Skuse) (Diptera: Culicidae) are responsible for significant nuisance biting and disease transmission in southern coastal Australia. Mosquito abundance, tide height, temperature and rainfall data were collected over three summer seasons (2002, 2003, 2004) at Port Pirie, South Australia and subjected to statistical analysis to develop ecological models for predicting problem mosquito outbreaks. A logistic regression model for Ae. camptorhynchus gave a predictive R2 of 0.30 using mean air temperature, whereas, for Ae. vigilax, tide height, mean air temperature and day length yielded a regression with an R2 of 0.68. These models identify significant environmental drivers for both species and may be useful in the prediction of future outbreaks, particularly of Ae. vigilax.
Genetic variation in resistance to mixed, predominantly Teladorsagia circumcincta nematode infections of sheep: from heritabilities to gene identification
Authors: STEAR M. J. , BOAG B. , CATTADORI I. , MURPHY L.
Published: February 2009

In cool temperate areas, such as Scotland, sheep are infected by a variety of nematodes but the dominant nematode is Teladorsagia circumcincta. Resistant animals have one or more of the following features: fewer adult nematodes, more inhibited larvae, shorter adult nematodes and decreased production of nematode eggs. In lambs at the end of the first grazing season, the heritability of adult worm length is very strong, whereas the heritability of egg production is moderate. The heritability of worm number is low while there is no detectable genetic variation in the number of inhibited larvae. The major mechanisms underlying resistance to T. circumcincta appear to be the IgA mediated suppression of worm growth and the mast cell mediated regulation of worm number. Mast cell responses are slow to develop, possibly because they are responsible for protein loss and reduced growth of the host. Two genes have been repeatedly associated with resistance to T. Circumcincta: the MHC class II DRB1 locus on chromosome 20 and the interferon‐γ locus on chromosome 3. Although the causative mutations are still unknown both genes are plausible candidates.
Effect of consistent condom use on 6‐month prevalence of bacterial vaginosis varies by baseline BV status
Authors: Yotebieng Marcel , Turner Abigail Norris , Hoke Theresa Hatzell , Van Damme Kathleen , Rasolofomanana Justin Ranjalahy , Behets Frieda
Published: February 2009

Objectives  Bacterial vaginosis (BV) is a condition characterized by a disturbed vaginal ecosystem which fluctuates in response to extrinsic and intrinsic factors. BV recurrence is common. To explore whether consistent condom use was associated with BV occurrence or recurrence, we compared the effect of condom use on BV prevalence after 6 months, among women with and without BV at baseline.

Methods  We used data from a randomized controlled trial, conducted among female sex workers in Madagascar during 2000–2001, that assessed the impact of adding clinic‐based counselling to peer education on sexual risk behaviour and sexually transmitted infection incidence. BV was diagnosed at two time points (baseline and 6 months) according to modified Amsel criteria. Consistent condom users were women reporting no unprotected sex acts with clients in the past month or non‐paying partners in the past year. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using multivariable regression models.

Results  At baseline, 563 (56%) women had BV. Of those, 360 (72%) had BV at 6 months, compared to 158 (39%) without BV at baseline. The adjusted 6‐month PR for BV comparing consistent to inconsistent condom users was 0.99 (95% CI: 0.85–1.13) among women with BV at baseline and 0.57 (95% CI: 0.30–0.94) among women without BV at baseline.

Conclusions  Consistent condom use was associated with reduced BV prevalence at 6 months for women who were BV‐negative at baseline, but had no effect among women who were BV‐positive at baseline. Male condoms appeared to protect against BV occurrence, but not BV recurrence.
Using stochastic dynamic programming to support weed management decisions over a rotation
Authors: BENJAMIN L R , MILNE A E , PARSONS D J , CUSSANS J , LUTMAN P J W
Published: February 2009

Benjamin LR, Milne AE, Parsons DJ, Cussans J & Lutman PJW (2009). Using stochastic dynamic programming to support weed management decisions over a rotation. Weed Research49, 207–216.

This study describes a model that predicts the impact of weed management on the population dynamics of arable weeds over a rotation and presents the economic consequences. A stochastic dynamic programming optimisation is applied to the model to identify the management strategy that maximises gross margin over the rotation. The model and dynamic programme were developed for the weed management decision support system –‘Weed Manager’. Users can investigate the effect of management practices (crop, sowing time, weed control and cultivation practices) on their most important weeds over the rotation or use the dynamic programme to evaluate the best theoretical weed management strategy. Examples of the output are given in this paper, along with discussion on their validation. Through this study, we demonstrate how biological models can (i) be integrated into a decision framework and (ii) deliver valuable weed management guidance to users.
Soil biota, but not soil nutrients, facilitate the invasion of Bidens pilosa relative to a native species Saussurea deltoidea
Authors: CUI Q‐G , HE W‐M
Published: February 2009

Cui Q‐G & He W‐M (2009). Soil biota, but not soil nutrients, facilitate the invasion of Bidens pilosa relative to a native species Saussurea deltoidea. Weed Research49, 201–206.

Existing evidence has shown that soil biota and nutrient availability in the introduced ranges are drivers of plant invasions. Bidens pilosa, an invasive species, grows better in rich soil from under shrubs than in poor soil from spaces between the shrubs. Here, we hypothesise that soil biota will benefit B. pilosa more than the native herb Saussurea deltoidea and that B. pilosa will also be favoured over S. deltoidea in nutrient‐rich soil compared with soil lower in nutrients. To test both hypotheses, we conducted an experiment in which B. pilosa and S. deltoidea were subjected to non‐sterile and sterile soils from both shrubs and gaps. Sterilisation had greater negative effects on the growth of B. pilosa than S. deltoidea indicating that mutualists appear to have stronger effects on the invasive than on the native plant. Although shrub soil was significantly richer in nutrients than gap soil, this difference did not affect biomass production of B. pilosa. In contrast, B. pilosa had greater total biomass in non‐sterile shrub soil than in non‐sterile gap soil. These findings suggest that successful invasions of B. pilosa are because of the shrub‐dependent effect of soil biota in the introduced ranges and that its habitat association appears to be closely linked to soil biota, but not soil nutrients.
Major complications after 400 continuous popliteal sciatic nerve blocks for post‐operative analgesia
Authors: COMPÈRE V. , REY N. , BAERT O. , OUENNICH A. , FOURDRINIER V. , ROUSSIGNOL X. , BECCARI R. , DUREUIL B.
Published: February 2009

Background: A continuous popliteal sciatic nerve block (CPSNB) has been performed with increasing frequency for post‐operative analgesia after foot surgery. Major complications associated with the placement of a perineural catheter remain rarely studied. The aim of this study was to prospectively determine the incidence of major complications (neurological and infectious) in post‐operative adult patients with a continuous popliteal catheter inserted by the anatomical posterior approach for analgesia after foot surgery.

Methods: All popliteal catheters were placed pre‐operatively under sterile conditions with the aid of a nerve stimulator technique. The primary outcome measure was the incidence of major complications including infection and neuropathy. As a secondary outcome, adverse effects as well as other complications were also evaluated. Data were expressed as median [25th–75th percentiles].

Results: A total of 400 patients were included in the study during a 2‐year period. The median time the catheter remained indwelling was 47 h [23, 54]. Major complications included three events (0.75%) with one infection (0.25%) and two neuropathies (0.50%). Three blocks were unsuccessful and the catheter insertion was difficult in 12 patients (3%). During the CPSNB procedure, one patient reported slight paraesthesia during stimulation. Patient satisfaction was scored at 4 for 89%, 3 for 6% and 2 for 5% on the analogue scale.

Conclusions: Major complications after the use of CPSN are not in fact rare. The incidence of severe neuropathy or infection complications is, respectively, 0.50% and 0.25%. However, the insertion of CPSN could be considered effective and is associated with only a few minor complications.
The use of desflurane or propofol in combination with remifentanil in myasthenic patients undergoing a video‐assisted thoracoscopic‐extended thymectomy
Authors: GRITTI P. , CARRARA B. , KHOTCHOLAVA M. , BORTOLOTTI G. , GIARDINI D. , LANTERNA L. A. , BENIGNI A. , SONZOGNI V.
Published: February 2009

Background: Although several studies of the use of desflurane in anesthesia have revealed many desirable qualities, there are no data on the use and effects especially on the neuromuscular function of desflurane on myasthenia gravis (MG) patients. The purpose of this study was to evaluate the use of either desflurane or propofol, both combined with remifentanil, in patients with MG undergoing a video‐assisted thoracoscopic‐extended thymectomy (VATET).

Methods: Thirty‐six MG patients who underwent VATET were enrolled. Nineteen patients were anesthetized with remifentanil and propofol infused with a target‐controlled infusion plasma model, and 17 patients with desflurane and remifentanil. No muscle relaxant was used. The intubating conditions, hemodynamic and respiratory changes, neuromuscular transmission and post‐operative complications were evaluated.

Results: Neuromuscular transmission was significantly decreased in the desflurane group (6.7%, from 3% to 9% during anesthesia P=<0.05). The intubating conditions were good in all 36 patients and 35 patients were successfully extubated in the operating room. The time‐to‐awakening, post‐operatory pH and base excess were significantly different in the two groups, with a decreasing mean arterial pressure in the group administered with desflurane. No patients required reintubation due to myasthenic or cholinergic crisis, or respiratory failure. No other significant differences between the two groups studied were observed.

Conclusion: Our experience indicates that anesthesia with desflurane plus remifentanil in patients with MG could determine a reversible muscle relaxation effect, but with no clinical implication, allowing a faster recovery with no difference in extubation time and post‐operative complications in the two groups.
Conceptualising a modified system for classification of in‐hand manipulation
Authors: Pont Karina , Wallen Margaret , Bundy Anita
Published: February 2009

Occupational therapists consider in‐hand manipulation (IHM) to be an important component of fine motor skills and to be related to handwriting and self‐care proficiency. These relationships have not been well explored nor has the impact of intervention including IHM skill enhancement on proficiency in motor tasks. We propose that the existing conceptualisation of IHM may contribute to a dearth of evidence in this area. This paper closely examines the existing classification systems of IHM. We propose an adaptation of Exner's classification system which contains more discrete categories of IHM movements and includes: finger‐to‐palm translation to achieve stabilisation, palm‐to‐finger translation, simple shift, complex shift, simple rotation and complex rotation. Further research to test this modified classified system and to explore evidence for IHM intervention is warranted.
Peritoneal albumin leakage: 2 year prospective cardiovascular event occurrence and patient survival analysis
Authors: ELSURER RENGIN , AFSAR BARIS , SEZER SIREN , OZDEMIR F NURHAN , HABERAL MEHMET
Published: February 2009

Aim:  High peritoneal transport status is a determinant of morbidity and mortality in peritoneal dialysis (PD) patients. It was hypothesized that 24 h peritoneal albumin leakage predicted 2 year prospective cardiovascular outcome and survival in patients receiving PD.

Methods:  Sixty‐six patients were included. A simplified peritoneal equilibration test was performed and 24 h peritoneal albumin leakage was calculated. Patients were followed up for 2 years. Patient outcome (alive or dead) and occurrence of a cardiovascular event were recorded.

Results:  During a 2 year follow‐up period, 10 (15.2%) patients had suffered from a cardiovascular event and seven (10.6%) patients had died. Patients who had suffered from a cardiovascular event during the follow up period were older (54.0 ± 9.4 years vs 44.3 ± 14.5 years, P = 0.025), had lower serum pre‐albumin concentrations (29.3 ± 10.0 g/dL vs 36.0 ± 9.2 g/dL, P = 0.034) and had higher 24 h peritoneal albumin leakage (median, 3.4 g/day (1.66–15.4 g/day) vs 2.4 g/day (0.76–7.31 g/day), P = 0.011) than patients who did not suffer from a cardiovascular event. In the Cox proportional hazards multivariate analysis of factors which differed significantly between patients with and without a cardiovascular event (age, serum pre‐albumin and 24 h peritoneal albumin leakage), only advanced age (hazards ratio, 1.083; 95% confidence interval, 1.023–1.147, P = 0.006) was an independent predictor of a cardiovascular event.

Conclusion:  In contrast to the hypothesis, 24 h peritoneal albumin leakage is not a predictor of 2 year prospective cardiovascular outcome and patient survival. Only advanced age independently predicts the occurrence of a cardiovascular event in patients receiving PD.
Predictors of poor outcomes in steroid therapy for immunoglobulin A nephropathy
Authors: SHIMIZU ARI , TAKEI TAKASHI , UCHIDA KEIKO , TSUCHIYA KEN , NITTA KOSAKU
Published: February 2009

Background:  Steroid therapy appears to be beneficial in patients of immunoglobulin A nephropathy (IgAN), as it causes a reduction in the proteinuria and improves the renal survival.

Methods:  A retrospective review of the 5 year follow‐up data of 60 patients with IgAN who were treated with steroids was conducted. Steroid non‐responders were defined as patients in whom the primary end‐point of a 30% decrease of the estimated glomerular filtration rate from baseline was reached. The patients were divided into two groups, namely, the steroid responder group (n = 47) and the steroid non‐responder group (n = 13), and the clinicopathophysiological characteristics were compared between the two groups.

Results:  Significant decrease of the proteinuria was observed in the responder group over the 5 year follow‐up period, whereas no significant change of the urinary protein excretion was observed in the non‐responder group during the same period. In regard to the pathological findings, significantly higher ratios of glomerular obsolescence and glomerular tuft adhesion to the Bowman's capsule, and significantly higher severity of interstitial fibrosis at the time of diagnosis in the non‐responder group than in the responder group were found. The rates of glomerular obsolescence and glomerular tuft adhesion to the Bowman's capsule, the severity of interstitial fibrosis, serum albumin and urinary protein excretion were identified as independent risk factors influencing the rate of renal function deterioration.

Conclusion:  To develop effective therapeutic modalities, it is important to have a thorough understanding of the clinicopathophysiological characteristics of IgAN patients showing poor treatment response to steroids (non‐responder group in this study).
Accumulation of trehalose in response to desiccation and salt stress in the terrestrial cyanobacterium Nostoc commune
Authors: Sakamoto Toshio , Yoshida Takayuki , Arima Hiromi , Hatanaka Yuji , Takani Yayoi , Tamaru Yoshiyuki
Published: February 2009

Changes in photosynthetic activity and trehalose levels in field‐isolated, natural colonies of the terrestrial cyanobacterium Nostoc commune responding to desiccation and salt stress were investigated. As the water content decreased in N. commune colonies during desiccation, photosynthetic O2‐evolving activity decreased and no activity was detected in desiccated colonies. A high level of O2 evolution was restored in the colonies as they absorbed atmospheric moisture, indicating that only a small amount of water is required for reactivation of photosynthesis. No detectable trehalose was found in fully hydrated N. commune colonies; however, trehalose accumulation occurred in response to water loss during desiccation and high levels of trehalose were detected in the air‐dried colonies. Moreover, a 0.2 M NaCl treatment also induced trehalose accumulation to a level equivalent to that by desiccation. Photosynthetic O2 evolution was inhibited by 0.2 M NaCl, indicating that N. commune can tolerate only low levels of salt. These results suggest that cessation of photosynthesis and trehalose accumulation occur in response to both matric water stress (desiccation) and osmotic water stress (high salt concentration), and that while trehalose may be a less effective osmoprotective compound than others, it is important for the extreme tolerance to desiccation observed in terrestrial cyanobacterium.