bluuebunny/crossref_metadata_2025 huggingface dataset:
Parent‐proxy report of their children's health‐related quality of life: an analysis of 13 878 parents' reliability and validity across age subgroups using the PedsQL 4.0 Generic Core Scales
Authors: Reading Richard
Published: August 2007

.
 
Varni J. W.,
Limbers C. A. &
Burwinkle T. M.
(
2007
)

,
5
,
2
.
 
DOI:10.1186/1477‐7525‐5‐2.

Background  Health‐related quality of life (HRQOL) measurement has emerged as an important health outcome in clinical trials, clinical practice improvement strategies, and healthcare services research and evaluation. While paediatric patient self‐report should be considered the standard for measuring perceived HRQOL, there are circumstances when children are too young, too cognitively impaired, too ill or fatigued to complete an HRQOL instrument, and reliable and valid parent‐proxy report instruments are needed in such cases. Further, it is typically parents' perceptions of their children's HRQOL that influences healthcare utilization. Data from the PedsQL DatabaseSM were utilized to test the reliability and validity of parent‐proxy report at the individual age subgroup level for ages 2–16 years as recommended by recent Food and Drug Administration (FDA) guidelines.

Methods  The sample analysed represents parent‐proxy report age data on 13 878 children ages 2–16 years from the PedsQL 4.0 Generic Core Scales DatabaseSM. Parents were recruited from general paediatric clinics, sub‐specialty clinics and hospitals in which their children were being seen for well‐child checks, mild acute illness or chronic illness care (n = 3,718, 26.8%), and from a State Children's Health Insurance Program in California (n = 10 160, 73.2%).

Results  The percentage of missing item responses for the parent‐proxy report sample as a whole was 2.1%, supporting feasibility. The majority of the parent‐proxy report scales across the age subgroups exceeded the minimum internal consistency reliability standard of 0.70 required for group comparisons, while the total scale scores across the age subgroups approached or exceeded the reliability criterion of 0.90 recommended for analysing individual patient scale scores. Construct validity was demonstrated utilizing the known groups approach. For each PedsQL scale and summary score, across age subgroups, healthy children demonstrated a statistically significant difference in HRQOL (better HRQOL) than children with a known chronic health condition, with most effect sizes in the medium‐to‐large effect size range.

Conclusion  The results demonstrate the feasibility, reliability and validity of parent‐proxy report at the individual age subgroup for ages 2–16 years. These analyses are consistent with recent FDA guidelines which require instrument development and validation testing for children and adolescents within fairly narrow age groupings and which determine the lower age limit at which reliable and valid responses across age categories are achievable. Even as paediatric patient self‐report is advocated, there remains a fundamental role for parent‐proxy report in paediatric clinical trials and health services research.
Evaluation of suspected child physical abuse
Authors: Reading Richard
Published: August 2007

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Kellogg N. D. &
(
2007
)

,
119
,
1232
–
1241
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DOI:10.1542/peds.2007–0883.
Bigger is better: implications of body size for flight ability under different light conditions and the evolution of alloethism in bumblebees
Authors: KAPUSTJANSKIJ A. , STREINZER M. , PAULUS H. F. , SPAETHE J.
Published: August 2007

In social insects, reproductive success and survival of the colony critically depend on the colony's ability to efficiently allocate workers to the various tasks which need to be performed. In bumblebees, workers show a large variation of body size within a colony. Large workers tend to leave the nest and forage for nectar and pollen, whereas small workers stay inside the nest and fulfill nest duties. It was speculated that size‐related differences of the sensory system might contribute to alloethism found in bumblebee colonies.

In the first part, we investigated how body size determines eye morphology. We measured several eye parameters of Bombus terrestris workers and drones. In both, workers and drones, larger individuals had larger eyes with larger facet diameters, more ommatidia and larger ocelli. At similar body size, drones exhibited larger eyes and ocelli compared to workers. Due to theoretical considerations, we predict that large individuals with large eyes should be better able to operate in illumination conditions of lower intensity than small individuals, since ommatidial sensitivity is proportional to the square of facet diameter.

In the second part, we tested this prediction. In a behavioural experiment, we first caught bumblebees of various sizes in the field and then determined the lowest light intensity level at which they are just able to fly under controlled laboratory conditions. We tested workers of B. terrestris and B. pascuorum, and workers and drones of B. lapidarius. Large bumblebees were able to fly under lower light levels compared to small bees, with light intensity thresholds ranging from 1·1 to 5·5 lux.

Our results indicate that the increased light sensitivity of the visual system of large bumblebees allows them to fly under poor light conditions, for example, very early in the morning or late at dusk. This is of potential benefit to the survival of a bumblebee colony since flowers that open early in the morning usually have accumulated a relatively high amount of nectar and pollen throughout the night, and large bumblebees can utilize these resources earlier than most other bees. Thus, our findings have important implications for the understanding of the functional significance and evolution of alloethism in bumblebee colonies.
Explaining isotope trophic‐step fractionation: why herbivorous fish are different
Authors: MILL A. C. , PINNEGAR J. K. , POLUNIN N. V. C.
Published: August 2007

An assumed constant trophic fractionation of 15N/14N between consumer and diet (usually 3·4 for diet–muscle tissue differences) allows inferences to be made about feeding interactions and trophic level in food web studies. However, considerable variability surrounds this constant, which may conceal subtle differences about the trophodynamics of consumers.

The feeding ecologies of herbivores and carnivores differ in terms of diet quality (in C : N terms) and food processing mechanisms, which may affect fractionation.

We present a new model that explores how consumer feeding rates, excretion rates and diet quality determine the 15N/14N ratios in the consumer's tissues and hence influence the magnitude of trophic fractionation.

Three herbivorous reef fish Acanthurus sohal, Zebrasoma xanthurum and Pomacentrus arabicus were chosen as study organisms. Empirical estimates of diet–tissue stable isotope fractionation were made in the field, and model parameters were derived from feeding observations and literature data.

The trophic fractionation values of A. sohal, Z. xanthurum and P. arabicus were 4·69, 4·47 and 5·25, respectively, by empirical measurement, and 4·41, 4·30 and 5·68, respectively, by model, indicating that herbivores have a higher trophic fractionation than the currently accepted value of 3·4.

The model was most sensitive to the excretion rate, which may differ between herbivores and carnivorous animals. This model is the first to determine stable isotope signatures of a consumer's diet mixture without applying a constant fractionation value.
Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast
Authors: Lee A H S , Hodi Z , Ellis I O , Elston C W
Published: August 2007

Aim:  To identify features useful in distinguishing phyllodes tumours from fibroadenomas on core biopsy.

Methods and results:  Starting from the diagnosis made on the surgical specimen, 12 features in the previous core biopsy specimens were analysed. Thirty‐six phyllodes tumours had 44 previous core biopsy specimens, which were reported as fibroadenoma in 11 and spindle cell lesion of uncertain nature in one, and included phyllodes tumour in the differential diagnosis in 32. The lesions with a core diagnosis of fibroadenoma were excised largely because they were growing or exceeded 30 mm; review of the corresponding surgical specimen showed heterogeneous stromal cellularity. Thirty‐eight fibroadenomas had previous core biopsy specimens reported as fibroadenoma in 37, and one of which included phyllodes tumour in the differential diagnosis. The following four features were significantly more common in cores from phyllodes tumours and had a κ statistic of > 0.6 in a reproducibility study: stromal cellularity increased in at least 50% compared with typical fibroadenoma, stromal overgrowth (×10 field with no epithelium), fragmentation and adipose tissue within stroma.

Conclusions:  This study describes features useful in the diagnosis of phyllodes tumour on core biopsy. Some core biopsy specimens from phyllodes tumours show features of fibroadenoma on core biopsy because of tumour heterogeneity.
Identification of serosal invasion and extramural venous invasion on review of Dukes' stage B colonic carcinomas and correlation with survival
Authors: Stewart C J R , Morris M , De Boer B , Iacopetta B
Published: August 2007

Aims:  To determine whether serosal invasion (SI) and/or extramural venous invasion (VI) could be more frequently identified on review of Dukes' stage B colonic carcinoma resection specimens and whether the revised findings correlated with clinical outcome.

Methods and results:  The original histology slides from 82 patients with Dukes' stage B colonic carcinoma were reviewed specifically to identify tumours showing SI and/or VI. All tumours were initially reported to be negative for both pathological parameters. The selected cases included 35 patients who died of carcinoma within 5 years of surgery and 47 patients with a minimum of 5‐years' postoperative survival. The review was blinded to the original histopathology reports and to clinical follow‐up data. SI and/or VI were identified in 26 cases (32%). Fourteen of 18 patients with SI, 8/12 patients with VI and all four patients with both adverse histological features died of carcinoma.

Conclusions:  Review of routinely sampled and stained colonic carcinoma resection specimens increased the proportion of cases classified as positive for SI and/or VI. The revised assessment correlated with patient outcome. Reliable identification of these features may permit stratification of high‐risk patients with Dukes' stage B colonic cancer who could benefit from adjuvant treatment.
Value of elastin staining in the assessment of peritoneal implants associated with ovarian serous borderline tumours
Authors: Stewart C J R , Brennan B A , Crook M L , Russell P
Published: August 2007

Aims:  To determine whether elastin stains aid in classifying peritoneal implants associated with ovarian serous borderline tumours (SBT).

Methods and results:  The study group comprised 80 implants (nine invasive and 71 non‐invasive) from 28 patients with ovarian SBT. Elastin stains were performed using histochemical and immunohistochemical methods to demonstrate the peritoneal elastic lamina (PEL), and evaluated with regard to assessment of the subtype of implant. The elastin stains demonstrated the PEL in most anatomical sites other than the omentum and the bladder and were considered helpful in 44/80 (55%) cases. The stains were most useful in the assessment of poorly oriented or traumatized biopsy specimens and in confirming the superficial distribution of non‐invasive implants. The staining was non‐contributory in most of the remaining biopsies, because the PEL was not identified.

Conclusions:  Demonstration of the PEL using elastin stains can be useful in the subclassification of implants associated with ovarian SBT and is of most value in confirming the superficial distribution of non‐invasive lesions. However, evaluation is limited by the absence of a defined elastic layer in a proportion of biopsy specimens, possibly reflecting their superficial location, as well as absence of a distinct PEL in sites such as the omentum.
Class III β‐tubulin, a marker of resistance to paclitaxel, is overexpressed in pancreatic ductal adenocarcinoma and intraepithelial neoplasia
Authors: Lee K M , Cao D , Itami A , Pour P M , Hruban R H , Maitra A , Ouellette M M
Published: August 2007

Aims:  Class III β‐tubulin (TUBB3) reduces microtubule stability and confers resistance to microtubule‐stabilizing taxanes, including paclitaxel and docetaxel. Pancreatic ductal adenocarcinomas show limited responsiveness to taxanes, but little is known of the underlying mechanisms. The aim of this study was to examine TUBB3 expression in pancreatic cancer cell lines, invasive pancreatic adenocarcinoma and pancreatic intraepithelial neoplasia (PanIN).

Methods and results:  Reverse transcriptase‐polymerase chain reaction and Western blot were used to study TUBB3 expression in pancreatic cancer cell lines. Immunohistochemistry was employed to assess TUBB3 in pancreatic cancer specimens, including 75 invasive adenocarcinomas and 41 PanIN precursor lesions. TUBB3 was undetectable in non‐neoplastic ducts of the pancreas. In contrast, the vast majority (78–93%) of pancreatic ductal adenocarcinomas demonstrated either diffuse or focal TUBB3 expression. TUBB3 was found to increase progressively in PanIN lesions from 3/16 of PanIN‐1 (19%), 5/17 of PanIN‐2 (29%) to 5/8 of PanIN‐3 lesions (63%).

Conclusions:  TUBB3 is expressed in most pancreatic ductal adenocarcinomas, possibly accounting for the suboptimal response of these tumours to microtubule‐stabilizing agents. Up‐regulation of TUBB3 in PanIN lesions suggests that microtubule dysfunction is an early feature of this disease. TUBB3 immunohistochemistry could potentially help identify pancreatic cancer patients lacking TUBB3 expression who might benefit from taxane therapy.
Distinct angiogenic and non‐angiogenic growth patterns of lung metastases from renal cell carcinoma
Authors: Sardari Nia P , Hendriks J , Friedel G , Van Schil P , Van Marck E
Published: August 2007

Aims:  We have recently evaluated a classification of non‐small‐cell lung cancer based upon the presence of an angiogenic or a non‐angiogenic growth pattern. The aim of the present study was to test the hypothesis that lung metastases of clear cell renal cell carcinoma (RCC) can grow without eliciting angiogenesis and give rise to the same set of growth patterns.

Methods and results:  Tissue sections of 24 patients with lung metastases from clear cell RCC were analysed. Haematoxylin and eosin and reticulin staining were performed to evaluate growth pattern. Double‐labelling with antibodies to CD34 and proliferating cell nuclear antigen (PCNA) was performed to determine the endothelial cell proliferation fraction (ECPF) and the microvessel density (MVD). Three growth patterns were observed. In the destructive growth pattern (54%), the architecture of the lung was not preserved. In the alveolar (33%) and interstitial growth patterns (13%), the normal lung parenchyma was preserved within the metastases. MVD was higher in the destructive than in the alveolar growth pattern (P = 0.009). ECPF was higher in the destructive (mean 31.1 ± 22.7%, median 30.0) than in the alveolar growth pattern (mean 3.6 ± 2.8%, median 3.2; P = 0.005).

Conclusions:  The present study demonstrates that highly angiogenic primary tumours can give rise to non‐angiogenic metastases. This type of metastasis may be resistant to antiangiogenic therapy.
Comparing the caries‐preventive effect of two fissure sealing modalities in public health care: a single application of glass ionomer and a routine resin‐based sealant programme. A randomized split‐mouth clinical trial
Authors: KERVANTO‐SEPPÄLÄ SARI , LAVONIUS EEVA , PIETILÄ ILPO , PITKÄNIEMI JANNE , MEURMAN JUKKA H. , KEROSUO EERO
Published: August 2007

Aim.  The aim of this study was to compare the caries‐preventive effect of two types of sealant modalities and to evaluate whether the caries‐preventive effect is related to sealant retention. A hypothesis was tested in which a glass ionomer sealant, once applied to the occlusal surface, was able to protect the fissure from caries even if the sealant appeared lost at visual inspection.

Design.  A 3‐year randomized split‐mouth trial evaluating two sealant modalities was performed at a public health centre in Finland. A chemically curing glass ionomer cement (GIC) and light‐curing resin‐based (RB) sealant material were applied randomly to the permanent second molars. Sealant application as a routine treatment procedure was carried out to 599 children in the age group of 12–16 years. Caries rate of the sealed teeth and sealant retention with both materials were analysed by a modified McNemar's test. The effectiveness, rate difference, and relative risk with both sealant materials were measured.

Results.  The difference in caries rate between the two modalities was highly significant. When compared to the GIC sealant method, the effectiveness of RB sealant method was 74.1% and the rate difference 3.2% (95% CI 1.44%, 4.98%). The relative risk for RB‐sealed surfaces vs. GIC‐sealed surfaces of having detectable dentin caries was 0.26 (95% CI 0.12, 0.57). The retention rate of sealants was higher with RB than GIC (P < 0.001). The effectiveness of the retention rate for RB sealants was 94.8% and the rate difference 87.2% (95% CI 83.86%, 90.50%). The relative risk during the 3‐year study period of having a defective or lost RB sealant was 0.052 (95% CI 0.036, 0.075) when compared to having a defective or lost GIC sealant.

Conclusion.  It is concluded that in preventing dentin caries a RB sealant programme including resealing when necessary was more effective than a single application of GIC. The original hypothesis was thus falsified.
A probiotic lozenge administered medical device and its effect on salivary mutans streptococci and lactobacilli
Authors: ÇAGLAR ESBER , KUSCU OZGUR ONDER , CILDIR SULE KAVALOGLU , KUVVETLI SENEM SELUI , SANDALLI NUKET
Published: August 2007

Background.  Previous studies have suggested that lactobacilli‐derived probiotics in dairy products may affect oral ecology, but the effects of different delivery methods have received little attention.

Aim.  The aim of the present study was to investigate the effect of the probiotic Lactobacillus reuteri, delivered by a new medical device, on the levels of salivary mutans streptococci and lactobacilli in young women with high Streptococcus mutans counts.

Design.  This is a randomized, double‐blind, placebo‐controlled study involving 20 healthy young women (aged 20 years): 10 as subjects and 10 as controls. The study subjects (Group A) sucked the medical device containing the probiotic lozenge with L. reuteri ATCC 55730/L. reuteri ATCC PTA 5289 (1.1 × 108 CFU) once daily for 10 days, while the control subjects (Group B) received placebo medical devices without bacteria. Salivary mutans streptococci and lactobacilli were enumerated with chair‐side kits at baseline and 1 day after the final ingestion.

Results.  Salivary S. mutans levels in the probiotic test group were significantly reduced, with statistical significance of reduction (P < 0.05).

Conclusions.  A short‐term daily ingestion of lactobacilli‐derived probiotics delivered via medical device containing probiotic lozenge reduced the levels of salivary mutans.
Evidence for a cost of immunity when the crustacean Daphnia magna is exposed to the bacterial pathogen Pasteuria ramosa
Authors: LITTLE TOM J. , KILLICK STUART C.
Published: August 2007

The deployment of the immune system has the obvious potential to ameliorate infection outcomes, but immune responses can also harm hosts by either damaging host tissues or monopolizing resources, leading to enhanced mortality. To gain insight into such a ‘cost of immunity’ when the crustacean Daphnia magna is challenged with the bacterium Pasteuria ramosa, we measured survivorship among hosts that resisted infection following exposure to various strains and doses of the parasite.

In the first of two experiments, these exposures were: single exposures with relatively non‐aggressive strains, double exposures with non‐aggressive strains, and exposure to aggressive strains. Mortality increased across this gradient of exposure. In a second experiment, we varied the dose of the most aggressive P. ramosa strain and found that resisting infection when a large dose was applied resulted in greater mortality than when a medium or low dose was applied.

Assuming that resistance is accomplished with an immune response, and that more aggressive parasites and/or larger doses of parasites are more immunostimulatory, these data are compatible with a cost of immunity. Indeed, in terms of survival, resisting parasites can be more harmful than infection.
Effects of reduced‐impact logging and forest physiognomy on bat populations of lowland Amazonian forest
Authors: Presley Steven J. , Willig Michael R. , Wunderle Joseph M. , Saldanha Luis Nélio
Published: August 2007

As human population size increases, demand for natural resources will increase. Logging pressure related to increasing demands continues to threaten remote areas of Amazonian forest. A harvest protocol is required to provide renewable timber resources that meet consumer needs while minimizing negative effects on biodiversity and ecosystem services. Reduced‐impact logging (RIL) may be a viable option to achieve these goals.

Effects of RIL (18 m3 ha−1) and forest physiognomy were assessed for populations of bats from Amazonian terra firme forest in Brazil at 20–42 months postharvest.

Based on 64 512 meter‐hours of netting, 1468 bats were captured representing 47 species, 30 genera, four families and five feeding ensembles. Five species (one nectarivore and four frugivores) responded to management in a consistent manner: four were more abundant in logged forest and one was more abundant in undisturbed forest. Ten species (one nectarivore, two gleaning animalivores and seven frugivores) responded to forest physiognomy in a consistent manner: nine were more abundant in closed‐canopy sites and one was more abundant in gaps. Three species (all frugivores) exhibited idiosyncratic responses to management that were contingent on physiognomy.

Using qualitative measures (changes in status from common to rare, or from present to absent), RIL elicited negative responses from 16 species, mostly rare taxa. After accounting for differences in total number of collected individuals, control forest harboured seven to 15 more rare species than did forest subjected to RIL.

Synthesis and applications. In the short term, RIL generally did not negatively affect populations of abundant bats. In contrast, reductions in abundance or local extirpation in response to RIL generally characterized uncommon or rare species. Arrangement of RIL sites in a matrix of undisturbed forest may allow source–sink dynamics to mitigate effects of RIL on rare or sensitive species and enhance sustainability at a regional scale.
Vegetation and fire history of a Chinese site in southern tropical Xishuangbanna derived from phytolith and charcoal records from Holocene sediments
Authors: Gu Yansheng , Pearsall Deborah M. , Xie Shucheng , Yu Jianxin
Published: August 2007

Aim  The aims of this paper are to reconstruct the vegetation and fire history over the past 2000 years in a well‐preserved rain‐forest area, to understand interactions between climate, fire, and vegetation, and to predict how rain forest responds to global warming and increased intensity of human activity.

Location  Xishuangbanna, south‐west China, 21–22° N, 101–102° E.

Methods  Phytolith (plant opal silica bodies) morphotypes, assemblages, and indices were used to reconstruct palaeovegetation and palaeoclimate changes in detail. Micro‐charcoal particles found in phytolith slides, together with burnt phytoliths and highly weathered bulliform cells, were employed to reconstruct a record of past fire occurrence. A survey of field sediments, lithology, and 14C dating were also employed.

Results  Phytoliths were divided into 11 groups and classified into 33 well‐described morphotypes according to their shape under light microscopy and their presumed anatomical origins and ecological significance. The phytolith assemblages were divided into six significant zones that reveal a complete history of vegetation changes corresponding to climate variation and fire occurrence. Phytolith assemblages and indices show that the palaeoclimate in the study area is characterized by the alternation of warm–wet and cool–dry conditions. Phytolith and charcoal records reveal that 12 fire episodes occurred. Comparison of burnt phytoliths with an aridity index (Iph) shows that fire episodes have a strong relationship with drought events.

Main conclusions  Our results indicate that fire occurrence in the tropical rain forest of Xishuangbanna is predominantly under the control of natural climate variability (drought events). Nearly every fire episode is coupled with a climatic event and has triggered vegetation composition changes marked by a pronounced expansion of grasses. This indicates that drought interacts with fire to exert a strong influence on the ecological dynamics of the rain forest. However, the impact of human activity in recent centuries is also significant. Our results are important for understanding the interactions between climate, fire, and vegetation, and for predicting how rain forest responds to global warming and increased human activity.
Body mass, habitat generality, and avian community composition in forest remnants
Authors: Brown William P.
Published: August 2007

Aim  Many theories of biodiversity and biogeography assume that species respond equally to variability in habitat area and isolation. This assumption does not allow for differential responses due to interspecific competition or other mechanisms, and therefore does not allow community composition to be predicted. As body size is relevant to area requirements and interspecific dominance, a natural experiment was conducted to quantify the differential responses of avian species abundance to variability in remnant area, isolation and forest cover based on average species body mass.

Location  Deciduous forest remnants of varying area and isolation throughout the State of Delaware, USA.

Methods  Forest remnants within stratified area and isolation classes were randomly selected for breeding bird surveys; total forest cover (ha) within 2 km of each survey point was subsequently determined as a covariate. Surveys were conducted within 100–150 m from the edge of each remnant and detected bird species were divided into five classes based on a log2‐transformation of body mass (very small, small, medium, large and very large). Assuming a negative binomial distribution, the abundance of detected individuals in each mass class was analysed using generalized linear models with remnant area, isolation, local forest cover and two‐way interactions specified as independent variables. The same analyses were conducted for individual species where sample size allowed.

Results  Very small, small and very large bodied species decreased in abundance with decreasing local forest cover and remnant area and with increasing remnant isolation, while large species increased in abundance. Medium‐sized species decreased in abundance with increasing forest cover, did not respond to remnant isolation and showed a concave, curvilinear response to increasing remnant area. Large and medium‐sized species were the most abundant birds in small, isolated remnants despite occurring in the largest remnants with the more abundant very small and small species, suggesting that communities are not randomly organized.

Main conclusions  Regardless of presumed habitat associations, large and medium‐sized species are of the appropriate size to be dominant competitors when forest resources are limiting, and thus may be considered ‘generalists’. The smallest species may be excluded entirely from small, isolated remnants even though such remnants meet their ecological needs; the needs of very large species are not met in small remnants. The applicability of biodiversity theories to community composition, species abundance and, by extension, to conservation, can be improved by incorporating differential responses based on body mass into their assumptions.
Evidence for Gondwanan vicariance in an ancient clade of gecko lizards
Authors: Gamble Tony , Bauer Aaron M. , Greenbaum Eli , Jackman Todd R.
Published: August 2007

Aim Geckos (Reptilia: Squamata), due to their great age and global distribution, are excellent candidates to test hypotheses of Gondwanan vicariance against post‐Gondwanan dispersal. Our aims are: to generate a phylogeny of the sphaerodactyl geckos and their closest relatives; evaluate previous phylogenetic hypotheses of the sphaerodactyl geckos with regard to the other major gecko lineages; and to use divergence date estimates to inform a biogeographical scenario regarding Gondwanan relationships and assess the roles of vicariance and dispersal in shaping the current distributions of the New World sphaerodactyl geckos and their closest Old World relatives.

Location Africa, Asia, Europe, South America, Atlantic Ocean.

Methods We used parsimony and partitioned Bayesian methods to analyse data from five nuclear genes to generate a phylogeny for the New World sphaerodactyl geckos and their close Old World relatives. We used dispersal–vicariance analysis to determine ancestral area relationships among clades, and divergence times were estimated from the phylogeny using nonparametric rate smoothing.

Results We recovered a monophyletic group containing the New World sphaerodactyl genera,Coleodactylus,Gonatodes,Lepidoblepharis,PseudogonatodesandSphaerodactylus, and the Old World Gekkotan generaAristelliger,Euleptes,Quedenfeldtia,Pristurus,SaurodactylusandTeratoscincus. The dispersal–vicariance analysis indicated that the ancestral area for this clade was North Africa and surrounding regions. The divergence between the New World spaherodactyl geckos and their closest Old World relative was estimated to have occurredc. 96 Myrbp.

Main conclusions Here we provide the first molecular genetic phylogenetic hypothesis of the New World sphaerodactyl geckos and their closest Old World relatives. A combination of divergence date estimates and dispersal–vicariance analysis informed a biogeographical scenario indicating that the split between the sphaerodactyl geckos and their African relatives coincided with the Africa/South America split and the opening of the Atlantic Ocean. We resurrect the family name Sphaerodactylidae to represent the expanded sphaerodactyl clade.
Examining the hierarchical factor structure of the SF‐36 Taiwan version by exploratory and confirmatory factor analysis
Authors: Wu Chia‐huei , Lee Keng‐lin , Yao Grace
Published: August 2007

Rationale  The purpose of this study was to examine the factor structure of the Medical Outcome Study Short Form‐36 Taiwan version (SF‐36 Taiwan version) using data from the 2001 National Health Interview Survey in Taiwan.

Method  The 2001 National Health Interview Survey was conducted by stratified multistage systematic sampling, resulting in 19 777 valid responses for the SF‐36 Taiwan version. In this study, the 19 777 participants were randomly divided into two independent samples. One sample (n = 9856) was used for exploratory factor analysis (EFA), and the other (n = 9921) was used for confirmatory factor analysis (CFA).

Results  The EFA suggested a seven‐first‐order‐factor structure for the SF‐36 Taiwan version. In addition, hierarchical EFA revealed that there was only one second‐order factor underlying the seven first‐order factors. Further, CFA was conducted on the other sample to compare the performances of the original model with eight first‐order factors and two second‐order factors, and the revised model with seven first‐order factors and one second‐order factor. The CFA results revealed that the original model was better than the revised model.

Conclusion  According to the EFA and CFA, it can be concluded that the original structure is still acceptable for the SF‐36 Taiwan version.
The relationship between second‐year medical students’ OSCE scores and USMLE Step 2 scores
Authors: Simon Steven R. , Bui Anh , Day Shelley , Berti David , Volkan Kevin
Published: August 2007

Rationale, aims and objectives  A valid tool to measure clinical competency early in medical school could identify students who may require special educational attention. The overall aim is to assess the relationship between students’ scores on an objective structured clinical examination (OSCE) given in the second year of medical school and their subsequent performance on Step 2 of the United States Medical Licensing Examination (USMLE Step 2).

Methods  Participants were 390 second‐year medical students participating in a required OSCE; complete data (Medical College Admission Test, OSCE, USMLE Step 1 and Step 2 scores) were available for 340 students (87%). Univariate correlations and linear regression analyses were performed.

Results  Total OSCE score was moderately correlated with USMLE Step 2 score (r = 0.395, P < 0.001), as were two skills subscores of the OSCE, differential diagnosis (r = 0.343, P < 0.001) and identification of abnormality (r = 0.322, P < 0.001). In linear regression analysis, neither OSCE total score nor any of the subscores independently predicted Step 2 scores; only Step 1 score (β = 0.687, P < 0.001) and female sex (β = 0.152, P < 0.001) remained independent correlates of Step 2 score.

Conclusion  OSCEs early in medical school can be useful in the early assessment of clinical competence.
The effects of a back rehabilitation programme for patients with chronic low back pain
Authors: Gaskell Lynne , Enright Stephanie , Tyson Sarah
Published: August 2007

Aim  The aim of this paper was to perform a pragmatic before–after analysis of a back rehabilitation programme (BRP) for patients with chronic low back pain (LBP). A total of 877 patients were recruited onto the BRP, which were carried out at four centres within the Wrightington, Wigan and Leigh NHS Trust. The BRP consisted of nine 2‐hour group sessions of therapy run over 5 weeks and included 1 hour of exercise and 1 hour of education, advice problem solving and goal setting.

Method  Using the Wilcoxen signed rank tests and paired t‐tests levels of pain, disability, anxiety and depression were significantly reduced pre‐post programme (P < 0.001). In addition, the levels of fitness and perceived control improved significantly (P < 0.001) suggesting that participants were better able to manage their LBP.

Conclusion  Overall, the BRP proved to be effective in reducing pain, disability, anxiety and depression levels for people with chronic LBP. However, despite significant improvements in outcome measures only 50% of the patients completed the BRP and questionnaires post BRP. The implications of the findings are discussed with respect to modified programmes and alternative management for patients within different subgroups of LBP.
Patient factors associated with attrition from a self‐management education programme
Authors: Gucciardi Enza , DeMelo Margaret , Offenheim Ana , Grace Sherry L. , Stewart Donna E.
Published: August 2007

Objective  To examine utilization patterns of diabetes self‐management training (DSME) and identify patient factors associated with attrition from these services at an ambulatory diabetes education centre (DEC).

Methods  A retrospective medical chart review of first time visits (536) to the centre between 1 August 2000 and 31 July 2001 was conducted for patients with type 2 diabetes. Descriptive analyses were conducted to examine utilization patterns over a 1‐year period. Multivariable logistic regression was used to identify patient factors associated with attrition from DSME and non‐use of group education among new patients.

Results  Almost 50% of new patients withdrew prematurely from recommended DSME services over the 1‐year period, and only 24.8% attended group education. Patient variables such as being older than 65 years of age, primarily speaking English, or working full or part‐time were associated with attrition from DSME and non‐use of group education when compared with middle aged, non‐English‐speaking, and non‐working patients.

Conclusions  High DSME attrition rates indicate that retention needs to become a focus of programme policy, planning and evaluation to improve programme effectiveness. DSME tailored to the cultural and linguistic characteristics of the community, and convenient and accessible to working and older patients will potentially increase retention in and accessibility to these services.
Are the outcomes of clinical pathways evidence‐based? A critical appraisal of clinical pathway evaluation research
Authors: El Baz Noha , Middel Berrie , Van Dijk Jitse P. , Oosterhof Andre , Boonstra Piet W. , Reijneveld Sijmen A.
Published: August 2007

Aim and objective To evaluate the validity of study outcomes of published papers that report the effects of clinical pathways (CP).

Method Systematic review based on two search strategies, including searching Medline, CINAHL, Embase, Psychinfo and Picarta from 1995 till 2005 and ISI Web of KnowledgeSM. We included randomized controlled or quasi‐experimental studies evaluating the efficacy of clinical pathway application. Assessment of the methodological quality of the studies included randomization, power analysis, selection bias, validity of outcome indicators, appropriateness of statistical tests, direct (matching) and indirect (statistical) control for confounders. Outcomes included length of stay, costs, readmission rate and complications. Two reviewers independently assessed the methodological quality of the selected papers and recorded the findings with an evaluation tool developed from a set of items for quality assessment derived from the Cochrane Library and other publications.

Results The study sample comprised of 115 publications. A total of 91.3% of the studies comprised of retrospective studies and 8.7% were randomized controlled studies. Using a quality‐scoring assessment tool, 33% of the papers were classified as of good quality, whereas 67% were classified as of low quality. Of the studies, 10.4% controlled for confounding by matching and 59.1% adopted parametric statistical tests without testing variables on normal distribution. Differences in outcomes were not always statistically tested.

Conclusion Readers should be cautious when interpreting the results of clinical pathway evaluation studies because of the confounding factors and sources of contamination affecting the evidence‐based validity of the outcomes.
Biophysical properties of salmonid alphaviruses: influence of temperature and pH on virus survival
Authors: Graham D A , Staples C , Wilson C J , Jewhurst H , Cherry K , Gordon A , Rowley H M
Published: August 2007

A series of laboratory studies were undertaken to investigate the survival of salmonid alphaviruses (SAV) under a range of conditions relevant to waste disposal, persistence and spread in the field, and to laboratory studies and testing. SAV was found to be rapidly inactivated in the presence of high levels of organic matter at 60 °C at pH 7.2 and at pH 4 and pH 12 at 4 °C, suggesting that composting, ensiling and alkaline hydrolysis would all be effective at inactivating virus in fish waste. Testing was conducted under sterile conditions at 4, 10, 15 and 20 °C in sea water, half‐strength sea water and fresh (hard) water, both in the absence and the presence of added organic matter. Virus survival was shown to be inversely related to temperature, and to be reduced by the presence of organic matter. Calculated half lives (t1/2) under these conditions ranged from 61.0 to 1.5 days. Testing in non‐sterile sea water resulted in reduced t1/2 values. The half life of SAV in serum was also found to be inversely related to temperature, emphasizing the need for rapid shipment of samples at 4 °C to laboratories for virus isolation studies.
Gastric emptying rate in subjects with experimentally shortened dental arches: a pilot study
Authors: HATTORI Y. , MITO Y. , WATANABE M.
Published: August 2007

Summary  Although a shortened dental arch has been reported to provide sufficient subjective chewing ability, the loss of molar occlusion significantly reduces trituration ability, and may result in an impaired digestive function including delayed gastric emptying. This study investigated the effect of the experimental loss of molar occlusion on gastric emptying rate. Thirteen healthy dentate males underwent two sessions of gastric emptying rate measurement after ingestion of the same test meal that contained ham, bread and an egg mixed with carbon‐labelled octanoic acid. A test food was divided into nine equal portions, and each was consumed in 60 cycles of chewing. In one of the two sessions, the subjects wore an intraoral appliance devised to simulate the occlusal conditions of the shortened dental arches. Two parameters of gastric emptying; namely, the lag phase (Tlag) and gastric half‐emptying time (T1/2), were evaluated by means of a 13C‐octanoic acid breath test. Following the measurement of gastric emptying in each session, masticatory performance was evaluated by a conventional sieve test. Masticatory performance decreased significantly in case of loss of molar occlusion (78·1 ± 11·1% versus 33·4 ± 18·2%, P <0·001); however, no significant changes were observed in terms of the gastric emptying parameters (Tlag: 99 ± 19 versus 105 ± 34 min; T1/2: 168 ± 32 versus 178 ± 48 min). Within the limitations of this study, it was concluded that reduction in food trituration caused by shortening of the dental arch does not significantly affect gastrointestinal digestive function.
Diagnosis of osteoporosis in oral health care
Authors: DEVLIN H. , HORNER K.
Published: August 2007

Summary  Osteoporosis is characterized by an increased risk of bone fractures, affecting especially the forearm, vertebrae and hip. Women are more commonly affected than men because their peak bone density is usually less than that of men at adulthood and declines at the menopause. Early detection of osteoporosis is advisable to prevent the often devastating consequences of hip fracture later in life, though a mass screening programme is not considered cost‐effective. Once osteoporotic individuals are identified, drug treatment can be effective in increasing their bone mineral density and reducing fracture rates. Is it possible for dentists to accurately detect early osteoporotic changes on dental radiographs and the affected individuals to be referred to a medical specialist? If the radiographs were taken for other diagnostic purposes, this would increase the cost effectiveness of this regime.
Outcomes of referrals over a six‐month period to a mental health gateway team
Authors: RYAN T. , HATFIELD B. , SHARMA I.
Published: August 2007

Mental health policy in recent years has prescribed the role, function and form for services in England. Evidence of their effectiveness post‐policy implementation has been limited to date and minimal guidance has been available on how services should operate together as whole systems. This paper reports findings from a study of referrals and their outcomes in respect of specialist community mental health services following implementation of national policy and its interpretation and configuration at a local level. Findings highlight that gateway workers configured as a team operating between primary and secondary care can effectively shield community mental health teams from high numbers of referrals that they would deem inappropriate. The study also identified the triage role of this service as being crucial to the effectiveness of developing and maintaining care pathways and also in potentially supporting the mental health capability of primary care.
Self‐reported care needs of outpatients with a bipolar disorder in the Netherlands
Authors: GOOSSENS P. J. J. , KNOPPERT‐VAN DER KLEIN E. A. M. , KROON H. , VAN ACHTERBERG T.
Published: August 2007

The care needs of patients with a bipolar disorder have not been studied to date. In the present research, the care needs, care received and unmet care needs for a population of outpatients with a bipolar disorder in the Netherlands are described. The participants (n = 157) completed the Need for Care Questionnaire and a questionnaire addressing various demographic and clinical characteristics. The results show the care needs to mainly involve the domains of psychological help, psychiatric help and social functioning. Unmet needs are frequently reported for all domains and found to be particularly frequent for needs on social functioning. Some significant associations between source of income, number of hospitalizations and involvement of community psychiatric nurses, on the one hand, and reported care needs, on the other hand, are identified and discussed. Incorporation of needs assessment into the treatment process is recommended in the form of structured questionnaires which can also then be used to guide and evaluate the treatment process. Future research should focus on the identification of the specific risk factors for particular care needs and thereby work to minimize the occurrence of such risk factors and promote early intervention efforts to reduce the burden on patients and their relatives.
Improving the nursing documentation: professional consciousness‐raising in a Northern‐Norwegian psychiatric hospital
Authors: KARLSEN R.
Published: August 2007

The new Norwegian health legislation has increased the quality demands on nursing documentation. The staff at a psychiatric hospital has, together with us, explored their own way of producing written nursing documentation. In collaboration with them, we have analysed 32 patient journals which were made anonymous. We read through the documents with a critical view. We compared the findings with current professional quality standards. The actual language in the reports was analysed critically. The purpose was that the staff would become aware of unintentional consequences of their own parlance. We contributed by giving them a suitable analysis tool, which can be used for exploring own practice. The analysis tool became an aid in making the necessary qualitative improvements. This has made them change their practice. Today, the wards can exhibit documentation systems that to a large extent satisfy current professional and legal demands. An important change is the staff's specific contributions are made explicit. The staff has become more resource‐oriented and the patient has, to a much larger extent than before, become an active participant in the development of the nursing plan.