bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of CD4+ T‐cell antibodies in a patient with idiopathic CD4+ T lymphocytopenia and cryptococcal meningitis
Authors: Salit Rachel B. , Hankey Kim G. , Yi Rosemary , Rapoport Aaron P. , Mann Dean L.
Published: September 2007

Idiopathic CD4+ T lymphocytopenia (ICL) is defined as a CD4+ T‐cell count <0·3 × 109/l or <20% of the total T‐cell count on two occasions in the absence of any immunodeficiency disorder or therapy associated with reduced CD4+ T‐cell count. Although several mechanisms of ICL have been reported, the pathophysiology is still largely unknown. This case report describes a patient who presented with cryptococcal meningitis and was subsequently discovered to meet the criteria for ICL. Flow cytometric analysis of the patient's peripheral blood mononuclear cells revealed antibodies coating a much larger proportion of his CD4+ T cells (33·61%) than the CD4+ T cells of normal donors (3·94 ± 1·77%). The reasons behind the development of these autoantibodies are explored.
Inhibitory mechanisms of resveratrol in platelet activation: pivotal roles of p38 MAPK and NO/cyclic GMP
Authors: Shen Ming Y. , Hsiao George , Liu Chang L. , Fong Tsorng H. , Lin Kuang H. , Chou Duen S. , Sheu Joen R.
Published: September 2007

Resveratrol has been reported to have antiplatelet activity; however, the detailed mechanisms have not yet been resolved. This study aimed to systematically examine the detailed mechanisms of resveratrol in the prevention of platelet activation in vitro and in vivo. Resveratrol (0·05–0·25 μmol/l) showed stronger inhibition of platelet aggregation stimulated by collagen (1 μg/ml) than other agonists. Resveratrol (0·15 and 0·25 μmol/l) inhibited collagen‐induced platelet activation accompanied by [Ca+2]i mobilization, thromboxane A2 (TxA2) formation, phosphoinositide breakdown, and protein kinase C (PKC) activation. Resveratrol markedly increased levels of NO/cyclic guanosine monophosphate (GMP), and cyclic GMP‐induced vasodilator‐stimulated phosphoprotein phosphorylation. Resveratrol markedly inhibited p38 mitogen‐activated protein kinase (MAPK) but not Jun N‐terminal kinase or extracellular signal‐regulated kinase‐2 phosphorylation in washed platelets. Resveratrol‐reduced hydroxyl radical (OH−) formation in the electron spin resonance study. In an in vivo study, resveratrol (5 mg/kg) significantly prolonged platelet plug formation of mice. In conclusion, the main findings of this study suggest that the inhibitory effects of resveratrol possibly involve (i) inhibition of the p38 MAPK‐cytosolic phospholipase A2‐arachidonic acid‐TxA2‐[Ca+2]i cascade and (ii) activation of NO/cyclic GMP, resulting in inhibition of phospholipase C and/or PKC activation. Resveratrol is likely to exert significant protective effects in thromboembolic‐related disorders by inhibiting platelet aggregation.
Clinical characteristics and treatment outcome of infants with non‐Hodgkin lymphoma
Authors: Mann Georg , Attarbaschi Andishe , Burkhardt Birgit , Niggli Felix , Klapper Wolfram , Ludwig Wolf‐Dieter , Schrappe Martin , Zimmermann Martin , Gadner Helmut , Reiter Alfred ,   The Berlin‐Frankfurt‐Münster Group
Published: September 2007

Non‐Hodgkin lymphoma (NHL) is rarely observed during infancy and data on its incidence, characteristics and outcome are scarce. The present study aimed to assess the prevalence, clinical presentation and treatment results of all infants who were diagnosed with NHL between October 1986 and December 2002 among 2084 patients treated according to the NHL‐BFM (Berlin‐Frankfurt‐Münster) multicentre trials 86, 90 and 95. We identified 20 (1%) infants with NHL including five with T‐cell lymphoblastic lymphoma (T‐cell LBL), seven with precursor B‐cell LBL (pB‐cell LBL), two with a mature Burkitt neoplasm, five with anaplastic large cell lymphoma (ALCL) and one with peripheral T‐cell lymphoma (PTCL). The PTCL patient, 3/7 pB‐cell LBL and 1/5 ALCL patients relapsed. One patient each from the T‐cell LBL and Burkitt lymphoma groups suffered from a second malignancy and one patient each with ALCL and Burkitt leukaemia died from treatment‐related toxicity. The 5‐year event‐free survival rate was 53 ± 12% for the 20 cases. This study has provided preliminary evidence that infants with NHL have a dismal prognosis and showed that infant NHL differed to lymphomas in older patients with respect to the distribution of gender, histopathologic subtypes as well as the ratio of T‐ to pB‐cell LBL and the frequency of relapses of pB‐cell LBL.
Association of autoimmune disease‐related gene polymorphisms with chronic graft‐versus‐host disease
Authors: Shimada Masako , Onizuka Makoto , Machida Shinichiro , Suzuki Rikio , Kojima Minoru , Miyamura Koichi , Kodera Yoshihisa , Inoko Hidetoshi , Ando Kiyoshi
Published: September 2007

Chronic graft‐versus‐host disease (GVHD) is the most common cause of poor outcomes after haematopoietic stem cell transplantation (HSCT), while the pathophysiology of chronic GVHD remains poorly understood. As both chronic GVHD and autoimmune disease share clinical features, we speculated that autoimmune disease‐related genes might be candidate chronic GVHD‐related genes. Recent large‐scale cohort studies showed that Fc receptor‐like 3 gene (FCRL3) single nucleotide polymorphism (SNP) and peptidylarginine deiminases citrullinating enzymes 4 gene (PADI4) haplotype were associated with autoimmune disease. The present study investigated the association between polymorphisms of these two genes and the incidence of chronic GVHD. We analysed 123 cases of Japanese human leucocyte antigen‐matched sibling recipients and their donors who underwent HSCT. Although PADI4, which is the rheumatoid arthritis‐specific related gene, was not associated with the occurrence of chronic GVHD, the recipient FCRL3‐169C/C genotype was significantly less frequent in chronic GVHD patients than in those without chronic GVHD (P = 0·0086). There was no relationship between FCRL3 polymorphism and acute GVHD. As FCRL3 is expressed by B cells and might have an important role in immunoregulation, this significant protective genetic effect raises the question of whether FCRL3 might also be involved in the pathogenesis of chronic GVHD.
Molecular characteristics in papillary thyroid cancers (PTCs) with no 131I uptake
Authors: Mian Caterina , Barollo Susi , Pennelli Gianmaria , Pavan Nicodemo , Rugge Massimo , Pelizzo Maria Rosa , Mazzarotto Renzo , Casara Dario , Nacamulli Davide , Mantero Franco , Opocher Giuseppe , Busnardo Benedetto , Girelli Maria Elisa
Published: September 2007

Objective  Papillary thyroid cancers (PTCs) with no iodine uptake have an aggressive behaviour and a poor prognosis. The aim of our study was to characterize, at molecular level, a subset of PTC with no 131 iodine (131I) uptake.

Design and methods  Forty‐eight cancer tissues were divided into three groups: Group 1, 28 primary cancers; Group 2, 7 recurrences capable of trapping 131I; and Group 3, 13 recurrences incapable of trapping 131I. mRNA levels of thyroid genes (sodium/iodide symporter NIS, thyroglobulin, thyroperoxidase and pendrin) and glycolytic metabolism genes (GLUT‐1, hexokinase I and II) and BRAF mutations were evaluated in the different groups.

Results  Cancers with no 131I uptake had slightly reduced NIS, significantly reduced thyroglobulin (P < 0·01), thyroperoxidase (P = 0·01) and pendrin (P = 0·03) and significantly increased GLUT‐1 (P = 0·01) gene expression levels; and a high frequency of BRAF mutations (77%). BRAFV600E mutation, in both primary and metastatic thyroid cancers, is associated with a marked drop in thyroperoxidase (29‐fold) and pendrin (20‐fold) expression and a considerable increase (five‐fold) in GLUT‐1 expression.

Conclusions  (1) The loss of 131I uptake in recurrences depends not only on a decrease in NIS gene, but possibly on a reduction in the molecules regulating its intracellular metabolism; (2) the high GLUT‐1 gene expression supports the use of positron emission tomography with specific tracers in clinical management of such cancers; and (3) BRAFV600E point mutations may lead to less differentiated phenotypes, suggesting a worse prognosis.
Frequent mutations of β‐catenin gene in sporadic secreting adrenocortical adenomas*
Authors: Tadjine Mimi , Lampron Antoine , Ouadi Lydia , Bourdeau Isabelle
Published: September 2007

Objective  Molecular alterations remain largely unknown in most sporadic adrenocortical tumours and hyperplasias. In our previous work, we demonstrated the differential expression of several Wnt/β‐catenin signalling‐related genes implicated in ACTH‐independent macronodular adrenal hyperplasias (AIMAH). To better understand the role of Wnt/β‐catenin signalling in adrenocortical tumours, we performed mutational analysis of the β‐catenin gene.

Methods  We studied 53 human adrenocortical samples (33 adenomas, 4 carcinomas, 13 AIMAH, 3 ACTH‐dependent adrenal hyperplasias) and the human adrenocortical cancer cell line NCI‐H295R. All samples were screened for somatic mutations in exons 3 and 5 of the β‐catenin gene. Eleven and six samples were analysed for β‐catenin protein expression by Western blotting and immunohistochemistry, respectively.

Results  No mutations were detected in adrenocortical carcinomas, AIMAH and ACTH‐dependent hyperplasias. Genetic alterations were found in 5 (15%) out of 33 adenomas: three cortisol‐secreting adenomas, one aldosterone‐secreting adenoma and one nonfunctional adenoma. Two‐point mutations occurred at serine residues of codons 37 and 45 (S37C and S45F). The remaining three tumours contained deletions of 6, 55 and 271 bp. H295R cells carry an activating S45P mutation. Western blot analysis of samples with 55‐ and 271‐bp deletions showed an additional shorter and more intense band representing an accumulation of the mutated form of β‐catenin protein. In addition, cytoplasmic and/or nuclear accumulation of β‐catenin was observed in mutated adenomas by immunohistochemistry.

Conclusions  Activating mutations of exon 3 of the β‐catenin gene are frequent in adrenocortical adenomas, and further characterization of the Wnt/β‐catenin signalling pathway should lead to a better understanding of adrenal tumourigenesis.
Hypovitaminosis D and parathyroid hormone response in the elderly: effects on bone turnover and mortality
Authors: Chen Jian Sheng , Sambrook Philip N. , March Lyn , Cameron Ian D. , Cumming Robert G. , Simpson Judy M. , Seibel Markus J.
Published: September 2007

Objective  To investigate whether absence of secondary hyperparathyroidism in the presence of hypovitaminosis D has altered bone turnover, fracture risk and mortality.

Design  A prospective cohort study.

Patients  A total of 1280 older men and women living in residential care facilities.

Measurements  We measured baseline serum 25‐hydroxyvitamin D (25OHD), serum intact PTH, serum amino‐terminal propeptide of type I collagen (PINP) and serum carboxy‐terminal telopeptide of type I collagen (CTX‐I). Deaths and fractures were recorded prospectively.

Results  Hypovitaminosis D (25OHD < 39 nmol/l) and absence of secondary hyperparathyroidism (PTH > 7·0 pmol/l) in the presence of hypovitaminosis D were common in this sample with a prevalence of 77·5% and 53·3%, respectively. In the presence of hypovitaminosis D, residents showing a hyperparathyroid response (n = 406) had significantly higher serum bone turnover markers than individuals with serum PTH levels ≤ 7·0 pmol/l (termed ‘low vitamin D, normal PTH’, n = 463). After adjusting for risk factors, mortality was significantly higher in the secondary hyperparathyroidism group than in the ‘low vitamin D, normal PTH’ group [hazard ratio (HR) = 1·35, 95% confidence interval (CI) 1·12–1·64; P = 0·002]. All residents with serum PTH levels ≤ 7·0 pmol/l (n = 603) were similar with regard to both bone turnover and mortality, independent of their actual vitamin D status.

Conclusion  Absence of secondary hyperparathyroidism in the presence of hypovitaminosis D appears to be common in the frail elderly and is associated with longer survival, similar to that observed in vitamin D‐replete elderly subjects.
Obestatin and ghrelin levels in obese children and adolescents before and after reduction of overweight
Authors: Reinehr Thomas , De Sousa Gideon , Roth Christian L.
Published: September 2007

Objectives  Obestatin and ghrelin, which are derived from the same gene, are observed to have opposite effects on weight status. The aims of this study were to compare obestatin concentrations in obese and normal‐weight children and to analyse the effect of weight loss on obestatin and ghrelin levels.

Methods  We examined anthropometrical markers and fasting serum obestatin, ghrelin, leptin, glucose and insulin concentrations in 44 obese children (mean age 11·2 years) before and after participating in a 1‐year outpatient obesity intervention programme based on a high‐carbohydrate, fat‐reduced diet and increased physical activity. Additionally, total ghrelin, obestatin and leptin levels were determined in 22 normal‐weight healthy children of similar age, gender and pubertal stage.

Results  Obestatin and leptin concentrations were significantly (P < 0·001) higher and ghrelin concentrations were significantly (P < 0·001) lower in obese children compared to nonobese children. In contrast to the 13 children without weight loss, substantial weight loss in 31 children led to a significant (P = 0·007) increase in obestatin and to a significant (P < 0·05) decrease in leptin and insulin concentrations, while ghrelin concentrations did not change significantly. Children with substantial weight loss demonstrated significantly (P = 0·009) lower obestatin and a tendency (P = 0·064) to higher ghrelin concentrations at baseline. Changes in insulin were not related to changes in ghrelin or obestatin.

Conclusion  The increase in obestatin and the decrease in ghrelin in obese children point towards an adaptation process of weight status. Weight reduction due to a long‐term lifestyle intervention resulted in an increase in obestatin levels.
Does a highly sensitive thyroglobulin (Tg) assay change the clinical management of low‐risk patients with thyroid cancer with Tg on T4 < 1 ng/ml determined by traditional assays?
Authors: Rosario P. W. , Purisch S.
Published: September 2007

Objective  To evaluate a highly sensitive thyroglobulin (Tg) assay [functional sensitivity (FS): 0·1 ng/ml] (Tg‐ICMA) in low‐risk patients with known Tg on T4 ≤ 1 ng/ml measured by a traditional assay (FS: 1 ng/ml) (Tg‐IRMA).

Methods  Tg‐ICMA was measured in serum samples stored at –70 °C. Samples were obtained 6 months or more after total thyroidectomy and remnant ablation with 131I, during L‐T4 therapy (TSH < 0·4 mIU/l). All patients had well‐differentiated and completely resected tumours, no ectopic uptake on post‐therapy whole‐body scans and were considered to be at low risk for recurrence. On the occasion of collection and retesting for this study, Tg‐IRMA was ≤ 1 ng/ml in all samples and no antibody interference was observed.

Results  Tg‐ICMA ≤ 0·1 ng/ml was observed in 130/178 (73%) patients and recurrence was diagnosed in only 1/130 (0·8%). Tg‐IRMA measured after L‐T4 withdrawal was > 1 ng/ml in 5/130 (3·8%) patients. Forty‐eight (27%) patients had Tg‐ICMA > 0·1 ng/ml (0·12–1·6 ng/ml) and recurrence was diagnosed in 5/48 (10·5%). Tg‐IRMA measured after L‐T4 withdrawal was > 1 ng/ml in 20/48 (41·6%) patients. A negative predictive value of 100% was achieved with Tg‐ICMA on T4 ≤ 0·1 ng/ml combined with neck ultrasonography (US) or with stimulated Tg‐IRMA ≤ 1 ng/ml.

Conclusions  Patients at low risk for recurrence with undetectable Tg on T4 measured by a highly sensitive assay (FS: 0·1 ng/ml) in the absence of antibody interference and with a negative sensitive neck US do not need to be submitted to Tg stimulation. Recurrence is rare in these cases and only a minority of patients convert to stimulated Tg > 1–2 ng/ml.
Analysis of gross deletions in the MEN1 gene in patients with multiple endocrine neoplasia type 1
Authors: Owens Martina , Ellard Sian , Vaidya Bijay
Published: September 2007

Background  Mutation analysis with direct DNA sequencing is commonly used for the molecular diagnosis of multiple endocrine neoplasia type 1 (MEN1). However, a significant number of patients, despite clinical features of MEN1, do not show MEN1 mutations on direct DNA sequencing. Some of these patients may have gross gene deletions not detected by direct DNA sequencing or mutations in the noncoding regions of the gene not examined routinely.

Objective  To determine the prevalence of gross deletions in MEN1 in a large cohort of MEN1 patients.

Patients and methods  During 1997–2006, we screened MEN1 mutations by direct DNA sequencing in 368 probands referred to our diagnostic molecular genetic laboratory. Of these, 101 probands (23 familial, 78 sporadic) fulfilled the clinical criteria for MEN1 (presence of at least two of the parathyroid, pancreatic or pituitary tumours) but were negative for mutations on DNA sequencing. Their DNA samples were examined for gross deletions of one or more exons of MEN1 by using multiple ligation‐dependent probe amplification (MLPA) and long‐range polymerase chain reaction (PCR) amplification. We also sequenced the minimal promoter region of MEN1 for mutations in the familial cases.

Results  We identified a gross deletion involving exons 5 and 6 of MEN1 in one proband (prevalence rate 1%). The sequencing of the minimal promoter region in the familial cases revealed no mutations.

Conclusion  Gross deletion in the MEN1 gene is an uncommon cause of MEN1 and should be tested for in patients with a high clinical suspicion but without mutations on direct DNA sequencing.
Effects of the progestagen‐only contraceptive implant Implanon® on cardiovascular risk factors
Authors: Merki‐Feld Gabriele S. , Imthurn Bruno , Seifert Burkhardt
Published: September 2007

Objective  Epidemiological studies on the cardiovascular risk of progestagen‐only contraceptives are rare. With the present study we aimed to investigate the effect of the low‐dose etonogestrel‐releasing contraceptive implant Implanon® on cardiovascular risk factors, including markers of inflammation.

Design  Longitudinal study.

Setting  Family planning centre of a University Hospital.

Subjects  Thirty‐six healthy, nonsmoking women with regular cycles (n = 18 controls without hormonal contraception; n = 18 cases requesting the insertion of Implanon®).

Measurements  Blood samples for the determination of C‐reactive protein (CRP), nitric oxide (NO), sex hormones and plasma lipids were taken in the early follicular phase of the cycle in both groups. A second sample was taken 12 weeks after Implanon insertion or in the controls during the early follicular phase of cycle 4.

Results  Implanon treatment caused a 36% decrease in CRP (P < 0·06) and a significant decrease in high density lipoprotein (HDL) (P < 0·007), low density lipoprotein (LDL) (P < 0·001), cholesterol (P < 0·001), testosterone (P < 0·05) and SHBG (P < 0·002). Levels of NO, oestradiol and progesterone were not affected in either group. The cholesterol/HDL ratio did not change in Implanon carriers. There was a significant correlation between the cardiovascular risk factors CRP, cholesterol/HDL ratio and NO.

Conclusion  The progestagen‐only implant Implanon does not exert a negative effect on the cardiovascular risk factors CRP, cholesterol/HDL ratio and NO. These results suggest that the use of a progestagen‐only contraception does not increase cardiovascular risk factors in healthy young women.
High prevalence of cardiac hypertophy without detectable signs of fibrosis in patients with untreated active acromegaly: anin vivostudy using magnetic resonance imaging
Authors: Bogazzi Fausto , Lombardi Massimo , Strata Elisabetta , Aquaro Giovanni , Di Bello Vitantonio , Cosci Chiara , Sardella Chiara , Talini Enrica , Martino Enio
Published: September 2007

Objective Left ventricular (LV) hypertrophy and myocardial fibrosis are considered the main pathological features of acromegalic cardiomyopathy. The aim of the study was to evaluate the proportion of LV hypertrophy and the presence of fibrosis in acromegalic cardiomyopathyin vivousing cardiac magnetic resonance (CMR).

Design and patients Fourteen consecutive patients (eight women, mean age 46 ± 10 years) with untreated active acromegaly were submitted to two‐dimensional (2D) colour Doppler and integrated backscatter (IBS) echocardiography and CMR.

Measurements LV volume, mass and wall thickness and myocardial tissue characterization (IBS and CMR).

Results On echocardiography: mean LV mass (LVM) and LVM index (LVMi) were 209 ± 48 g and 110 ± 24 g/m2, respectively; hypertrophy was revealed in five patients (36%); abnormal diastolic function [evaluated by isovolumic relaxation time (IVRT) or early (E) to late or atrial (A) peak velocities (E/A ratio)] was found in four patients (29%). Systolic function evaluated by measuring LV ejection fraction (LVEF) was normal (mean 72 ± 12%) in all patients. Six patients (43%) had increased IBS (mean 57·4 ± 6·2%). On CMR: mean LVM and LVMi were 151 ± 17 g and 76 ± 9 g/m2, respectively; 10 patients (72%) had LV hypertrophy. Contrastographic delayed hyperenhancement was absent in all patients; on the contrary, mild enhancement was revealed in one patient. Systolic function was normal in all patients (LVEF 67 ± 11%). LVMi was not related to serum IGF‐1 concentrations or the estimated duration of disease.

Conclusions CMR is considered to be the gold standard for evaluating cardiac hypertrophy, fibrosis and systolic function. Using CMR, 72% patients with untreated active acromegaly had LV hypertrophy, which was only detected in 36% patients by echocardiography. However, cardiac fibrosis was absent in all patients irrespective of the estimated duration of disease. Although a very small increase in collagen content (as suggested by increased cardiac reflectivity at IBS), not detectable by CMR, could not be ruled out, it is unlikely that it would significantly affect cardiac function.
Seasonal dynamics of carbon and nitrogen pools and fluxes under continuous arable and ley‐arable rotations in a temperate environment
Authors: Murphy D. V. , Stockdale E. A. , Poulton P. R. , Willison T. W. , Goulding K. W. T.
Published: September 2007

Improved understanding of the seasonal dynamics of C and N cycling in soils, and the main controls on these fluctuations, is needed to improve management strategies and to better match soil N supply to crop N demand. Although the C and N cycles in soil are usually considered to be closely linked, few data exist where both C and N pools and gross N fluxes have been measured seasonally. Here we present measurements of inorganic N, extracted soluble organic N, microbial biomass C and N, gross N fluxes and CO2 production from soil collected under wheat in a ley‐arable and continuous arable rotation within a long‐term experiment. The amounts of inorganic N and extracted soluble organic N were similar (range 5–35 kg N ha−1; 0–23 cm) but had different seasonal patterns: whilst inorganic N declined during wheat growth, extracted soluble organic N peaked after cultivation and also during maximal stem elongation. The microbial biomass was significantly larger in the ley‐arable (964 kg C ha−1; 0–23 cm) than the continuous arable rotation (518 kg C ha−1; 0–23 cm) but with no clear seasonal pattern. In contrast, CO2 produced from soil and gross N mineralization showed strong seasonality linked to soil temperature and moisture content. Normalization of soil CO2 production and gross N mineralization with respect to these environmental regulators enabled us to study the underlying influence of the incorporation of fresh plant material into soil on these processes. The average normalized gross rates of N mineralized during the growing season were 1.74 and 2.55 kg N ha−1 nday−1 in continuous arable and ley‐arable rotations respectively. Production rates (gross N mineralization, gross nitrification) were similar in both land uses and matched rates of NH4+ and NO3− consumption, resulting in periods of net N mineralization and immobilization. There was no simple relationship between soil CO2 production and gross N mineralization, which we attributed to changes in the C : N ratio of the mineralizing pool(s).
Macroinvertebrate communities of non‐glacial high altitude intermittent streams
Authors: CHAVES M. L. , RIERADEVALL M. , CHAINHO P. , COSTA J. L. , COSTA M. J. , PRAT N.
Published: September 2007

1. Macroinvertebrate assemblages of five non‐glacial intermittent high altitude headwater streams (above 1400 m – Serra da Estrela, Portugal), with dry periods of different lengths (0–3 months), were investigated in nearly undisturbed conditions to (i) examine spatial differences and identify environmental variables responsible for the observed invertebrate patterns, (ii) assess the association of dry period length with invertebrate community structure and (iii) determine the influence of using different taxonomic identification levels (order, family and genus) to assess invertebrate community patterns.

2. More than 100 macroinvertebrate genera were identified. Insects clearly dominated these communities with more than 95% of total captures and around 95% of the total richness. Diptera were the most rich and abundant group with chironomid occurrences comprising over 70% of macroinvertebrate captures.

3. The highest taxon richness, diversity, EPT (Ephemeroptera + Plecoptera + Trichoptera) and OCH (Odonata + Coleoptera + Heteroptera) genus richness, the greatest number of exclusive and characteristic taxa identified by the Indicator Value (IndVal), and a distinct community structure shown by Canonical Correspondence Analyses (CCA), were found in the only stream that was never totally dry, with pools lasting over summer. Environmental gradients that spatially structured the macroinvertebrate communities were always related to flow variations.

4. Over time, the highest abundances found in these systems were also related to flow variations and maximum genus richness occurred in the connected pools or in isolated pools. Streams with longer dry periods presented a distinct recolonization phase, with higher abundance of the stonefly larvae Nemoura sp. and the presence of the chironomid larvae Krenosmittia sp., possibly arriving from the hyporheos.

5. Taxonomic level of invertebrate identification was vital for recognizing the characteristic taxa (IndVal) of streams yet was not critical for identifying streams with the highest macroinvertebrate richness/diversity or structuring environmental gradients.

6. Overall, this study emphasizes the variability of high altitude intermittent streams macroinvertebrate communities, despite spatial proximity. This variability was probably related to flow intermittency and hydrologic permanence, different vegetation covers and riverbed substrata. Consequently, the establishment of reference conditions should involve long‐term data collections and more detailed physical characterization. Also, these findings have significant implications for accurately predicting the ecological consequences of future climate change in high altitude scenarios.
Joint inversion of multiple data types with the use of multiobjective optimization: problem formulation and application to the seismic anisotropy investigations
Authors: Kozlovskaya E. , Vecsey L. , Plomerová J. , Raita T.
Published: September 2007

In geophysical studies the problem of joint inversion of multiple experimental data sets obtained by different methods is conventionally considered as a scalar one. Namely, a solution is found by minimization of linear combination of functions describing the fit of the values predicted from the model to each set of data. In the present paper we demonstrate that this standard approach is not always justified and propose to consider a joint inversion problem as a multiobjective optimization problem (MOP), for which the misfit function is a vector. The method is based on analysis of two types of solutions to MOP considered in the space of misfit functions (objective space). The first one is a set of complete optimal solutions that minimize all the components of a vector misfit function simultaneously. The second one is a set of Pareto optimal solutions, or trade-off solutions, for which it is not possible to decrease any component of the vector misfit function without increasing at least one other. We investigate connection between the standard formulation of a joint inversion problem and the multiobjective formulation and demonstrate that the standard formulation is a particular case of scalarization of a multiobjective problem using a weighted sum of component misfit functions (objectives). We illustrate the multiobjective approach with a non-linear problem of the joint inversion of shear wave splitting parameters and longitudinal wave residuals. Using synthetic data and real data from three passive seismic experiments, we demonstrate that random noise in the data and inexact model parametrization destroy the complete optimal solution, which degenerates into a fairly large Pareto set. As a result, non-uniqueness of the problem of joint inversion increases. If the random noise in the data is the only source of uncertainty, the Pareto set expands around the true solution in the objective space. In this case the ‘ideal point’ method of scalarization of multiobjective problems can be used. If the uncertainty is due to inexact model parametrization, the Pareto set in the objective space deviates strongly from the true solution. In this case all scalarization methods fail to find the solution close to the true one and a change of model parametrization is necessary.
Discrete scale invariance connects geodynamo timescales
Authors: Jonkers A.R.T.
Published: September 2007

The geodynamo exhibits a bewildering gamut of time-dependent fluctuations, on timescales from years to at least hundreds of millions of years. No framework yet exists that comprises all and relates each to all others in a quantitative sense. The technique of bootstrapped discrete scale invariance quantifies characteristic timescales of a process, based upon log-periodic fits of modulated power-law scaling of size-ranked event durations. Four independent geomagnetic data sets are analysed therewith, each spanning different timescales: the sequence of 332 known dipole reversal intervals (0–161 Ma); dipole intensity fluctuations (0–2 Ma); archeomagnetic secular variation (5000 B.C.–1950 A.D.); and historical secular variation (1590–1990 A.D.).

Six major characteristic timescales are empirically attested: circa 1.43 Ma, 56 Ka, and 763, 106, 21 and 3 yr. Moreover, all detected wavelengths and phases of the detected scaling signatures are highly similar, suggesting that a single process underlies all. This hypothesis is reinforced by extrapolating the log-periodic scaling signal of any particular data set to higher timescales than observed, through which predictions are obtained for characteristic scales attested elsewhere. Not only do many confirm one another, they also predict the typical duration of superchrons and geomagnetic jerks. A universal scaling bridge describes the complete range of geodynamo fluctuation timescales with a single power law.
Dental appointment no‐shows: why do some parents fail to take their children to the dentist?
Authors: HALLBERG ULRIKA , CAMLING ELISABETH , ZICKERT INGEGERD , ROBERTSON AGNETA , BERGGREN ULF
Published: September 2007

Background.  Children are considerably dependent on their parents, not least in relation to achieving good oral health. There is a group of children who do not show up for dental treatments or only regular check‐ups despite reminders from the dental health clinic. The cost of patients failing to come for scheduled appointments is also considered significant.

Aim.  The aim of this study was to illuminate the main problem explaining why some parents fail to bring their children to the dental health clinics or to encourage and supervise them when they can take the responsibility themselves for dental treatments or only regular dental check‐ups.

Design.  In‐depth interviews were carried out with 16 parents of children who regularly had failed to turn up for appointments at the dental health clinic. The verbatim transcribed interviews were analysed in line with the guidelines for grounded theory.

Results.  A core category, ‘being overloaded in daily life’, emerged from the data and formed, together with three additional related categories, a conceptual model.

Conclusions.  Our results indicate that these families experience an overload of demands related to their daily living and survival. Health‐promoting efforts in the form of regular dental check‐ups for their children have low priority for them.
Consumers’ and professionals’ perceptions of a breast cancer review clinic
Authors: McCaughan Eilis , McSorley Oonagh
Published: September 2007

Title.  Consumers’ and professionals’ perceptions of a breast cancer review clinic

Aim.  This paper is a report of a study to explore the healthcare needs of women attending consultant‐led breast cancer review clinics from their own perspectives, how these healthcare needs were being met, and healthcare professionals’ perceptions of ways in which the service could be delivered more efficiently and effectively.

Background.  The value of routine medical follow‐up both in terms of detection of recurrence and patient satisfaction has been questioned. However traditional, where routine follow‐up continues, there are rising numbers of women with breast cancer attending review clinics.

Methods.  A qualitative approach was adopted, using non‐participant observation during seven outpatient oncology/surgical breast review sessions. Interviews were carried out in 2005 with a convenience sample of 21 women clinic attenders, two outpatient nurses, three breast care nurses, four oncologists, three surgeons and an outpatient sister.

Findings.  Although women saw themselves as having returned to a precancer state, they still had fears of recurrence and a need for reassurance. This need was generally met through the review clinic but many psychosocial needs were unaddressed. However, nurses seemed to be under‐used as a potential source of support. Medical and nursing staff perceived that women needed to be reviewed but acknowledged that appropriately prepared nurses could deliver a more holistic and efficient service.

Conclusion.  The number of women with breast cancer requiring ongoing review is likely to increase, but the current review service is not meeting all their needs. A nurse‐led follow‐up service could be an attractive alternative to routine medical follow‐up.
Clinical decision‐making skills on the developmental journey from student to Registered Nurse: a longitudinal inquiry
Authors: Standing Mooi
Published: September 2007

Title.  Clinical decision‐making skills on the developmental journey from student to Registered Nurse: a longitudinal inquiry

Aim.  This paper is a report of a study to explore, from the perspective of nursing students, how they acquire clinical decision‐making skills and how well‐prepared they feel in this respect regarding their responsibilities as Registered Nurses.

Background.  Previous research has focused mainly on exploring experienced nurses’ judgement and decision‐making. Some studies have elicited senior nursing students’ understanding of the process, but none has explored the development of clinical decision‐making skills throughout the educational programme and in the first year as a Registered Nurse.

Method.  A volunteer sample of 20 respondents, broadly representative of the student cohort regarding qualifications, age, gender and nursing specialty, was recruited. A longitudinal hermeneutic phenomenological study was carried out from 2000 to 2004, using interviews, reflective journals, care studies, critical incident analyses and document analysis.

Findings.  Ten conceptions of nursing and 10 perceptions of clinical decision‐making were identified and a growing pattern of inter‐relationships between them became apparent. A ‘matrix model’ was developed by cross‐referencing the two thematic categories within the timeline of respondents’ developmental journey through significant milestones and changing contexts. As Registered Nurses they found having to ‘think on your feet’ without the ‘comfort blanket’ of student status both a stressful and formative learning experience.

Conclusion.  Further collaboration between education and health service partners is recommended to integrate clinical decision‐making throughout the nursing curriculum, enhance the development of such vital skills, and facilitate the transition from student to Registered Nurse.
Healthcare and support needs of women with suspected breast cancer
Authors: Liao Mei‐Nan , Chen Miin‐Fu , Chen Shin‐Cheh , Chen Ping‐Ling
Published: September 2007

Title.  Healthcare and support needs of women with suspected breast cancer

Aim.  This paper is a report of a study to investigate changes in the healthcare and support needs during the diagnostic period, and factors that affect these needs in women with suspected breast cancer.

Background.  Although the needs of women with breast cancer are well recognized, few studies have examined the needs of women with suspected breast cancer during the diagnostic period.

Method.  This longitudinal study used an investigator‐developed, self‐administered questionnaire to collect data from 127 women in Taiwan on three occasions: notification of need for breast biopsy, before biopsy and after diagnosis. The data were collected from November 2004 to April 2005.

Findings.  Participants had high need levels before and after diagnosis, with their top needs in the domains of healthcare services for diagnosis, follow‐up and consultation, and information about the disease. They needed disease‐ and treatment‐related information more than emotional support. Need levels were higher (P < 0·01) before diagnosis than after, highest before biopsy, and lowest after diagnosis. Furthermore, needs were higher (P < 0·01) before than after diagnosis for diagnostic services, disease information, and involvement of family and friends. Higher needs were found in married women with more education and no history of benign tumours. Need level did not differ statistically significantly by age, religious status, degree of social support, family history and breast symptoms.

Conclusion.  Need levels of women with suspected breast cancer vary during the diagnostic period, are highest before breast biopsy, and related to personal characteristics and cultural context. Therefore, during this period, nursing staff should provide patients and families with culturally sensitive, individualized, supportive care.
The Chinese Childbirth Self‐Efficacy Inventory: the development of a short form
Authors: Ip Wan‐Yim , Chung Tony KH , Tang Catherine SK
Published: September 2007

Aims and objectives.  To examine the validity and reliability of the short form of the Childbirth Self‐Efficacy Inventory in a clinical Chinese pregnant population.

Background.  Childbirth self‐efficacy has become an important psychological construct for both childbirth educators and researchers because pregnant women's perception may influence the meaning and consequences of childbirth. Assessment done by the original Childbirth Self‐Efficacy Inventory limits the scientific rigor for generating additional research into the construct, as its items were repetitive and its structure is lengthy.

Methods.  This prospective study investigated 293 Chinese pregnant women in their third trimester of pregnancy. The women completed the short form of the Childbirth Self‐Efficacy Inventory, the Chinese Self‐efficacy Scale and the socio‐demographic questionnaire in an interview room of the study hospital. The re‐testing of the scale on the participants was carried out two weeks later in the same clinic.

Results.  Factor analysis and item‐subscale correlations supported the conceptual dimensions of the short form of the Chinese Childbirth Self‐Efficacy Inventory. The Cronbach's alpha coefficients for both subscales were over 0·9. The convergent validity with the Chinese Self‐Efficacy Scale was reflected by a moderate correlation for the two subscales. The efficacy expectancy subscale differentiated primigravid from multigravid women (t = 2·83, P < 0·01, CI = −2·33 to 2·34).

Conclusions.  The reliability and validity information presented in this paper supports the use of the short form of the Childbirth Self‐Efficacy Inventory as a research instrument in measuring the childbirth self‐efficacy among the Chinese population. Further validation of the measure is warranted.

Relevance to clinical practice.  The reliable short form of the Childbirth Self‐Efficacy Inventory could be used in routine clinical practice in maternity care services to provide a point of reference for future research and development in both childbirth education and clinical practice.
Exploring the efficacy of a case management model using DOTS in the adherence of patients with pulmonary tuberculosis
Authors: Hsieh Chia‐Ju , Lin Li‐Chan , Kuo Benjamin Ing‐Tiau , Chiang Chi‐Huei , Su Wei‐Juin , Shih Jen‐Fu
Published: September 2007

Aim.  To explore the efficacy of hospitals using case management with Directly Observed Treatment – Short course (DOTS) to monitor the adherence of patients with pulmonary tuberculosis in Taiwan.

Background.  Non‐adherence to anti‐tuberculosis chemotherapy is the major problem in treating patients with tuberculosis. Community‐based case management coupled with DOTS has been applied to patients with tuberculosis and has resulted in good results in some countries. Taiwan has a high incidence of tuberculosis, and although it has implemented DOTS, the expected increased efficacy has not yet been realized.

Design and methods.  The study used a quasi‐experimental design. Using age and gender as matching factors, 96 subjects were randomly assigned to one of three groups in 2002–2003. Experimental group I was to receive DOTS case management comprising in‐hospital education, direct daily observation in the first two months and one home visit per week. Experimental group II received traditional case management comprising in‐hospital education and one home visit per month. The control group did not receive any intervention.

Results.  The adherence, the rate of completion, the treatment success, sputum conversion and chest X‐ray improvement of experimental group I were significantly improved compared with experimental group II and the control group. The completion rate in experimental group I was higher than the general rate for Taiwan during the past six years and the treatment success rate met the standards of the World Health Organization.

Conclusion.  Hospitals using case management with DOTS can improve the adherence of tuberculosis patients and the control of tuberculosis‐epidemic situations.

Relevance to clinical practice.  In a rapidly changing healthcare environment, clinical nurses can make a significant contribution to healthcare delivery for tuberculosis patients. This study has provided further insight into the implementation of hospital‐to‐community level case management using DOTS by nurses.
Disruption of parent participation: nurses’ strategies to manage parents on children's wards
Authors: Coyne Imelda
Published: September 2007

Aims and objectives.  To investigate parent participation in the hospitalized child’s care from the perspectives of children, parents and nurses.

Background.  Parent participation in the hospitalized child’s care has been increasingly promoted in paediatric nursing for many years because it ameliorates the adverse aspects of hospitalization, avoids parental separation and contributes to quality care for sick children. Parent participation is assumed to be unproblematic but evidence exists that nurses often have difficulty caring for parents.

Design.  Using grounded method, data were collected through in‐depth interviews, questionnaires and observation with 12 nurses from four paediatric wards in two hospitals in England.

Results.  The dominant process appeared to be the socialization of parents to their role on the ward through inclusionary and exclusionary tactics. Nurses controlled the nature of parents’ participation and parents had to ‘toe the line’. Although participation was presented as optional, parents were presented with no course other than acceptance. Parents were expected to stay with their child, behave properly and be involved in care. When parents did not adhere to these norms, they caused disruption to the order and routine of the ward. Compliance or non‐compliance to the set of norms and rules was followed by reward or punishment.

Conclusion.  The nurses’ dependence on parents’ active participation in the organization and delivery of the work suggests that parent participation as it is practised is clearly about administrative efficiency, not consumer empowerment.

Relevance to clinical practice.  Organizational and managerial issues must be examined to ensure that nurses are adequately prepared and resourced to support parents on the ward. Continuing assessment of parents’ expectations though a structured assessment tool would help reduce misunderstandings and conflict. Nurses should assess the situational context before relying on subjective impressions and assumptions about parents’ participation in care.
Criteria for evaluation of measurement properties of clinical balance measures for use in fall prevention studies
Authors: Moe‐Nilssen Rolf , Nordin Ellinor , Lundin‐Olsson Lillemor ,   on behalf of and partly based upon discussions within Work Package 3 of the European Community Research Network Prevention of Falls Network Europe
Published: September 2007

Work Package 3 of the Prevention of Falls Network Europe has evaluated measurement properties of clinical balance measures to be used to: (1) select participants for interventions with the goal to prevent falls in older people, and (2) assess the results of such intervention on balance function.

Inclusion in a fall prevention study may be based on measures identifying subjects who have impaired balance or increased risk of future falls. We propose that an appropriate statistical method to analyse discriminative ability of a balance measure is discriminant analysis or logistic regression analysis. The optimal cut‐off score is best determined by plotting a receiver‐operating‐characteristic curve for different cut‐off values. The evaluation of predictors for risk of future falls should be based on a study design with a prospective data collection of falls.

Sensitivity to change is a measurement property needed to evaluate the outcome of an intervention. The standardized response mean is frequently encountered in the literature and is recommended as a statistical measure of sensitivity to change in the context of an intervention study.

Adequate reliability is a prerequisite for consistent measurement. Relative reliability may be reported as an intraclass correlation coefficient and absolute reliability as the within‐subject standard deviation (sw), also called standard error of measurement. When measurement error is proportional to the score, calculation of a coefficient of variation can be considered.

In a second paper, the authors will evaluate clinical balance measures for use in fall prevention studies based upon criteria recommended in this report.