bluuebunny/crossref_metadata_2025 huggingface dataset:
Pivotal Research in Cardiovascular Syndromes in the Elderly:
Authors: McKay Charles R. , Rich Michael W. , Vlietstra Ronald E. , Kitzman Dalane W. , Fleg Jerome L. , Krumholz Harlan M. , Lakatta Edward G. , Cooke John P. , Cannon Christopher P. , Ezekowitz Michael D. , Frohlich Edward D. , Jalife Jose , Kass David A. , Kottke Bruce A. , Muller James E. , Saltin Bengt , Shen Win K. , Somers Virend K.
Published: June 2007

The PRICE‐1 conference was designed to identify near term priorities for funding cardiovascular research in the elderly. Twenty topics were identified with either break throughs in fundamental mechanisms of aging with cardiovascular systems or with critical importaance to cardiovascular carve of the elderly.
Peripheral Arterial Disease: Epidemiology and Drug Therapy
Authors: McDermott Mary McGrae
Published: June 2007

Lower‐extremity peripheral arterial disease (PAD) is common among older men and women, affecting 20%–30% of older men and women in general medicine practices. History and physical examination are insensitive measures of PAD. However, PAD can be noninvasively and reliably diagnosed in the office with the ankle‐brachial index, a ratio of Doppler‐recorded systolic pressures in the lower and upper extremities. An ankle‐brachial index <0.90, consistent with PAD, is associated with increased risk of cardiovascular morbidity and mortality in addition to functional impairment. Drug therapy in PAD is directed at reducing the increased risk of cardiovascular events and improving walking impairment. Intensive atherosclerotic risk factor intervention and angiotensin‐converting enzyme inhibitors are recommended for reducing cardiovascular event rates in persons with PAD. Components of an effective exercise intervention and drug therapy to reduce claudication‐related walking impairment in PAD are also reviewed.
Pacing Therapy in the Elderly
Authors: Kusumoto Fred M. , Phillips Robert , Goldschlager Nora
Published: June 2007

Bradycardia due to sinus node dysfunction and atrioventricular block is more commonly observed in the elderly. Aging is associated with progressive fibrosis in both the sinus node and atrioventricular conduction system (AV node, His bundle, right and left bundles). In the absence of reversible causes implantation of a permanent pacemaker is often required in the patient with symptomatic bradycardia. For elderly patients with sinus node dysfunction, pacing modes that preserve atrioventricular synchrony are associated with a reduced incidence of atrial fibrillation and improved quality of life. For patients with atrioventricular block, the importance of preserving atrioventricular synchrony in the elderly is controversial and is currently being evaluated.
Atrial Fibrillation in the Elderly: Anticoagulation Strategies and Indications in the Very Elderly
Authors: Kamath Sridar , Lip Gregory Y.H.
Published: June 2007

With increasing life expectancy and the older mean age of the general population, the prevalence of atrial fibrillation is likely to increase, making this arrhythmia an even more important public health problem, especially in the elderly. While atrial fibrillation is increasingly common in the elderly, paradoxically, the data on intervention trials in atrial fibrillation among the elderly are limited. When considering anticoagulation in the elderly patient with atrial fibrillation, the following five questions should be addressed. 1) Is there a definite indication (for example, atrial fibrillation plus risk factor[s])? 2) Is there a high risk of bleeding or strong contraindication against anticoagulation? 3) Will concurrent medication or disease states significantly increase bleeding risk or interfere with anticoagulation control? 4) Is drug compliance and attendance at anticoagulant clinic for monitoring likely to be a problem? 5) Will there be regular review of the patient, especially with regard to risks and benefits of anticoagulation? Careful and continuing evaluation of the elderly patient with atrial fibrillation is necessary to ensure that the risks of bleeding do not outweigh the benefits from anticoagulation.
Long‐Term Survival of Quiescent Left Atrial Myxoma in an Elderly Patient
Authors: Kay Jay F. L. , Chow Wing
Published: June 2007

Left atrial myxoma, if left untreated, is inexorably progressive and usually fatal. The classical management of this disease is prompt surgical removal. However, there may be exceptions to this traditional dogma. The authors report an 85‐year‐old man who presented with features of chronic obstructive airway disease and congestive heart failure 15 years previously. Auscultation of the heart showed a pansystolic murmur. Two‐dimensional echocardiography revealed a nonobstructive, calcified, and well circumscribed mass in the left atrium, with a pedicle attached to the interatrial septum. Because the patient refused high‐risk cardiac surgery related to his comorbidity, he was managed medically with a bronchodilator, diuretics, and digoxin. There have been no features of embolism or intracardiac obstruction, and serial echocardiography demonstrates no disease progression over this long period of time. This case illustrates that calcified left atrial myxoma may exhibit a quiescent phase. Tumor calcification, slow growth potential, and the absence of intracardiac obstruction may correlate with a better outcome in the elderly patient.
Pathophysiology of Hypertension in the Elderly
Authors: Laurent Stèphane , Boutouyrie Pierre , Benetos Athanase
Published: June 2007

Systolic hypertension is the most common type of hypertension in the elderly and a major modifiable cardiovascular risk factor. Systolic hypertension is associated with a wide pulse pressure resulting largely from excessive large artery stiffness. Arterial stiffness increases with age independently of mean blood pressure or the presence of other risk factors. In this review, the authors discuss the effects of age and blood pressure on arterial stiffness, the physiology of arterial compliance, and the anatomic changes of large arteries with aging. In most studies reported in the literature, elderly populations are relatively small. The role of both age and gender on arterial stiffness and wave reflection has been poorly investigated, particularly in subjects over 70 years. In this elderly population, further research is needed concerning the pathophysiology, epidemiology, and pharmacology of hypertension.
Ethical Issues in the Management of Geriatric Cardiac Patients
Authors: Basta Lofty L. , Basta Lofty L.
Published: June 2007

Ethical Issue: A patient asks to put an end to the nightmare of living with a lifesaving AICD
Limited influence of UGT1A1*28 and no effect of UGT2B7*2 polymorphisms on UGT1A1 or UGT2B7 activities and protein expression in human liver microsomes
Authors: Peterkin Vincent C. , Bauman Jonathan N. , Goosen Theunis C. , Menning Lee , Man Michael Z. , Paulauskis Joseph D. , Williams J. Andrew , Myrand Scott P.
Published: June 2007

What is already known about this subject

• The UGT1A1*28 polymorphism is known to reduce UGT1A1 enzyme activities, via an extra TA repeat in the promoter.

• However, a gap exists with regard to a comprehensive assessment of the influence of this genotype on variability in enzyme activity.

• There is equivocal evidence on the functional relevance of the UGT2B7*2 polymorphism on UGT2B7 enzyme activities.

What this study adds

• Using comprehensive approaches to measure enzyme activities and protein expression levels, the UGT1A1*28 polymorphism is shown to contribute to only 40% of the variability in enzyme activities for UGT1A1.

• A novel, nonproprietary method for genotyping UGT1A1*28 is provided.

• Definitive evidence is provided to conclude there is no effect of the UGT2B7*2 polymorphism on zidovudine glucuronidation activity.

Aims

UGT1A1 and UGT2B7 are enzymes that commonly contribute to drug glucuronidation. Since genetic factors have been suggested to contribute to variability in activities and expression levels of these enzymes, a quantitative assessment of the influence of the major genotypes (UGT1A1*28 or UGT2B7*2) on enzyme activities was conducted.

Methods

Using a bank of microsomal samples from 59 human livers, the effect of UGT1A1*28 or UGT2B7*2 polymorphisms were investigated on rates of estradiol 3‐glucuronidation (a marker of UGT1A1 enzyme activity) or zidovudine glucuronidation (a marker of UGT2B7 enzyme activity) and levels of immunoreactive protein for each enzyme. Glucuronidation rates for both enzymes were measured at Km/S50 and 10 times Km/S50 concentrations.

Results

UGT1A1 and UGT2B7 enzyme activities varied up to 16‐fold and sixfold, respectively. Rates at Km/S50 concentration closely correlated with rates at 10 times Km/S50 concentration for both enzymes (but not at 1/10th Km for UGT2B7). Enzyme activities correlated with relative levels of immunoreactive protein for UGT1A1 and UGT2B7. Furthermore, rates of zidovudine glucuronidation correlated well with rates of glucuronidation of the UGT2B7 substrate gemcabene, but did not correlate with UGT1A1 enzyme activities. For the UGT1A1*28 polymorphism, consistent with levels of UGT1A1 immunoreactive protein, mean UGT1A1 activity was 2.5‐ and 3.2‐fold lower for TA6/TA7 (P < 0.05) and TA7/TA7 (P < 0.001) genotypes in comparison with the TA6/TA6 genotype.

Conclusions

Relative to the observed 16‐fold variability in UGT1A1 activity, these data indicate only a partial (approximately 40%) contribution of the UGT1A1*28 polymorphism to variability of interindividual differences in UGT1A1 enzyme activity. For the UGT2B7*2 polymorphism, genotype had no influence on immunoreactive UGT2B7 protein or the rate of 3'‐azido‐3'‐deoxythymidine glucuronidation.
Pharmacokinetics, safety, and efficacy of mycophenolate mofetil in combination with sirolimus or ciclosporin in renal transplant patients
Authors: Pescovitz Mark D. , Vincenti Flavio , Hart Marquis , Melton Larry , Whelchel John , Mulgaonkar Shamkant , McKay Diane , Leung Mimi , Calleja Elizabeth , Bouw M. René
Published: June 2007

Aims

To compare the pharmacokinetics of mycophenolic acid (MPA) and its metabolite (MPAG) when mycophenolate mofetil (MMF) is administered in combination with sirolimus or ciclosporin (CsA) in renal allograft recipients. Safety and efficacy (biopsy‐proven acute rejection (BPAR)) were also assessed.

Methods

Patients (n = 45) were randomized 2 : 1 to receive treatment with sirolimus (n = 30; dosed to maintain trough concentrations of 10–25 ng ml−1 until week 8, and then 8–15 ng ml−1 thereafter) or CsA (n = 15; administered as per centre practice) both in combination with daclizumab, oral MMF and corticosteroids. Pharmacokinetic assessments were performed at day 7, week 4, and months 3 and 6 post‐transplant. The primary endpoint was the AUC(0,12 h) for MPA and MPAG. The pharmacokinetics of sirolimus were also assessed.

Results

MPA exposure was 39–50% lower (month 6 mean AUC(0,12 h) (95%CI): 40.4 (33.8, 47.0) vs. 68.5 (54.9, 82.0) µg ml−1 h) and MPAG exposure was 25–52% higher (722 (607, 838) vs. 485 (402, 569) µg ml−1 h at month 6) in the presence of CsA compared with sirolimus across visits. BPAR was 40.0% with sirolimus and 13.3% with CsA. The incidence of hypertension, tremors and hirsutism was higher with CsA than with sirolimus, while the incidence of diarrhoea, hyperlipidaemia and impaired wound closure was higher with sirolimus. No deaths, malignancies or graft losses were reported.

Conclusions

Co‐administration of sirolimus with MMF led to greater MPA exposure, but lower MPAG exposure, than co‐administration with CsA. As rejection rates were higher in the absence of CsA, further study of calcineurin inhibitor‐free regimens is required before general recommendations can be made.
Recent advances in the understanding of mastocytosis: the role of KIT mutations*
Authors: Orfao Alberto , Garcia‐Montero Andrés C. , Sanchez Laura , Escribano Luis
Published: June 2007

Mastocytosis is a heterogeneous disorder characterised by the expansion and accumulation of mast cells in different organs and tissues. Mast cell physiology is closely dependent on activation of the stem cell factor/Kit signalling pathways and accumulating evidences confirm the physiopathological key role of activating KIT mutations (typically D816V) in mastocytosis and their relationship with the clinical manifestations of the disease. This paper reviews the most recent advances in the understanding of the molecular mechanisms associated with KIT mutations in mastocytosis, including recent data about the use of new therapies targeting the Kit molecule and its associated downstream signalling pathways.
High risk of pregnancy‐related venous thromboembolism in women with multiple thrombophilic defects
Authors: Folkeringa Nienke , Brouwer Jan Leendert P. , Korteweg Fleurisca J. , Veeger Nic J.G.M. , Erwich Jan Jaap H.M. , Van Der Meer Jan
Published: June 2007

Pregnancy is associated with an increased risk of venous thromboembolism, which probably varies according to the presence of single or multiple thrombophilic defects. This retrospective family cohort study assessed the risk of venous thromboembolism during pregnancy and puerperium, and the contribution of concomitant thrombophilic defects in families with hereditary antithrombin, protein C or protein S deficiencies. Probands were excluded. Of 222 female relatives, 101 were deficient and 121 non‐deficient. Annual incidences of venous thromboembolism were 1·76% in deficient women versus 0·19% in non‐deficient women [adjusted relative risk (RR) 11·9; 95% confidence interval (CI), 3·9–36·2]. Other single and multiple thrombophilic defects increased the risk in deficient women from 1·55% to 2·14% and 2·92%, and in non‐deficient women from 0·16% to 0·09% and 0·54% respectively. Deficient women were at lower risk (1·37%; 0·80–2·19) than deficient women that had never been pregnant (2·96%; 1·53–5·18); RR 0·5 (0·2–0·99). This difference was due to the predominance of events related to oral contraceptives in deficient women that had never been pregnant (75%), while 71% of events in deficient women that had had at least one pregnancy were pregnancy‐related. In conclusion, women with hereditary deficiencies of antithrombin, protein C or protein S are at high risk of pregnancy‐related venous thromboembolism. This risk is increased by multiple additional thrombophilic defects.
Decreased TCR ζ‐chain expression in T cells from patients with acquired aplastic anaemia
Authors: Solomou Elena E. , Wong Susan , Visconte Valeria , Gibellini Federica , Young Neal S.
Published: June 2007

In aplastic anaemia, T cells have a central role in the pathophysiology of bone marrow destruction. This study showed that T cells from patients with aplastic anaemia expressed decreased T‐cell receptor (TCR) ζ‐chain protein and mRNA levels compared to healthy controls. Patients with decreased TCR ζ‐chain showed an abnormal response in intracellular calcium following stimulation through the TCR. We also observed an altered pattern of the transcription factors CREMα and Elf‐1 that are implicated in ζ‐chain transcription. We concluded that TCR ζ‐chain expression was decreased in the majority of patients with aplastic anaemia, regardless of disease activity or treatment status.
Treatment of acromegaly improves quality of life, measured by AcroQol
Authors: Paisley Angela N. , Rowles Susannah V. , Roberts Margaret E. , Webb Susan M. , Badia X. , Prieto L. , Shalet Stephen M. , Trainer Peter J.
Published: June 2007

Background   AcroQol is a disease‐generated questionnaire, developed to assess quality of life (QOL) in patients with acromegaly. We have previously demonstrated severely impaired QOL in patients with acromegaly and the value of AcroQol in measuring QOL in a cross‐sectional study compared with the non‐disease‐specific generic tools ‘Psychological general wellbeing schedule’ (PGWBS) and EuroQol (EQ‐5D), and the disease‐specific signs and symptoms score (SSS).

Aim, subjects and methods   We re‐evaluated these tools in a longitudinal study of 56 of the previously reported patients (33 male, mean age 55 ± 15 years), in order to determine change in QOL over time and the effect of different treatment modalities. Data were analysed using Spearman's correlation tests.

Results   Baseline median IGF‐I was 354 ng/ml (range 48–899) and at re‐evaluation 217 ng/ml (60–594) (P < 0·001) [median time interval 608 days (113–1136)]. Analysis of change in IGF‐I levels and AcroQol scores demonstrated a significant negative correlation (i.e. a reduction in IGF‐I being associated with improved overall QOL (r = –0·36, P = 0·006). Significant negative correlations were also seen in the physical (r = –0·33, P = 0·01), psychological (r = –0·37, P = 0·005) and appearance (r = –0·42, P = 0·001) AcroQol subdomains. No correlations were seen between change in IGF‐I and change in overall PGWBS score or subdomains, SSS or EQ‐5D.

Conclusions   In summary, of the tools studied we have demonstrated AcroQol to be uniquely capable of detecting changes in QOL associated with treatment‐induced improvement in the main biochemical marker of disease activity in patients with acromegaly. Further studies are required to evaluate the long‐term biological significance of the changes seen in AcroQol.
Derevator: a soft tissue elevator for maxillary sinus in Endoscopic sinus surgery
Authors: Dere H. , Ozcan K.M. , Ozcan I.
Published: June 2007

Keypoints

• Removal of the soft tissue lesions from the maxillary sinus is sometimes difficult and time consuming in endoscopic sinus surgery.

• Failure of endoscopic removal may necessitate combination of canine fossa approach and endoscopic approach.

• Our new instrument, ‘Derevator’, is designed for easy removal of the pathological soft tissue lesions from the maxillary sinus through middle meatal antrostomy.

• Derevators are available for both adults and children. Suction‐tipped ones are also available.
Lesson plans in surgical training
Authors: Lester S.E. , Robson A.K.R.
Published: June 2007

Keypoints

• Lesson plans in surgery enable trainers and trainees to agree on goals that balance training needs with service commitments.

• Lesson plans are individualised to the trainee and encourage ownership of learning.

• They are based on SMART criteria and therefore have a sound educational footing.

• Most of the work in creating a lesson plan falls to the trainee. The total time for creation of each plan is approximately 20 min.

• Our use of lesson plans for surgical training has been met with favourable response from both trainer and trainees.
Photodynamic therapy in the treatment of multiple primary tumours in the head and neck, located to the oral cavity and oropharynx
Authors: Copper M.P. , Triesscheijn M. , Tan I.B. , Ruevekamp M.C. , Stewart F.A.
Published: June 2007

Objectives:  Multiple primary tumours are a common problem in the head and neck cancer patients. Curative surgery or radiotherapy of these tumours can be very mutilating or even impossible. This study aims at evaluating meta‐tetrahydroxy‐phenyl chlorin‐mediated photodynamic therapy for second or multiple primary tumours in the head and neck.

Design:  Retrospective study of all patients with second or multiple primary tumours treated by photodynamic therapy over a 10‐year period.

Setting:  All patients were treated in the Netherlands Cancer Institute, a tertiary referral centre for the head and neck cancer patients.

Participants:  A total of 27 patients with 42 the second or the multiple primary head and neck tumours were treated by photodynamic therapy (0.15 mg/kg meta‐tetrahydroxy‐phenyl chlorin).

Main outcomes measures:  Cure rates.

Results:  Twenty‐eight of 42 tumours were cured (67%). Cure rates for stage I or in situ disease were 85%versus 38% for stage II/III.

Conclusions:  Cure rates for photodynamic therapy of the multiple primary head and neck tumours were lower than previously described for first primaries, but were still very encouraging for this difficult patient population. The high cure rate obtained in stage I multiple primaries emphasises the importance of a meticulous follow‐up of patients treated for the head and neck cancer to detect new tumours at a curable stage.
Male‐specific sterility caused by the loss of CR16
Authors: Suetsugu Shiro , Banzai Yoshibumi , Kato Masayoshi , Fukami Kiyoko , Kataoka Yuki , Takai Yoshimi , Yoshida Nobuaki , Takenawa Tadaomi
Published: June 2007

The gene encoding the protein known as “corticosteroids and regional expression 16” (CR16) has been shown to be regulated by glucocorticoids. CR16 is a member of the Wiskott–Aldrich syndrome protein (WASP)‐interacting protein (WIP) family. It binds to the neural WASP (N‐WASP), which activates the Arp2/3 complex to induce actin polymerization. CR16 is highly expressed in the testes, particularly in the Sertoli cells, which harbor sperm progenitors and play an important role in spermatogenesis. We found male‐specific sterility in the CR16‐knockout mice. The sperms of the CR16‐knockout mice had abnormal head morphology, and greatly diminished fertilization ability in in vitro fertilization experiments. CR16 and N‐WASP were localized to the actin filaments at the Sertoli cell–spermatid junctions (SspJs). The level of N‐WASP but not the transcript was decreased in the testes and Sertoli cells of the CR16‐knockout mice. Therefore, CR16 and N‐WASP are suggested to play important roles in spermatogenesis.
The mysterious case of the missing paradigm: a review of critical information systems research 1991–2001
Authors: Richardson Helen , Robinson Bruce
Published: June 2007

Abstract.  In this journal, Chen and Hirschheim have provided a historical analysis of positivist and interpretivist research paradigms and methodologies in the 10 years following the much cited work of Orlikowski and Baroudi. In this paper, we investigate the mysterious case of the missing paradigm – that of the critical approach to information systems (IS) research. We take Chen and Hirschheim’s survey as our starting point and aim to fill the gap left by the absence of the critical paradigm in their analysis and make some criticisms of their method. Recent years have seen the growth of IS research that consciously adopts a critical perspective. This paper charts the development of critical IS research over the period of 1991–2001, adding some comments on more recent developments. We conclude by critically reflecting on the current development of critical research in the field of IS.
Examining the integrated influence of fairness and quality on learners’ satisfaction and Web‐based learning continuance intention
Authors: Chiu Chao‐Min , Chiu Chao‐Sheng , Chang Hae‐Ching
Published: June 2007

Abstract.  As with any other information system (IS), the success of Web‐based learning depends largely on user satisfaction and other factors that eventually increase users’ intentions to continue using the service (continuance intention). This research integrates the IS success model and fairness theory to construct a model for investigating the motivations behind learners’ intentions to continue using Web‐based learning. Our model theorizes that the three dimensions of quality (i.e. information, system and service) and the three dimensions of fairness (i.e. distributive, procedural and interactional) affect learners’ satisfaction. We also argue that satisfaction and the three dimensions of fairness will influence learners’ intention to continue using Web‐based learning. The hypothesized model is validated empirically using data collected from 289 learners of a Web‐based learning service. The results show that information quality, system quality, system use, distributive fairness and interactional fairness exhibit significant positive effects on satisfaction. Also, procedural fairness and satisfaction play significant roles in shaping learners’ intention to continue using Web‐based learning.
Dentine‐bonded resin composite (Retroplast) for root‐end filling: a prospective clinical and radiographic study with a mean follow‐up period of 8 years
Authors: Yazdi P. M. , Schou S. , Jensen S. S. , Stoltze K. , Kenrad B. , Sewerin I.
Published: June 2007

Aim  To evaluate treatment outcome after using a resin composite (Retroplast, RP) in combination with a dentine‐bonding agent (GLUMA) as root‐end filling material after 1 year as well as after more than 5 years (final examination). Also, the influence of various pre‐, intra‐ and postoperative factors on the treatment outcome was studied.

Methodology  All patients (87) undergoing root‐end resection consecutively treated by root‐end filling with RP on an incisor, canine, pre‐molar, or first molar (87 teeth, 118 roots) were initially enrolled in the study. RP was applied on the entire resected surface that was prepared to a slightly concave shape and after conditioning with EDTA and GLUMA. The treatment outcome involving subjective, clinical and radiographic parameters was evaluated after 1 year and at the final examination. A total of 27 patients (36 roots) were excluded from the study because of unavailability of follow‐up (19) and extraction of the operated tooth for reasons other than failed surgery (8). Consequently, 60 patients (82 roots) were included in the final material. The mean follow‐up period at the final examination was 8 years (range: 6.5–9 years).

Results  The radiographic evaluation at the final examination revealed that 77%, 5%, 7% and 11% of the treated roots were characterized by complete, incomplete, uncertain and unsatisfactory healing, respectively. A total of 95% of the roots classified as completely healed at the 1‐year control were also completely healed at the final examination. Two roots (5%) showing complete healing at the 1‐year control revealed unsatisfactory healing at the final examination because of displaced or lost RP‐filling. Moreover, 60% of the roots with uncertain healing at the 1‐year control demonstrated complete or incomplete healing at the final examination. The classification according to subjective, clinical and radiographic parameters revealed that 78% of the teeth were characterized by a successful treatment outcome at the final examination. Evaluation of the influence of various pre‐, intra‐ and postoperative factors on the treatment outcome revealed that the radiographic classification at the final examination was exclusively influenced by the radiographic classification at the 1‐year control (P < 0.001).

Conclusions  The present long‐term study indicates that RP can be used for root‐end filling with a successful treatment outcome.
Capacity building in nursing and midwifery research and development: an old priority with a new perspective
Authors: McCance Tanya V. , Fitzsimons Donna , Keeney Sinead , Hasson Felicity , McKenna Hugh P.
Published: June 2007

Title. Capacity building in nursing and midwifery research and development: an old priority with a new perspective.

Aim.  This paper is a report of a study to identify strategic priorities to inform the development of a regional strategy for nursing and midwifery research and development.

Background.  Research capacity has been highlighted internationally as a crucial element in the advancement of nursing and midwifery research and development. Research capacity has been defined as that which relates to the ability to conduct research. In a strategic context, however, there is a broader perspective that encompasses activities related both to ‘using’ and ‘doing’ research.

Methods.  A modified nominal group technique was employed. Three rounds were used to identify the main strategic priorities for nursing and midwifery research and development. Round one was based on the Delphi Technique and further rounds were based on the nominal group technique approach. Data were collected during February 2005. Participants (n = 105) were those involved in the research and development agenda for nursing and midwifery in Northern Ireland.

Findings.  Capacity building was highlighted as a central component from the final 12 priorities, with three key areas identified: (1) the importance of strong and visible leadership; (2) developing research expertise that will enable the profession to deliver programmes of research and (3) increasing the capacity of individuals and organizations to engage in development activity.

Conclusion.  The 12 priorities identified emphasize the need for a broad perspective on building capacity that reflects involvement in a range of activities that span ‘research’ and ‘development’. This has important implications globally if nurses and midwives are to develop the knowledge and skills required to engage in research and development as an integral part of their practice. Embracing this broader perspective has the potential to enhance performance that will contribute to continuous quality improvement.
A geometric morphometric approach to the study of ecogeographical and clinal variation in vervet monkeys
Authors: Cardini Andrea , Jansson Anna‐Ulla , Elton Sarah
Published: June 2007

Aim  To examine and visualize clines in size and shape of Cercopithecus aethiops Linneus, 1758 (Primate, Cercopithecidae) skulls, and to investigate environmental factors which might best explain the observed variation.

Location  Sub‐Saharan Africa.

Methods  Eighty‐six three‐dimensional anatomical landmarks were used to describe 306 skulls of adult C. aethiops sampled over its entire distribution. Geometric morphometric methods for the quantitative analysis of form variation were applied. Size and shape variables were computed and regressed onto geographical coordinates and environmental variables (elevation, temperature, rainfall, moisture and Shannon rainfall diversity index) using both linear and curvilinear models. Components (geographical, environmental, spatially structured environmental and residual) of ecogeographical variation in skull form were partitioned using partial regression. A novel approach for summarizing and visualizing nonlinear patterns of clinal variation using surface rendering of three‐dimensional shapes is presented.

Results  Clinal variation in size and shape was highly significant, and was best described by curvilinear models. There were strong similarities between females and males. The cline in size was especially pronounced, explaining up to about 40% of observed variation, and was mainly longitudinal rather than latitudinal. A major trend of clinal shape variation also occurred from west to east, and corresponded to an expansion of the face relative to the neurocranium in the west. In the east, skulls also tended to be deeper and with narrower zygomatic arches. Geography and the spatially structured environmental component were the major contributors to the explained variance in size in both sexes, but the proportion of variance explained by the latter was smaller in females. In contrast, geography and environment explained similar amounts of variation in shape and their contribution was about twice that of the spatially structured environmental component. About 60–80% of variation in skull form was not explained by any variable in the analysis. The main factors influencing skull size differed in females and males, with rainfall being very influential in males. Both female and male skull shapes were strongly affected by average annual rainfall.

Main conclusions  A strong spatial and environmental basis to variations in African vervet monkey skull form was evident. However, the observed pattern did not conform to predictions based on Bergmann's rule. Rainfall consistently emerged as an important predictor, which may contribute to intraspecific variation in the size and shape of vervet monkey skulls through its effect on habitat productivity.
Decay of similarity of gamasid mite assemblages parasitic on Palaearctic small mammals: geographic distance, host‐species composition or environment
Authors: Vinarski Maxim V. , Korallo Natalia P. , Krasnov Boris R. , Shenbrot Georgy I. , Poulin Robert
Published: June 2007

Aim  The similarity between parasite assemblages should decrease with increasing geographic distance between them, increasing dissimilarity in environmental conditions, and/or increasing dissimilarity of the local host fauna, depending on the dispersal abilities of the parasites and the intimacy of their associations with the host. We tested for a decay in the similarity of gamasid mite assemblages parasitic on small mammals with increasing geographic, ‘environmental’ and ‘host faunal’ (= ‘host’) distances.

Location  We used data on assemblages of haematophagous gamasid mites (superfamily Dermanyssoidea) parasitic on small mammals (Insectivora, Lagomorpha and Rodentia) from 26 different regions of the northern Palaearctic.

Methods  Similarity in mite assemblages was investigated at the compound community level across all regions, and at the component community level, across populations of the same host species for each of 11 common host species. Similarity between pairs of mite communities was estimated using both the Jaccard and the Sorensen indices. Environmental distance was estimated as the dissimilarity between locations in a composite measure of climatic variables, and host faunal distance was simply taken as the reciprocal of indices of similarity between the composition of host faunas in different locations. Generalized Linear Models (GLM) and Akaike's Information Criterion were used to select the best model of decay in similarity as a function of geographic, ‘environmental’ and ‘host faunal’ distances.

Results  Overall, despite slight differences among host species, the similarity in mite assemblages decreased with both increasing ‘environmental’ distance and increasing ‘host faunal’ distance, but was generally unaffected by geographic distance between regions. The similarity of component communities of gamasid mites among host populations was determined mainly by similarity in the physical environment, whereas that of compound communities varied mainly with host‐species composition.

Main conclusions  Our results indicate that the general decay in community similarity with increasing geographic distances does not apply to assemblages of gamasid mites; it is possible that they can overcome great distances by means of passive dispersal (either by phoresy or wind‐borne), or more likely they occur wherever their hosts are found as a result of tight cospeciation in the past. Mite assemblages on small mammalian hosts seem to be affected mainly by local environmental conditions, and, to a much lesser extent, by the species composition of local host communities.
Geographical range size and host specificity in ectoparasites: a case study withAmphipsyllafleas and rodent hosts
Authors: Shenbrot Georgy , Krasnov Boris , Lu Liang
Published: June 2007

Aim To identify the factors that determine the geographical range sizes of ectoparasites with different degrees of host specificity.

Location The study used data on the distributions of fleas of the genusAmphipsyllaand their rodent hosts across the Holarctic.

Methods All known points of occurrence of 32 flea species and 51 species of their rodent hosts were mapped. The shape and size of the geographical range of each species were estimated using a combination of the minimal convex polygon technique and modelling with thegarpalgorithm. Factors determining the geographical range sizes of the fleas were identified using stepwise multiple regression analysis.

Results The geographical range size of fleas that are strongly host‐specific across their entire ranges correlated positively with the geographical range size of the fleas’ principal hosts, and negatively with the geographical range size of the fleas’ potential competitors. The geographical range sizes of both (1) fleas that are locally host‐specific but that shift their host preferences geographically, and (2) host‐opportunistic fleas were positively correlated only with the area of the geographical ranges of their principal hosts. Strongly host‐specific fleas occupied 0.2–80.0% of the geographical range of their principal hosts, whereas this figure was 0.9–83.7% in locally host‐specific fleas and 16.6–63.7% in host‐opportunistic fleas.

Main conclusions The main determinant of the geographical range size of a flea species is the size of the geographical range of its hosts. The role of potential competitors in determining the geographical range size is stronger in host‐specific than in host‐opportunistic fleas. Cases in which the geographical range of a parasite is smaller than the geographical range(s) of its host(s) owing to narrower parasite environmental tolerances are much more frequent in host‐opportunistic than in host‐specific fleas.
No effect of varying soil resource heterogeneity on plant species richness in a low fertility grassland
Authors: REYNOLDS HEATHER L. , MITTELBACH GARY G. , DARCY‐HALL TARA L. , HOUSEMAN GREGORY R. , GROSS KATHERINE L.
Published: June 2007

Coexistence theory predicts that greater heterogeneity of resources or other fitness‐constraining environmental factors will promote species diversity, yet this classic mechanism of coexistence has rarely been tested in manipulative field experiments.

Here we present results from the fourth year of a long‐term experiment designed to test the heterogeneity‐diversity hypothesis in a low productivity grassland where we directly manipulated the spatial heterogeneity of soil nutrients. In addition to unfertilized controls, we created heterogeneous and homogeneous nutrient enrichment treatments by applying fertilizer to field plots in a patchy or uniform manner. Fertilization treatments were crossed with seed addition and cover reduction treatments, to allow examination of the effects of recruitment limitation and competition from established vegetation on diversity responses to nutrient heterogeneity.

In contrast to predictions, we found that spatially heterogeneous soil nutrient supply did not promote increased species richness or greater species sorting relative to a uniform supply of soil nutrients. Instead, both nutrient enrichment treatments depressed plant species richness (especially at small spatial scales) and, depending on cover reduction and on spatial location in the field, increased the abundance of two spreading clonal species.

Our results do not support the heterogeneity‐diversity hypothesis, and suggest that the response of clonal species to nutrient enrichment may constrain how plant diversity responds to resource heterogeneity. Future tests of the heterogeneity‐diversity hypothesis should explicitly consider the scale of resource heterogeneity and foraging capability of the plant species in the community.
The effectiveness of antidepressant medication in the management of behaviour problems in adults with intellectual disabilities: a systematic review
Authors: Sohanpal S. K. , Deb S. , Thomas C. , Soni R. , Lenôtre L. , Unwin G.
Published: June 2007

Background  A comprehensive systematic review was performed to establish the current evidence base regarding the effectiveness of antidepressant medication for the management of behaviour problems in adults with intellectual disabilities.

Method  An electronic search of PsycInfo, Embase, Medline and Cinahl databases was conducted spanning the time period 1990 to October 2005 for primary trials. This was supplemented by hand searching and cross‐referencing of relevant reviews. Strict scientific methodology requirements were formulated that the studies had to meet in order to merit inclusion in this review.

Results  One crossover randomized controlled trial in a small cohort, seven prospective uncontrolled trials and two retrospective studies were yielded in the search. Of these, one explored the effectiveness of the tricyclic antidepressant – clomipramine, and nine considered various selective serotonin reuptake inhibitors (SSRIs).

Conclusion  Evidence based primarily on a small number of either prospective or retrospective case studies that included a small number of participants and often used non‐validated outcome measures for a short period of follow‐up, suggests that antidepressants, particularly SSRIs, show improvement of aggression and self‐injurious behaviour on average in less than 50% of cases and the rest show either no improvement or deterioration. The effect is most pronounced in the presence of an underlying anxiety or an associated diagnosis of obsessive‐compulsive disorder. Most studies have highlighted the concern regarding adverse effects.
The effectiveness of antipsychotic medication in the management of behaviour problems in adults with intellectual disabilities
Authors: Deb S. , Sohanpal S. K. , Soni R. , Len tre L. , Unwin G.
Published: June 2007

Background  Psychopharmacological intervention in the management of behaviour problems in adults with intellectual disabilities (ID) has become a common treatment strategy. This has become a cause for concern, given that the evidence for its effectiveness is uncertain and most drugs are not licensed for this use.

Methods  A comprehensive systematic review of empirical research on the effectiveness of antipsychotic medication was conducted. Electronic and manual searches of literature were conducted. Stringent scientific methodology determined those primary trials that were worthy of inclusion.

Results  This review revealed one randomized controlled trial (RCT), one controlled, four uncontrolled prospective and three retrospective case series studies in adults. Additionally, two studies in both adults and children – one crossover RCT and one prospective controlled trial – were found.

Conclusion  Presently, there is RCT‐based evidence for risperidone to be effective in both adults and children; however, this treatment carries a certain amount of risk associated with adverse effects. There is also evidence to support the use of other antipsychotics, primarily atypicals, but the evidence is based on noncontrolled case studies. There is currently not enough evidence available to recommend specific medication for specific behaviour problems. Before prescribing medication, clinicians should carry out a thorough assessment of behaviour, including its causes and consequences, and draw up a formulation providing the rationale for the prescribed intervention after considering all medication‐ and nonmedication‐based management options.
Symptoms of dementia among adults with Down's syndrome: a qualitative study
Authors: Deb S. , Hare M. , Prior L.
Published: June 2007

Background  Dementia is common among adults with Down's syndrome (DS); yet the diagnosis of dementia, particularly in its early stage, can be difficult in this population. One possible reason for this may be the different clinical manifestation of dementia among people with intellectual disabilities.

Aims  The aim of this study was to map out the carers' perspective of symptoms of dementia among adults with DS in order to inform the development of an informant‐rated screening questionnaire.

Method  Unconstrained information from carers of people with DS and dementia regarding the symptoms, particularly the early symptoms of dementia, was gathered using a qualitative methodology. Carers of 24 adults with DS and dementia were interviewed. The interviews were recorded and fully transcribed. The transcripts were then analysed using qualitative software.

Results  There appeared to be many similarities in the clinical presentation of dementia in adults with DS and the non‐intellectually disabled general population. Like in the non‐intellectually disabled general population, forgetfulness especially, impairment of recent memory combined with a relatively intact distant memory and confusion were common, and presented early in dementia among adults with DS. However, many ‘frontal lobe’‐related symptoms that are usually manifested later in the process of dementia among the general population were common at an early stage of dementia among adults with DS. A general slowness including slowness in activities and speech, other language problems, loss of interest in activities, social withdrawal, balance problems, sleep problems, loss of pre‐existing skills along with the emergence of emotional and behaviour problems were common among adults with DS in our study.

Conclusions  This study highlights the similarities in the clinical presentation of dementia among the general population and people with DS with a particular emphasis on the earlier appearance of symptoms associated with the frontal lobe dysfunction among adults with DS.
The effectiveness of mood stabilizers and antiepileptic medication for the management of behaviour problems in adults with intellectual disability: a systematic review
Authors: Deb S. , Chaplin R. , Sohanpal S. , Unwin G. , Soni R. , Lenotre L.
Published: June 2007

Background  Psychotropic medications are used to manage behaviour problems in adults with intellectual disability (ID). One group of psychotropic medication are mood stabilizers such as lithium and some antiepileptic drugs.

Method  A comprehensive systematic review was performed to determine the evidence base for the effectiveness of mood stabilizers in the management of behaviour problems among adults with ID. Electronic searches of PsycInfo, Medline, Embase and Cinahl databases were conducted, as well as a thorough hand search for relevant literature. We reviewed primary trials relating to adults only that satisfied strict inclusion criteria.

Results  One randomized controlled trial (RCT) relating to lithium use and two non‐RCTs, one on lithium and the other on carbamazepine, were revealed. In addition, one prospective non‐controlled trial on sodium valproate and three retrospective case series studies were discovered, of which one considered the efficacy of lithium, one valproate and one topiramate.

Conclusions  The current evidence lends some support for the use of lithium and some antiepileptic mood stabilizer medication for the management of behaviour problems in adults with ID. However, because most studies reviewed here are riddled with obvious methodological constrains, the findings have to be interpreted with caution.
Adaptation in the Corticosterone and Hyperthermic Responses to Stress Following Repeated Stressor Exposure
Authors: Barnum C. J. , Blandino P. , Deak T.
Published: June 2007

Previous studies have shown that repeated daily exposure to the same (homotypic) stressor results in habituation of the corticosterone (CORT) response. Others have found that the stress response to a more ethologically relevant stressor, social defeat, does not habituate and, in some cases, sensitisation has been observed. Similar observations have been noted when core temperature is examined. Although habituation and/or sensitisation have been reported during stressor exposure, little is known about the development of an anticipatory fever in response to daily stressor exposure. The aim of the present study was to compare systematically commonly used laboratory stressors (i.e. restraint, cage confinement and social defeat) using a common set of procedures and analyses. Specifically, we examined: (i) the development of an anticipatory fever to repeated (5 days) homotypic stressor exposure; (ii) the adaptation of the fever response during stressor exposure; and (iii) the resolution of the fever response to stressors presented at the same time each day. For comparison, adaptation of the CORT response was also examined to assess the degree to which habituation to repeated stressor exposure may represent a more general response observed across diverse physiological measures. Habituation was observed after restraint and cage confinement, but not observed in either the CORT or hyperthermic responses to repeated social defeat. Furthermore, no anticipatory fever response was observed with repeated exposure to restraint, cage confinement, or social defeat. These data suggest that habituation to repeated stressor exposure may not occur with all homotypic stressor paradigms. In addition, rats do not appear to entrain an anticipatory fever response to a stressor presented at the same time each day, at least not within 5–6 days of repeated exposure.