bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings from data analysis and outcomes using metastudy techniques
Authors: Roe Brenda , Ostaszkiewicz Joan , Milne Jill , Wallace Sheila
Published: November 2006

Title. Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings from data analysis and outcomes using metastudy techniques

Aim.  This paper reports a comparison of the data analysis and outcomes from four Cochrane systematic reviews on bladder training and voiding programmes for the management of urinary incontinence using metastudy descriptive techniques to inform clinical practice, generate new ideas and identify future research directions.

Background.  Bladder training is used for cognitively and physically able adults to regain continence by increasing the time interval between voids. Prompted voiding, habit retraining and timed voiding, collectively known as voiding programmes, are generally used for people with cognitive and physical impairments in institutional settings. Bladder training and voiding programmes feature as common clinical practice for the management of urinary incontinence.

Methods.  A synopsis of four Cochrane systematic reviews that included randomized controlled trials on bladder training, prompted voiding, habit retraining and timed voiding was undertaken using metastudy techniques for the synthesis of qualitative research, and has provided a discursive comparison and contrast of the meta‐data analysis and outcomes of these reviews.

Results.  Frequency of incontinence was the most common and constant outcome measure of effectiveness in the reviews. Limited data were available on other health outcomes, change in dependency status, quality of life and cost‐effectiveness. The systematic review on bladder training included different types of urinary incontinence, whereas those on voiding programmes did not differentiate the type of incontinence. There is evidence on the effectiveness of bladder training but long‐term follow up studies are needed. Evidence on the effectiveness of voiding programmes is limited and not available for many outcomes.

Conclusion.  Future research needs to consider the theory underpinning interventions for bladder training and voiding programmes for urinary incontinence and should incorporate recognized ‘quality’ research designs, established outcomes and long‐term follow up. It is unclear whether health outcomes for people with comorbidities, cognitive and physical impairments will improve if extensive diagnostic and assessment investigations are undertaken.
Hospital food service: a comparative analysis of systems and introducing the ‘Steamplicity’ concept
Authors: Edwards J. S. A. , Hartwell H. J.
Published: November 2006

Background  Patient meals are an integral part of treatment hence the provision and consumption of a balanced diet, essential to aid recovery. A number of food service systems are used to provide meals and the Steamplicity concept has recently been introduced. This seeks, through the application of a static, extended choice menu, revised patient ordering procedures, new cooking processes and individual patient food heated/cooked at ward level, to address some of the current hospital food service concerns. The aim of this small‐scale study, therefore, was to compare a cook‐chill food service operation against Steamplicity. Specifically, the goals were to measure food intake and wastage at ward level; ‘stakeholders’ (i.e. patients, staff, etc.) satisfaction with both systems; and patients’ acceptability of the food provided.

Method  The study used both quantitative (self‐completed patient questionnaires, n = 52) and qualitative methods (semi‐structured interviews, n = 16) with appropriate stakeholders including medical and food service staff, patients and their visitors.

Results  Patients preferred the Steamplicity system overall and in particular in terms of food choice, ordering, delivery and food quality. Wastage was considerably less with the Steamplicity system, although care must be taken to ensure that poor operating procedures do not negate this advantage. When the total weight of food consumed in the ward at each meal is divided by the number of main courses served, at lunch, the mean intake with the cook‐chill system was 202 g whilst that for the Steamplicity system was 282 g and for the evening meal, 226 g compared with 310 g.

Conclusions  The results of this small study suggest that Steamplicity is more acceptable to patients and encourages the consumption of larger portions. Further evaluation of the Steamplicity system is warranted.
Chronic hepatitis B virus infection acquired in childhood: special emphasis on prognostic and therapeutic implication of delayed HBeAg seroconversion
Authors: Chu C.‐M. , Liaw Y.‐F.
Published: November 2006

Summary.  In high endemic areas of hepatitis B virus (HBV) infection, the vast majority of infection is acquired perinatally or during early childhood. The age of the patient is, therefore, almost equivalent to the duration of HBV infection. The natural history of chronic HBV infection consists of three chronological phases: immune tolerance, immune clearance and low replicative phases. The prevalence of hepatitis B e antigen (HBeAg) in asymptomatic HBV carriers is around 90% before 15 years of age, and decreases remarkably to less than 10% after 40 years of age. The immune clearance phase is characterized by a series of hepatitis flares and remissions. These will be followed eventually by HBeAg seroconversion, which is usually accompanied by remission of liver disease and confers favourable outcome. However, patients with persistent HBeAg seropositivity over 40 years of age are associated with a significantly higher risk for progression to cirrhosis than those with HBeAg seroconversion before 40 years of age, and thus should be considered as patients with ‘delayed’ HBeAg seroconversion. Antiviral or immunomodulatory therapy should be considered seriously for these patients.
Predictors of immunity after hepatitis A vaccination in HIV‐infected persons
Authors: Overton E. T. , Nurutdinova D. , Sungkanuparph S. , Seyfried W. , Groger R. K. , Powderly W. G.
Published: November 2006

Summary.  Hepatitis A virus (HAV) infection remains a health risk for human immunodeficiency virus (HIV)‐infected persons. While the inactivated HAV vaccine affords protection to immunocompetent persons >95% of the time, rates of developing protective antibody (anti‐HAV) in HIV+ persons are considerably lower. Although low CD4+ T‐cell counts have previously been reported to be correlated with this poor response, the effect of HIV viraemia on HAV vaccine response has not previously been reported. The medical records of HIV‐infected patients who had received at least one dose of HAV vaccine (Havrix, 1440 EIU) were reviewed for factors associated with the development of a protective anti‐HAV response. Serological data with regard to anti‐HAV status after vaccination were available in 238 patients with 133 individuals (49.6%) developing immunity after vaccination. In a logistic regression model, the only factors associated with a protective antibody response were an HIV plasma RNA level <1000 copies/mL at the time of vaccination (P = 0.011) and male gender (P = 0.016). Neither nadir CD4+ T cell count nor CD4+ T‐cell count at time of vaccination were predictive of the development of anti‐HAV. Suppression of HIV replication at time of vaccination is associated with a protective antibody response to HAV vaccination in HIV‐infected adults. The low rate of response warrants further research in alternative strategies for HAV vaccination among HIV‐infected persons.
Expression of a nitric oxide degrading enzyme induces a senescence programme in Arabidopsis
Authors: MISHINA TATIANA E. , LAMB CHRIS , ZEIER JÜRGEN
Published: November 2006

Nitric oxide (NO) has been proposed to act as a factor delaying leaf senescence and fruit maturation in plants. Here we show that expression of a NO degrading dioxygenase (NOD) in Arabidopsis thaliana initiates a senescence‐like phenotype, an effect that proved to be more pronounced in older than in younger leaves. This senescence phenotype was preceded by a massive switch in gene expression in which photosynthetic genes were down‐regulated, whereas many senescence‐associated genes (SAGs) and the 1‐aminocyclopropane‐1‐carboxylic acid (ACC) synthase gene ACS6 involved in ethylene synthesis were up‐regulated. External fumigation of NOD plants with NO as well as environmental conditions known to stimulate endogenous NO production attenuated the induced senescence programme. For instance, both high light conditions and nitrate feeding reduced the senescence phenotype and attenuated the down‐regulation of photosynthetic genes as well as the up‐regulation of SAGs. Treatment of plants with the cytokinin 6‐benzylaminopurin (BAP) reduced the down‐regulation of photosynthesis, although it had no consistent effect on SAG expression. Metabolic changes during NOD‐induced senescence comprehended increases in salicylic acid (SA) levels, accumulation of the phytoalexin camalexin and elevation of leaf γ‐tocopherol contents, all of which occurred during natural senescence in Arabidopsis leaves as well. Moreover, NO fumigation delayed the senescence process induced by darkening individual Arabidopsis Columbia‐0 (Col‐0) leaves. Our data thus support the notion that NO acts as a negative regulator of leaf senescence.
Exhumation during crustal folding in the Namche‐Barwa syntaxis
Authors: Burg Jean‐Pierre , Davy Philippe , Nievergelt Peter , Oberli Felix , Seward Diane , Diao Zhizhong , Meier Martin
Published: November 2006

Geological observation in the eastern end of the Himalaya shows that the Asia/India Suture is folded. Metamorphic rocks derived from India occur structurally below the suture, in the core of a regional antiform. Isotopic and fission track dating establish cooling‐exhumation of rocks from c.30 km depth within the last 4 Myr. We argue that exhumation is caused by ∼ 10 mm yr‐1 erosion coeval with crustal scale folding.
Unusual isotopic phenomena in Welsh quarry water and carbonate crusts
Authors: Andrews Julian E. , Gare Simon G. , Dennis Paul F.
Published: November 2006

Modern terrestrial speleothem‐like calcareous deposits in streams draining a disused lime quarry on Black Mountain, South Wales have anomalously negative δ18O and δ13C compositions compared with other similar European deposits. Black Mountain water chemistry is unusual only in its locally very high pH (> 11.5) and carbonate ion concentrations. The high pH is caused by dissolution of lime spoil, resulting in high OH– concentrations. This high alkalinity causes uptake of atmospheric CO2 and strong fractionation of both carbon and oxygen stable isotopes, resulting in calcite precipitates with unusually negative isotopic compositions. Since shifts in δ18O of < 1° are highly significant for Holocene palaeoclimate reconstructions, depletions caused by hyperalkaline waters must be avoided. While extreme lime spoil contamination should be obvious, less heavily affected sites will record smaller fractionation effects and might escape detection. Even small depletions from low‐level contamination will have large effects on palaeotemperatures based on carbonate crust δ18O values.
The Kostomuksha greenstone belt, NW Baltic Shield: remnant of a late Archaean oceanic plateau?
Authors: Puchtel I. S. , Hofmann A. W. , Jochum K. P. , Mezger K. , Shchipansky A. A. , Samsonov A. V.
Published: November 2006

The Kostomuksha greenstone belt consists of two lithotectonic terranes, one mafic igneous and the other sedimentary, separated by a major shear zone. The former contains submarine 2.8 Gyr old komatiite‐basalt lavas and volcaniclastic lithologies with trace element and isotopic compositions resembling those of recent oceanic flood basalts [ɛNd(T) =+ 2,8, μ.1= 8.73 (Nb/Th)N= 1.5–2.1 (Nb/La)N= 1.0–1.5]. We suggest that the mafic terrane is a remnant of the upper crustal part of an Archaean oceanic plateau derived from partial melting of a mantle plume head. When the plateau reached the continental margin, it collided with the sedimentary terrane but was too buoyant to subduct. As a result, the volcanic section of the plateau was imbricated and obducted thus becoming a new piece of continental crust. The deeper zones were subducted and disappeared from the geological record.
A laterally constricted shear zone system — the Nordre Strømfjord steep belt, Nagssugtoqidian Orogen, W. Greenland
Authors: Passchier C. W. , den Brok S. W. I. , van Gool J. A. M. , Marker M. , Manatschal G.
Published: November 2006

Many ductile shear zones are interpreted to operate by simple shear flow but some form under other flow regimes. Lineations and foliations in such shear zones can lie obliquely to those in simple shear zones, which can lead to erroneous tectonic interpretations on the assumption of simple shear flow. This paper describes a gently dipping shear zone system from the N‐central segment of the Palaeoproterozoic Nagssugtoqidian orogen of W. Greenland, which operated with a lateral constriction component. This resulted in the development of upright folds with axes parallel to the transport direction where the constriction component is weak. Where it is strong, a linear fabric and even a subvertical foliation normal to the rotation axis of bulk flow developed. This steep foliation is interpreted as the origin of the Nordre Strømfjord steep belt, previously interpreted as a crustal‐scale sinistral transcurrent shear zone. Shear zones of this type may occur elsewhere and shear zone fabrics should therefore be carefully analysed before the direction of tectonic transpost can be determined
Sensitivity and evolution of sea‐turtle magnetoreception: observations, modelling and constraints from geomagnetic secular variation
Authors: Courtillotl Vincent , Hulot Gauthier , Alexandrescu Mioara , le Mouë Jean‐Louis , Kirschvink Joseph L.
Published: November 2006

In a series of papers, Lohmann and Lohmann (1991, 1994a, 1994b, 1996) provide evidence for remarkable sensitivity of sea‐turtles to the earth's magnetic field and suggest that it is used by these animals to determine global position and to navigate. In this paper, we emphasize that a consequence of these observations taken together is that sea‐turtles should be able to accurately detect the full (vector) magnetic‐field, and perhaps spatial gradients. In order to interpret these observations, we propose a simple model in which the turtle is considered as a small permanent magnet, on which the geomagnetic field exerts a torque. This torque varies as a function of turtle azimuth and field parameters which depend mainly on latitude. Although this simple model accounts for some of the observational evidence, discrepancies might be due to a number of other factors, such as speed of magnetic field changes during experiments or lack of field homogeneity. Also, the earth's field has varied significantly over the last few centuries and some of the magnetic features observed today and suggested by the Lohmanns for use in sea‐turtle navigation were very different or even not present two or three centuries ago. This would place constraints on the rate at which genetically inherited magnetic behavioural preferences can change with time. Alternately, it may imply that the experimental results need to be re‐evaluated and complemented.
Preliminary isotopic and palaeomagnetic evidence for Younger Dryas and Holocene climate evolution in NE Asia
Authors: Bernasconi S. M. , Dobson J. , McKenzie J. A. , Ariztegui D. , Niessen F. , Hsü K. J. , Chen Y. , Yang Q.
Published: November 2006

Until recently the Younger Dryas cooling event was thought to be restricted to the North Atlantic region. However, preliminary evidence based on magnetic susceptibility and stable isotope data from Lake Hetongchahannor, a hypersaline alkaline lake in Inner Mongolia indicates that this event is observed in NE Asia. In addition we find indications of wetter climatic conditions between 9000 and 6000 yr BP, possibly due to increased monsoon activity, followed by a progressive aridification towards the present time.
Growth response of six weed species and spring barley (Hordeum vulgare) to increasing levels of nitrogen and phosphorus
Authors: ANDREASEN C , LITZ A‐S , STREIBIG JC
Published: November 2006

A glasshouse experiment was carried out to investigate the influence of increasing levels of nitrogen and phosphorus on the growth of six common weed species growing alone or in competition with spring barley (Hordeum vulgare). Capsella bursa‐pastoris, Chenopodium album, Papaver rhoeas, Sinapis arvensis, Spergula arvensis, Viola arvensis and spring barley were grown in pots with different levels of nitrogen (0, 30, 60, 90, 120 and 150 kg N ha−1) or phosphorus (0, 10, 20, 30, 40 and 60 kg P ha−1). The aboveground parts of the plants were harvested after 7 weeks and the dry weight of shoots, percentage N and P content of the shoot and uptake of N and P were determined. A linear or a polynomial model was used to describe the data. Growing alone, Spergula arvensis was the only weed species that increased its dry weight at the same rate as barley. Weed species with low dry weight increase had larger increases in percentage N or P content than barley, indicating a luxury accumulation of nutrients. The uptake of N and P per pot did not differ much between weeds and barley. V. arvensis and P. rhoeas accumulated least nutrients (per cent of dry matter) and Spergula arvensis accumulated most. Weeds grew poorly in competition with barley. The percentage N and P content in barley did not change when they grew in competition with weeds.
A gift or a yoke? Women’s and men’s responses to genetic risk information from BRCA1 and BRCA2 testing
Authors: D’Agincourt‐Canning L
Published: November 2006

This qualitative study explored the impact of genetic risk information from BRCA1/2 testing on individuals’ subjective understandings of self and self‐identity. In‐depth interviews were conducted with 39 participants (34 women and 5 men) who had received test results from BRCA1/2 testing. Themes emerging from qualitative data analysis revealed that participants linked their positive results to becoming more aware of their physical selves (embodied self), their selves in relation to family (familial‐relational self) and their selves in relation to wider kinship or social groups (social self). Genetic information was generally viewed as enabling; it allowed participants to take measures (surveillance or prophylactic surgery) to confront the disease. However, for a small minority of women, knowledge about their genetic risk had a profound and limiting effect on their agency. Rather than giving them a sense of control, they saw little opportunity to fight the disease. For a few people, identification of a genetic mutation thrust them into an uncertain state, that is in a position of being neither ill nor completely well. In one case, BRCA information led to a disruption of social identity. Further work is needed to assess the impact of age and life stage on psychological responses to genetic information on cancer susceptibility.
PKD2 gene mutation analysis in Korean autosomal dominant polycystic kidney disease patients using two‐dimensional gene scanning
Authors: Chung W , Kim H , Hwang YH , Kim SY , Ko A‐r , Ro H , Lee KB , Lee JS , Oh K‐H , Ahn C
Published: November 2006

Autosomal dominant polycystic kidney disease (ADPKD) is genetically heterogeneous and is caused by mutations in the PKD1 or PKD2 genes. ADPKD caused by PKD2 mutations is characterized by a longer survival and a later onset of end‐stage renal disease than ADPKD caused by PKD1 mutations. PKD2 encodes a 2.9‐kb messenger RNA and is derived from 15 exons. Two‐dimensional gene scanning (TDGS) is more efficient in detecting mutations in genes such as PKD2 because it can scan the whole coding regions simultaneously. In order to determine the prevalence of Korean PKD2 patients, all the coding sequences of PKD2 were screened using TDGS and direct sequencing in 46 randomly selected ADPKD patients (group 1). Another 45 ADPKD patients (group 2), who were presumed to be PKD2 patients, were screened in order to identify the type of mutation in the Korean PKD2 patients. Eight novel different mutations and three known mutations in the PKD2 gene were detected in 17 patients: 6 patients (13.0%) in group 1 and 11 patients (24.4%) in group 2. Considering the sensitivity of TDGS, the prevalence of PKD2 in Korean population might be greater than 18.6%. Both known and novel mutations were identified by TDGS in Korean PKD2 patients. Overall, these results showed that TDGS might be useful for diagnosing PKD2.
Clinical and molecular analysis of X‐linked Charcot‐Marie‐Tooth disease type 1 in Spanish population
Authors: Casasnovas C , Banchs I , Corral J , Martínez‐Matos JA , Volpini V
Published: November 2006

From 1995 to 2004, 979 families with hereditary peripheral neuropathy were referred to the Genetic Diagnosis Center. Using single‐strand conformation analysis (SSCA), the connexin 32 gene was analysed in all the patients from 498 families with sporadic or dominant inheritance with no male‐to‐male transmission and absence of the 17p2 duplication or deletion. Affected males had pes cavus, distal leg weakness, muscular distal atrophy, areflexia and distal sensory loss. The 106 families in which SSCA revealed abnormal migration electrophoresis were directly sequenced. We found 34 families (59 patients) with mutations in connexin 32 gene. In electrophysiological studies, 58.8% families presented slow and 14.7% intermediate nerve conduction velocities. Molecular findings revealed that codon 164 (29.4 ± 15.3%) and the second extracellular (EC2) domain (44.1 ± 16.6%) were the most frequently affected codon and domain of the connexin 32. Six novel mutations, Leu39fs, Glu47Gly, His153fs, Cys179Tyr, Cys201Phe and Ser211fs, were found in our study.
Pediatric renal transplantation with mycophenolate mofetil immunosuppression in a single center from Mexico
Authors: Martinez‐Mier Gustavo , Mendez‐Lopez Marco T. , Budar‐Fernandez Luis F. , Estrada‐Oros Jorge , Franco‐Abaroa Regino , George‐Micelli Esteban , Rios‐Martinez Luis , Calzada‐Grijalva Jose Francisco , Gonzalez‐Velazquez Felipe
Published: November 2006

Abstract:  An MMF‐based immunosuppression has reduced the acute rejection rate in adults and in children in the early post‐transplantation period. In the present study, pediatric renal transplantation patients on a CyA, MMF, and steroids regimen were prospectively evaluated. Patients with CyA, MMF, and steroid therapy without antibody induction were evaluated for surgical aspects, renal function, rejection, and survival, growth after transplantation, adverse events and medication discontinuation. Between February 2003 and May 2005, 21 kidney transplantation patients under 18 yr old were followed for at least 12 months. Within one year after transplantation, three patients developed four episodes of acute rejection (19%). Graft loss because of rejection occurred in one patient. One‐year mean serum creatinine was 1.19 ± 0.3 mg/dL. Mean calculated CrCl by Schwartz formula was 82.3 ± 19.7 mL/min*1.73 m2. Major adverse events included infections of the urinary tract and diarrhea, abdominal pain, and GI symptoms. No patients have discontinued the use of MMF. Good results in pediatric kidney transplantation can be achieved by using CyA/MMF/steroids. MMF is effective and relatively safe in reducing the incidence of acute rejection even without induction therapy 12 months after transplantation.
Durable remission following a third allogeneic stem cell transplantation in a patient with repeatedly relapsing SAA. The importance of stroma cells for sustained engraftment?
Authors: Weber‐Mzell Daniela , Urban Christian , Benesch Martin , Rojacher Tanja , Zois Birgit , Höfler Gerald , Schwinger Wolfgang
Published: November 2006

Abstract:  Diagnosis of acquired AATP which finally progressed to SAA was established in an eight‐yr‐old boy. PBSCT from an HLA‐identical unrelated donor using high numbers of CD34+ selected stem cells was performed and resulted in complete remission for almost two yr. However, SAA reoccurred with 100% donor hematopoiesis and was reversed by a second CD 34+ selected PBSCT from the same donor. Declining blood cell counts after an interval of two yr indicated second relapse. Chimerism analysis in PB and BM aspirates revealed a small autologous cell population of 4–12% and 2–11%, respectively. Finally, a third transplantation with unmanipulated BM from the same donor resulted in sustained remission with 100% donor hematopoiesis. The patient is in complete remission for more than five yr following the third SCT. Late graft failure or late graft rejection known to occur after transplantation of highly purified CD34+ cells, or even graft exhaustion caused by stromal dysfunction due to the underlying disease necessitated a third transplantation. Regardless of the cause of relapse, transplantation of unmanipulated BM instead of highly purified PBSCTs led to a permanent and stable engraftment in a third attempt after two previous PBSCTs.
Altitudinal variation in photosynthetic capacity, diffusional conductance and δ13C of butterfly bush (Buddleja davidii) plants growing at high elevations
Authors: Shi Zuomin , Liu Shirong , Liu Xingliang , Centritto Mauro
Published: November 2006

In this study, we have examined several physiological, biochemical and morphological features of Buddleja davidii plants growing at 1300 m above sea level (a.s.l.) and 3400 m a.s.l., respectively, to identify coordinated changes in leaf properties in response to reduced CO2 partial pressure (Pa). Our results confirmed previous findings that foliar δ13C, photosynthetic capacity and foliar N concentration on a leaf area basis increased, whereas stomatal conductance (gs) decreased with elevation. The net CO2 assimilation rate (Amax), maximum rate of electron transport (Jmax) and respiration increased significantly with elevation, although no differences were found in carboxylation efficiency of Rubisco (Vcmax). Consequently, also the Jmax to Vcmax ratio was significantly increased by elevation, indicating that the functional balance between Ribulose‐1,5‐biphosphate (RuBP) consumption and RuBP regeneration changes as elevation increases. Our results also indicated a homeostatic response of CO2 transfer conductance inside the leaf (mesophyll conductance, gm) to increasing elevation. In fact, with elevation, gm also increased compensating for the strong decrease in gs and, thus, in the Pi (intercellular partial pressure of CO2) to Pa ratio, leading to similar chloroplast partial pressure of CO2 (Pc) to Pa ratio at different elevations. Because there were no differences in Vcmax, also A measured at similar PPFD and leaf temperature did not differ statistically with elevation. As a consequence, a clear relationship was found between A and gm, and between A and the sum of gs and gm. These data suggest that the higher dry mass δ13C of leaves at the higher elevation, indicative of lower long‐term Pc/Pa ratio, cannot be attributed to changes either in diffusional resistances or in carboxylation efficiency. We speculate that because temperature significantly decreases as the elevation increases, it dramatically affects CO2 diffusion and hence Pc/Pa and, consequently, is the primary factor influencing 13C discrimination at high elevation.
Does esomeprazole prevent post‐operative nausea and vomiting?
Authors: Raeder J. , Dahl V. , Bjoernestad E. , Edlund G. , Modin S. , Naucler E. , Bergheim R. , Kilhamn J.
Published: November 2006

Background:  Esomeprazole is a potent proton pump inhibitor (PPI), reducing acid production as well as gastric juice volume. This study evaluated the possible beneficial effect of esomeprazole on reducing post‐operative nausea and vomiting (PONV).

Methods:  Patients undergoing laparoscopic or open gynaecological surgery, or laparoscopic cholecystectomy were randomized to receive three peri‐operative doses double blindly of either esomeprazole 40 mg or placebo, given intravenously or orally. All patients were given a standardized anaesthesia regimen including fentanyl and sevoflurane/nitrous oxide.

Results:  The study population consisted of 284 patients. Demographic data and known PONV risk factors were similar for the two treatment groups. PONV was observed in 77% of patients on esomeprazole vs. 81% on placebo (NS) and rescue antiemetic medication was needed in 56% vs. 53%, respectively (NS). The proportion of patients that vomited during 0–24 h was lower on esomeprazole than placebo (38% vs. 49%; NS), and the mean amount of vomit was significantly lower (52 vs. 86 g; P < 0.05). The use of neostigmine, use of opioids and type of surgery were significant risk factors for PONV (P < 0.05). The 24‐h incidence of PONV was 63% after laparoscopic gynaecology, 80% after laparoscopic cholecystectomy and 88% after open gynaecological laparotomy, whereas laparoscopic cholecystectomy had the lowest risk when corrected for other risk factors of PONV.

Conclusion:  Esomeprazole had no clinically relevant effect on the overall 24‐h incidence of PONV. However, esomeprazole significantly reduced the total amount of vomit during 24‐h post‐operatively. This may be of value in patients with an increased risk of pulmonary aspiration.
Cervical epidural analgesia via a thoracic approach using nerve‐stimulation guidance in adult patients undergoing total shoulder replacement surgery
Authors: Tsui B. C. H. , Bury J. , Bouliane M. , Ganapathy S.
Published: November 2006

Background:  Continuous cervical epidural anesthesia can provide excellent peri‐ and post‐operative analgesia, although several factors prevent its widespread use. Advancing catheters from thoracic levels to the cervical region may circumvent these barriers, provided they are accurately positioned. We hypothesize that guiding catheters from thoracic to cervical regions using low‐current epidural stimulation will have a high success rate and enable excellent analgesia in adults undergoing total shoulder arthroplasty.

Methods:  After Institutional Review Board approval, adult patients were studied consecutively. A 17‐G Tuohy needle was inserted into the thoracic epidural space using a right paramedian approach with loss of resistance. A 20‐G styletted epidural catheter, with an attached nerve stimulator, was primed with saline and a 1–10 mA current was applied as it advanced in a cephalad direction towards the cervical spine. Muscle twitch responses were observed and post‐operative X‐ray confirmed final placement. After a test dose, an infusion (2–8 ml/h) of ropivacaine 2 mg/ml and morphine 0.05 mg/ml (or equivalent) was initiated. Verbal analog pain scale scores were collected over 72 h.

Results:  Cervical epidural anesthesia was performed on 10 patients. Average current required to elicit a motor response was 4.8 ± 2.0mA. Post‐operative X‐ray of catheter positions confirmed all catheter tips reached the desired region (C4–7). The technical success rate for catheter placement was 100% and excellent pain control was achieved. Catheters were positioned two to the left, four to the right and four to the midline.

Conclusion:  This epidural technique provided highly effective post‐operative analgesia in a patient group that traditionally experiences severe post‐operative pain and can benefit from early mobilization.
Identification and geographic distribution of vegetative compatibility types of Cryphonectria parasitica and occurrence of hypovirulence in Greece
Authors: Perlerou C. , Diamandis S.
Published: November 2006

Castanea sativa, one of the most precious forest trees in Greece, is affected by the spread of chestnut blight all over the country. Identification and mapping of the vegetative compatibility (vc) types of the fungus Cryphonectria parasitica was carried out and the occurrence of hypovirulence was checked. In 11 chestnut populations distributed all over Greece, 627 isolates were obtained and their vc type was determined. Four vc types were identified by means of tester isolates: EU‐12 was found to be the dominant vc type reaching a percentage of 88%, with EU‐2 (6%), EU‐10 (3%) and EU‐1 (2%) following. EU‐12 was found in all 11 populations investigated whereas EU‐2 was isolated from five populations and EU‐10 and EU‐1 were found only in one population each. Natural hypovirulence was also found in five populations of 11 examined. Perithecia were not found in either population, a finding supported by the fact that all Greek isolates examined belonged to a single mating type, MAT‐1. The low diversity in vc types, the absence of the perithecial stage and the occurrence of natural hypovirulence in some areas support the feasibility of successful application of biological control on the national level in Greece.
Endophytic fungi in Siberian larch (Larix sibirica) needles
Authors: Kauhanen M. , Vainio E. J. , Hantula J. , Eyjolfsdottir G. G. , Niemelä P.
Published: November 2006

Endophytic fungi were isolated from surface‐sterilized needles of the Siberian larch. Samples were collected from a native growing site of the Siberian larch in north‐western Russia and from sites in Russia, Finland and Iceland where the Siberian larch has been introduced. The isolated fungi were classified to operational taxonomic units (OTUs) using colony morphology and molecular characteristics. Needle colonization rates were 50–99% and in total 79 OTUs were found. There were five common OTUs, which covered 86.2% of all isolates. The most common OTU lacked from the youngest plantations in Finland (Solböle) and in Iceland (Kjarnaskógur). The highest similarity in regard to the frequency of OTUs occurred among the stands established long ago in Finland, and the UPGMA clustering using similarity indices separated the seven stands into two major groups.
Survival and vitality of Gremmeniella abietina on Pinus sylvestris slash in northern Sweden
Authors: Witzell J. , Bernhold A. , Hansson P.
Published: November 2006

Survival and vitality of Gremmeniella abietina on Pinus sylvestris slash was studied in northern Sweden during 2003 and 2004. Once a month between September 2003 and April 2004, two to three trees were cut down and debranched. Shoots with pycnidia were sampled at the felling date and then at every consecutive month. The percentage of germinated conidia from each shoot was calculated after 24, 48 and 72 h incubation. The vitality of G. abietina pycnidia in the slash remained high the whole period. Intact pycnidia were found on slash several months after the time of conidial sporulation, which indicates that new pycnidia may be produced on dead pine branches. Sampling of shoots from slash on 13‐ to 18‐month‐old clear‐cuts showed conidial germination capacity as high as in pycnidia collected in fresh slash. Due to survival of G. abietina in slash it is recommended to postpone planting of P. sylvestris seedlings in northern boreal areas to the third vegetation period after sanitary clear‐cuts.
A pilot study of ice‐slurry application for inducing laparoscopic renal hypothermia
Authors: Laven Brett A. , Kasza Kenneth E. , Rapp David E. , Orvieto Marcelo A. , Lyon Mark B. , Oras John J. , Beiser David G. , Vanden Hoek Terry L. , Son Hyunjin , Shalhav Arieh L.
Published: November 2006

OBJECTIVE

To assess, in a pilot study, the feasibility of delivering a microparticulate ice slurry (MPS) to provide regional hypothermia, as renal cooling during laparoscopic procedures is cumbersome and inefficient.

MATERIALS AND METHODS

An ex vivo preparation was used to simulate the boundary conditions of a kidney. Four pig kidneys were placed onto a thin membrane overlying a constant temperature bath (37 °C) with parenchymal thermocouples. Renal surfaces were coated with MPS and temperatures recorded. In an in vivo pig model we assessed laparoscopic delivery and cooling ability of the MPS under physiological conditions. Kidneys in two pigs were laparoscopically exposed; thermocouple probes were placed throughout the kidney and the hilum was clamped. MPS was delivered through a modified 5‐mm laparoscopic suction/irrigation cannula. Cortical and core body temperatures were measured.

RESULTS

In the ex vivo study, the mean (sd) initial temperature was 37.1 (0.4) °C; the mean time to reach 15 °C was 10.3 (2.6) min and the mean nadir temperature was 13.0 (1.5) °C. In vivo, the MPS was delivered with no technical difficulty; the mean renal unit starting temperature and core body temperature were 37.2 °C and 37.0 °C, respectively. The mean (range) time to reach 15 °C was 16.5 (5.5–28.6) min. The mean nadir core body temperature was 34.0 °C.

CONCLUSION

This initial study showed efficient and rapid induction of renal hypothermia using MPS delivered through 5‐mm laparoscopic ports, with no technical difficulty. These exploratory pilot findings support further, larger scale, histopathological and renal functional investigations of topical ice slurries as a means of providing renal hypothermia in laparoscopic procedures.
A History of Drug Advertising: The Evolving Roles of Consumers and Consumer Protection
Authors: DONOHUE JULIE
Published: November 2006

Direct‐to‐consumer advertising (DTCA) of prescription drugs in the United States is controversial. Underlying the debate are disagreements over the role of consumers in medical decision making, the appropriateness of consumers engaging in self‐diagnosis, and the ethics of an industry promoting potentially dangerous drugs. Drug advertising and federal policy governing drug advertising have both responded to and reinforced changes in the consumer's role in health care and in the doctor‐patient relationship over time. This article discusses the history of DTCA in the context of social movements to secure rights for health care patients and consumers, the modern trend toward consumer‐oriented medicine, and the implications of DTCA and consumer‐oriented medicine for contemporary health policy debates about improving the health care system.
Self‐concept in young adults with a learning disability from the Jewish community
Authors: Bunning Karen , Steel Gabriela
Published: November 2006

A small pilot study was conducted to explore the self‐concept of young people with a learning disability from a Jewish community in an inner city area. Four young people participated in the project. All attended a college dedicated to the further education of people with special needs from the Jewish community. Semi‐structured interviews were carried out with the participants. A low‐technology augmentative communication strategy called ‘Talking Mats’ was employed [J. Murphy and L. Cameron (2002b)Talking Mats and learning disability: a low‐tech resource to help people to express their views and feelings. Scotland, University of Stirling] to cater for the participant's varying communication needs. The participant placed relevant symbols on a mat to capture views expressed during interview. Three key themes emerged from the data: ‘being young’, ‘having a learning disability’ and ‘being Jewish’. The narratives associated with each theme were closely intertwined. Membership of the Jewish community was central to the concept of self. The research highlighted the importance of context and cultural belonging to the construction of identity. Use of ‘Talking Mats’ during interview proved an accessible format, both for exploring the views of people with learning disabilities, and providing them with feedback about the research.
An evaluation of research and training resources for the sex education of people with moderate to severe learning disabilities
Authors: Grieve Alan , McLaren Shona , Lindsay William R.
Published: November 2006

To review the literature on issues surrounding the sexuality of people with moderate to severe learning disability (SLD), and evaluate available assessment and training methods. This research arose from an increasing number of referrals for clinical intervention in the training and education of appropriate social and sexual behaviour in people with moderate to SLD. What became apparent was the lack of suitable materials and assessments, which is significant as a large number of persons with SLD have problems with language, and so require tools and programmes which have enhanced levels of pictorial support. This research was necessary as people with SLD are vulnerable and have been open to emotional and sexual abuse [Ment Handicap Res16 (1993) 193]. Also, the present study was also required to help keep clients safe and reduce their vulnerability. It has been proposed that this should be achieved through providing educative input. An extensive review of the literature revealed that the research on sexuality in SLD was limited. Furthermore, where research had been conducted, poor methodology or validation issues were common, and materials appeared overly complicated for clients with moderate to SLD. Further research into the development and validation of assessment tools and training programmes which increase appropriate sexual behaviours is urgently required.
Molecular Epidemiology of Phenylalanine Hydroxylase Deficiency in Southern Italy: a 96% Detection Rate with Ten Novel Mutations
Authors: Daniele A. , Cardillo G. , Pennino C. , Carbone M. T. , Scognamiglio D. , Correra A. , Pignero A. , Castaldo G. , Salvatore F.
Published: November 2006

Hyperphenylalaninemia (HPA) comprises a group of autosomal recessive disorders mainly caused by phenylalanine hydroxylase (PAH) gene mutations. We investigated PAH mutations in 126 HPA patients from Southern Italy who were identified in a neonatal screening program. The promoter, coding and exon‐flanking intronic sequences of the PAH gene were amplified and sequenced. Mutations were identified in 240/249 alleles (detection rate: 96.4%). We found 60 gene variants; the most frequent were p.R261Q (15.7% of alleles), p.A403V (11.6% of alleles) and c.1066‐11G > A (8.8% of alleles). The remaining mutations were rare, and ten are novel. This mutation epidemiology differs from that reported for Northern Italy and other European countries. We also identified several discordant genotype/phenotype correlations. About two‐thirds of all mild phenylketonuria patients showed at least one tetrahydrobiopterin (BH4)‐responsive mutation, and are thus candidates for a customized therapeutic approach.
The Early Jurassic ammonite Badouxia from British Columbia, Canada
Authors: LONGRIDGE LOUISE M. , SMITH PAUL L. , TIPPER HOWARD W.
Published: November 2006

Abstract:  Most species of the Lower Jurassic ammonite genus Badouxia are restricted to the eastern Pacific where they are of fundamental importance to the Hettangian/Sinemurian ammonite zonation of North America. The fauna from the type area for the genus has been restudied and four species and two transitional forms are now recognized. Badouxia forticostata and Badouxia castlensis are new. Badouxia occidentalis (Frebold) and Badouxia oregonensis Taylor are placed in synonymy with Badouxia canadensis (Frebold). These major taxonomic changes and subsequent modification to the range of B. canadensis require revisions to the current zonation for the Western Cordillera of North America. The Oregonensis Zone is re‐named the Mineralense Zone. The Canadensis Zone is abandoned and its previously defined Rursicostatum and Columbiae subzones are elevated to the level of full zones. Large samples indicate that most species of Badouxia display a remarkable range of continuously variable morphology. In addition, the genus shows some of the best‐documented evidence of sexual dimorphism in Early Jurassic ammonites. Badouxia spans the Hettangian/Sinemurian boundary and based on the range of different species, five stratigraphic intervals are recognized. Intervals 1–3 correlate with the north‐west European Angulata Zone. The majority of interval 4 and the whole of interval 5 correlate with the north‐west European Bucklandi Zone. The age of the base of interval 4 is uncertain.
Marine reptiles from the Lower Cretaceous of South Australia: elements of a high‐latitude cold‐water assemblage
Authors: KEAR BENJAMIN P.
Published: November 2006

Abstract:  The Lower Cretaceous rocks of South Australia have yielded a diverse marine reptile assemblage of up to five families of plesiosaur (including a new cryptoclidid or cimoliasaurid, indeterminate elasmosaurids, a possible polycotylid, rhomaleosaurids, and pliosaurid) and one family of ichthyosaur (ophthalmosaurid). Other common associated vertebrates include chimaerids and osteichthyans. Sharks, dipnoans and dinosaurs are uncommon and marine turtles are notably absent. The main fossil‐producing strata belong to the Lower Aptian–Lower Albian Bulldog Shale although the Upper Albian Oodnadatta Formation has produced isolated elements. Both these units comprise finely laminated shaly mudstones and claystones deposited in a transgressive shallow coastal, epicontinental marine environment. Estimates of palaeolatitude place South Australia between 60° and 70°S, in the late Early Cretaceous. Sedimentary structures (including lonestone boulders and glendonites), fossils, isotope data and climatic modelling also indicate that seasonally cool–cold conditions (possibly with winter freezing) prevailed during deposition of the Bulldog Shale. This contrasts markedly with climate regimes typically tolerated by modern aquatic reptiles but suggests that some of the South Australian Mesozoic taxa may have possessed adaptations (including elevated metabolic levels and/or annual migration) to cope with low temperatures. A high proportion of juvenile plesiosaur remains in the Bulldog Shale might also indicate that nutrient‐rich cold‐water coastal habitats functioned as both ‘safe calving grounds’ and refuges for young animals prior to their entering the open sea as adults. The occurrence of plesiosaurs and ichthyosaurs in the high‐latitude Lower Cretaceous of southern Australia, along with plesiosaurs and mosasaurs in the Upper Cretaceous of South America, Antarctica, New Zealand and the Chatham Islands, demonstrates that Mesozoic marine reptiles utilized southern high‐latitude environments over a considerable period of time, and that these records do not represent casual occupation by isolated taxa.
Suburban life and the boundaries of nature: resilience and rupture in Australian backyard gardens
Authors: Head Lesley , Muir Pat
Published: November 2006

Despite an academic shift from dualistic to hybrid frameworks of culture/nature relations, separationist paradigms of environmental management have great resilience and vernacular appeal. The conditions under which they are reinforced, maintained or ruptured need more detailed attention because of the urgent environmental challenges of a humanly transformed earth. We draw on research in 265 Australian backyard gardens, focusing on two themes where conceptual and material bounding practices intertwine; spatial boundary‐making and native plants. We trace the resilience of separationist approaches in the Australian context to the overlay of indigeneity/ non‐indigeneity atop other dualisms, and their rupture to situations of close everyday engagement between people, plants, water and birds. Our ethnographic methods show that gardens are places where both attitudes and practices can change in the process of such engagements. In a world where questions of sustainability are increasingly driven by cities and their residents, these chains of agency help identify areas of hope and transformative potential as well as concern.