bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance of mowing and flood frequency in promoting species richness in restored floodplains
Authors: Gerard Marian , El Kahloun Mohssine , Rymen Joke , Beauchard Olivier , Meire Patrick
Published: November 2009

In recent years, European water management policies have promoted floodplain rehabilitation for flood mitigation purposes. This could provide opportunities for the restoration of valuable floodplain meadows. However, during restoration projects, it is essential to understand the effects of the measures undertaken. In this study, we focus on the interaction between flood frequency and mowing in determining species composition of temperate lowland floodplain meadows. We hypothesized that the interaction of regular flooding with annual mowing would result in higher species richness than annual mowing or regular flooding alone.

We compared the composition of annually mown and non‐mown vegetation located in floodplain sites differing in flood frequencies. The presence of different plant growth forms and functional types was investigated in order to explain the mechanisms underlying the differences found.

Both flood frequency and mowing affected species composition. However, flood regime was less important than mowing regime.

Mowing was shown to strongly affect species composition by reducing productivity and competitiveness and offering opportunities for weak competitors. Annually mown sites harboured higher numbers of smaller species compared to non‐mown sites which supported higher populations of tall graminoid species. CSR strategists (where C is competitiveness, S is stress‐tolerance and R is ruderality) were most common in mown sites, demonstrating that mowing imposes a moderate degree of disturbance and nutrient stress.

Only the combination of frequent flooding with annual mowing clearly increased species richness. This can be attributed to the fact that mowing provides the necessary gaps for germination of flood imported seeds.

Synthesis and applications. Apart from focusing on the restoration of flood dynamics, managers should pay attention to the implementation and maintenance of extensive land management practices to ensure sustainable restoration results. Note that many European riparian sites have been abandoned during the last 20 years as a result of changes in policies and agricultural markets, yet annual disturbance and/or the creation of open vegetation gaps through annual mowing are necessary in order to maintain species‐rich vegetations in these systems. The evaluation of possible administrative options bringing together the interests of farmers and conservationists is an important challenge in determining the restoration and preservation of these valuable floodplain habitats.
Reconstructing unpredictability: experiences of living with an implantable cardioverter defibrillator over time
Authors: Morken Ingvild Margreta , Severinsson Elisabeth , Karlsen Bjørg
Published: November 2009

Background.  The experience of living with an implantable cardioverter defibrillator over time is still poorly understood. Few qualitative studies have investigated this phenomenon.

Aims.  To explore implantable cardioverter defibrillator recipients’ experiences of living with an implantable cardioverter defibrillator over time.

Design.  Qualitative.

Methods.  Semi‐structured interviews were performed with 16 persons living with an implantable cardioverter defibrillator. The constant comparative method of grounded theory was used for data collection and analysis.

Results.  The core category was defined as ‘Reconstructing the unpredictability of living with an ICD’ and illustrated by four categories: ‘losing control’; ‘regaining control’; ‘lacking support’; and ‘seeking support’. The category ‘losing control’ encompassed experiences of unpredictability leading to uncertainty as a result of the triggering of the device. Reduced activity to avoid shocks played a major role. In the category ‘regaining control’, wellbeing increased as time elapsed after the shock and the implantable cardioverter defibrillator recipients reconstructed the unpredictability by adapting to life changes, trusting the implantable cardioverter defibrillator as a life saver and accepting uncertainty. The category labelled ‘lacking support’ highlighted the implantable cardioverter defibrillator recipients’ experiences of lack of appropriate support and advice from health care professionals. The final category ‘seeking support’ illustrates the implantable cardioverter defibrillator recipients’ attempts to obtain guidance and support from family members and health care professionals and the importance of these aspects for the recovery process.

Conclusion.  Living with an implantable cardioverter defibrillator over time was characterised by unpredictability and uncertainty associated with the triggering of the device. Despite coping with uncertainty by means of several strategies, a new onset of arrhythmia could reinforce the feeling of losing control. An important finding was the reduced activity level.

Relevance for clinical practice.  The results provide knowledge that can aid the design of an intervention programme aimed at reducing patient insecurity and enhancing physical activity. Nurses are in a key position to implement such strategies.
Exploring the profiles of nurses’ job satisfaction in Macau: results of a cluster analysis
Authors: Chan Moon Fai , Leong Sok Man , Luk Andrew Leung , Yeung Siu Ming , Van Iat Kio
Published: November 2009

Aims.  To determine whether definable subtypes exist within a cohort of nurses with regard to factors associated with nurses’ job satisfaction patterns and to compare whether these factors vary between nurses in groups with different profiles.

Background.  Globally, the health care system is experiencing major changes and influence nurses’ job satisfaction and may ultimately affect the quality of nursing care for patients.

Design.  A descriptive survey.

Methods.  Data were collected using a self‐reported structured questionnaire. Nurses were recruited in two hospitals in Macao. Two main outcome variables were collected: Predisposing characteristics and five components on job satisfaction outcomes.

Results.  A cluster analysis yielded two clusters (n = 649). Cluster 1 consisted of 60·6% (n = 393) and Cluster 2 of 39·4% (n = 256) of the nurses. Cluster 1 nurses were younger, more educated and had less work experience and more intention to change their career than nurses in Cluster 2. Cluster 2 nurses had more work experiences, were of more senior grade and were more satisfied with their current job in terms of peer supports, autonomy and professional opportunities, scheduling and relationships with team members than nurses in Cluster 1.

Conclusions.  Findings might help by providing important information for health care managers to identify strategies/methods to target a specific group of nurses in hopes of increasing their job satisfaction levels.

Relevance to clinical practice.  As a long‐term investment, hospital management has to promote work environments that support job satisfaction to attract nurses and thereby improve the quality of nursing care. The results of this study might provide hospital managers with a model to design specified interventions to improve nurses’ job satisfaction.
DNA relaxation‐dependent phase biasing of the fim genetic switch in Escherichia coli depends on the interplay of H‐NS, IHF and LRP
Authors: Corcoran Colin P. , Dorman Charles J.
Published: November 2009

Reversible inversion of the DNA element fimS is responsible for the phase variable expression of type 1 fimbriae in Escherichia coli. The FimB tyrosine integrase site‐specific recombinase inverts fimS in the on‐to‐off and off‐to‐on directions with approximately equal efficiencies. However, when DNA supercoiling is relaxed, fimS adopts predominantly the on orientation. This orientational bias is known to require binding of the nucleoid‐associated protein LRP within fimS. Here we show that binding of the IHF protein to a site immediately adjacent to fimS is also required for phase‐on orientational bias. In the absence of both LRP and IHF binding, fimS adopts the off orientation and the H‐NS protein is required to maintain this alternative orientational bias. Thus, fimS has three Recombination Directionality Factors, H‐NS, IHF and LRP. The relevant H‐NS binding site straddles the left inverted repeat in phase‐off fimS and this site is disrupted when fimS inverts to the on orientation. The inversion of fimS with the associated creation and removal of an H‐NS binding site required for DNA inversion biasing represents a novel mechanism for modulating the interaction of H‐NS with a DNA target and for influencing a site‐specific recombination reaction.
Novel Sinorhizobium meliloti quorum sensing positive and negative regulatory feedback mechanisms respond to phosphate availability
Authors: McIntosh Matthew , Meyer Stefan , Becker Anke
Published: November 2009

The Sin quorum sensing system of Sinorhizobium meliloti depends upon at least three genes, sinR, sinI and expR, and N‐acyl homoserine lactones (AHLs) as signals to regulate multiple processes in its free‐living state in the rhizosphere and in the development towards symbiosis with its plant host. In this study, we have characterized novel mechanisms of transcription control through which the system regulates itself. At low AHL levels a positive feedback loop activates expression of sinI (AHL synthase), resulting in amplification of AHL levels. At high AHL levels, expression of sinI is reduced by a negative feedback loop. These feedback mechanisms are mediated by the LuxR‐type regulators ExpR and SinR. Expression of sinR and expR is regulated by ExpR in the presence of AHLs. A novel ExpR binding site in the promoter of sinR is responsible for the reduction of expression of this gene. In addition, expression of sinR, upon which sinI expression is dependent, is induced by phoB during growth under phosphate‐limiting conditions. This indicates that this response ensures quorum sensing in phosphate‐restricted growth.
Pyoverdine and PQS mediated subpopulation interactions involved in Pseudomonas aeruginosa biofilm formation
Authors: Yang Liang , Nilsson Martin , Gjermansen Morten , Givskov Michael , Tolker‐Nielsen Tim
Published: November 2009

Using flow chamber‐grown Pseudomonas aeruginosa biofilms as model system, we show in the present study that formation of heterogeneous biofilms may occur through mechanisms that involve complex subpopulation interactions. One example of this phenomenon is expression of the iron‐siderophore pyoverdine in one subpopulation being necessary for development of another subpopulation that does not itself express the pyoverdine synthesis genes. Another example is quorum sensing‐controlled DNA release in one subpopulation being necessary for development of another subpopulation that does not itself express the quorum‐sensing genes.
Two proteolytic modules are involved in regulated intramembrane proteolysis of Bacillus subtilis RsiW
Authors: Heinrich Janine , Hein Kerstin , Wiegert Thomas
Published: November 2009

Stress‐induced degradation of the Bacillus subtilis anti‐sigma factor RsiW results in the induction of genes controlled by the extracytoplasmic function sigma factor σW. RsiW is cleaved by the mechanism of regulated intramembrane proteolysis at site‐1 and ‐2 by PrsW and RasP respectively, and is then further degraded by cytoplasmic Clp peptidases. In a reconstituted Escherichia coli system, PrsW removes 40 amino acids from RsiW by cleaving between Ala168 and Ser169 of the extracytoplasmic domain, thereby generating RsiW‐S1. Further trimming of RsiW‐S1's C‐terminus by the periplasmic tail‐specific protease Tsp is crucial for subsequent RasP‐catalysed clipping. In B. subtilis, mutation of RsiW at Ala168 severely impairs site‐1 processing. RsiW‐S1 is undetectable in wild‐type B. subtilis and knockout strains lacking various extracytoplasmic proteases. While it can be stabilized by C‐terminal tagging, even this fusion protein is still attacked. Thus, several peptidases seem to be involved in trimming of RsiW downstream of PrsW and upstream of RasP in B. subtilis. Overall, the RsiW degradation pathway can be subdivided into two modules each consisting of a site‐specific peptidase that prepares RsiW for further degradation by downstream proteases.
A prospective study of maternal carboxyhaemoglobin and pre‐eclampsia risk
Authors: Rudra Carole B. , Williams Michelle A. , Schiff Melissa A. , Koenig Jane Q. , Dills Russell , Yu Jianbo
Published: November 2009

Rudra CB, Williams MA, Schiff MA, Koenig JQ, Dills R, Yu J. A prospective study of maternal carboxyhaemoglobin and pre‐eclampsia risk. Paediatric and Perinatal Epidemiology 2010; 24: 35–44.

We aimed to measure the relationship between early‐pregnancy maternal carboxyhaemoglobin and subsequent pre‐eclampsia risk. A nested case–control analysis was conducted using data from a western Washington State cohort study (1996–2004). We measured maternal whole blood carboxyhaemoglobin in 128 women who developed pre‐eclampsia and 419 normotensive controls (mean gestational age at blood draw, 14.8 weeks). After adjustment for confounders, high (≥1%) vs. low (<0.7%) carboxyhaemoglobin odds ratios [OR] and 95% confidence intervals [CI] were 4.09 [1.30, 12.9] in multiparous women, 0.53 [0.23, 1.26] in primiparae and 1.11 [0.55, 2.25] in the overall study population (parity interaction P = 0.01). The influence of parity on the association was unexpected. The association between high carboxyhaemoglobin and pre‐eclampsia risk in multiparae implicates hypoxia at the fetal‐maternal interface as a pathogenic mechanism. These results also suggest that the aetiology of the disease may differ according to parity.
Plant lipid‐associated fibrillin proteins condition jasmonate production under photosynthetic stress
Authors: Youssef Abir , Laizet Yec’han , Block Maryse A. , Maréchal Eric , Alcaraz Jean‐Pierre , Larson Tony R. , Pontier Dominique , Gaffé Joël , Kuntz Marcel
Published: November 2009

The role of a subfamily of lipid globule‐associated proteins, referred to as plant fibrillins (FIB1a, ‐1b, ‐2), was determined using a RNA interference (RNAi) strategy. We show that Arabidopsis plants with reduced levels of these plastid structural proteins are impaired in long‐term acclimation to environmental constraint, namely photooxidative stress imposed by high light combined with cold. As a result, their photosynthetic apparatus is inefficiently protected. This leads to the prevalence of an abnormal granal and stromal membrane arrangement, as well as higher photosystem II photoinhibition under stress. The visible phenotype of FIB1‐2 RNAi lines also includes retarded shoot growth and a deficit in anthocyanin accumulation under stress. All examined phenotypic effects of lower FIB levels are abolished by jasmonate (JA) treatment. An atypical expression pattern of several JA‐induced genes was observed in RNAi plants. A JA‐deficient mutant was found to share similar stress phenotypic characteristics with FIB RNAi plants. We conclude a new physiological role for JA, namely acclimation of chloroplasts, and that light/cold stress‐related JA biosynthesis is conditioned by the accumulation of plastoglobule‐associated FIB1‐2 proteins. Consistent correlative data suggest that this FIB effect is mediated by plastoglobule (and triacylglycerol) accumulation as the potential site for initiating the chloroplast stress‐related JA biosynthesis.
Eccrine sweat response in children with asthma
Authors: Oflu A. , Soyer O. U. , Tuncer A. , Sackesen C. , Kalayci O.
Published: November 2009

To cite this article: Oflu A, Soyer OU, Tuncer A, Sackesen C, Kalayci O. Eccrine sweat response in children with asthma. Allergy 2010; 65: 645–648.

Background:  Even though there is a general conviction among parents of asthmatic children and pediatricians that asthmatic children sweat more than healthy ones, this has not been formally tested.

Aim:  To determine sweating response and factors affecting this response in children with asthma and compare these findings with healthy children.

Method:  Eighty‐two children with asthma and 51 healthy controls aged 6–18 years were enrolled in the study. Transepidermal water loss (TEWL) was measured on palmar, volar, forehead, and back surfaces before and after exercise and was expressed as the difference between the measurements recorded before and after exercise.

Results:  Transepidermal water loss measurements (after exercise – resting) on the palmar surface were higher in children with asthma [22.8 g/m2 h (15–34.3)] compared with healthy children [15.2 g/m2 h (6–22.2)] (P < 0.001). However, a gender stratified analysis showed that the TEWL measurements were higher on all surfaces only in boys but not in girls. Within the group of asthmatic children, TEWL measurements on the volar surface and back were lower in patients using anti‐inflammatory therapy compared with those who were on as needed bronchodilator therapy only.

Conclusion:  Our results show that asthma is associated with a higher rate of sweating response to exercise in boys, and anti‐inflammatory treatment decreases the amount of sweating. The relationship of eccrine sweating with muscarinic receptor response and methacholine hyperresponsiveness remains to be determined.
Sustained effect of SQ‐standardized grass allergy immunotherapy tablet on rhinoconjunctivitis quality of life
Authors: Frølund L. , Durham S. R. , Calderon M. , Emminger W. , Andersen J. S. , Rask P. , Dahl R.
Published: November 2009

To cite this article: Frølund L, Durham SR, Calderon M, Emminger W, Andersen JS, Rask P, Dahl R. Sustained effect of SQ‐standardized grass allergy immunotherapy tablet on rhinoconjunctivitis quality of life. Allergy 2010; 65: 753–757.

Background:  The prevalence of allergic rhinoconjunctivitis has increased significantly over the past decades with grass pollen being a common trigger. The impact of allergy on patient’s quality of life is substantial.

Aim:  To investigate the sustained effect on quality of life during the grass pollen season 1 year after 3 years of treatment with the SQ‐standardized grass allergy immunotherapy tablet (AIT), Grazax® (Phleum pratense 75,000 SQ‐T/2800 BAU; ALK, Denmark).

Methods:  The trial was a randomized, parallel‐group, double‐blind, placebo‐controlled trial in adult subjects with a history of moderate‐severe grass pollen induced rhinoconjunctivitis inadequately controlled by symptomatic medications. Subjects received 3 years of grass AIT (n = 157) or placebo (n = 126), followed by 1 year of follow‐up. Quality of life assessments were based on the standardized rhinoconjunctivitis quality of life questionnaire (RQLQ(S)); completed weekly during the entire grass pollen season.

Results:  During follow‐up, the overall RQLQ(S) score for the entire grass pollen season was significantly improved in the active group (relative difference to placebo: 23%, P = 0.004). The improvement was higher during the peak pollen season (28%, P = 0.001). The treatment effect of grass AIT during the follow‐up year and the previous three treatment years was similar. Improvements were found in all seven RQLQ(S) domains. The RQLQ(S) as a function of the weekly average pollen counts showed a clear separation between the treatment groups (P < 0.001).

Conclusion:  In subjects inadequately controlled by symptomatic medications, grass AIT provided sustained and clinically relevant improvements in rhinoconjunctivitis quality of life compared to placebo. The effect increased with increasing grass pollen exposure.
Histamine H4receptor antagonist ameliorates chronic allergic contact dermatitis induced by repeated challenge
Authors: Seike M. , Furuya K. , Omura M. , Hamada‐Watanabe K. , Matsushita A. , Ohtsu H.
Published: November 2009

To cite this article:Seike M, Furuya K, Omura M, Hamada‐Watanabe K, Matsushita A, Ohtsu H. Histamine H4receptor antagonist ameliorates chronic allergic contact dermatitis induced by repeated challenge.Allergy2010;65: 319–326.

Background: The present study observed effects of the histamine H4receptor on chronic allergic contact dermatitis induced by repeated challenge in mice.

Methods: Acute contact dermatitis was induced by single epicutaneous challenge of 2,4,6‐trinitro‐1‐chlorobenzene (TNCB) to the ear. Chronic allergic contact dermatitis was developed by repeated epicutaneous challenge using TNCB on the dorsal back skin. H4receptor antagonist JNJ7777120 was administered to wild‐type mice, while H4receptor agonist 4‐methylhistamine was administered to histidine decarboxylase (HDC) (−/−) mice that synthesized no histamine.

Results: HDC (−/−) mice did not differ phenotypically from HDC (+/+) mice, and H4receptor antagonist/agonist did not have clinical effects in terms of acute contact dermatitis reactions. H4receptor antagonist ameliorated skin eczematous lesions induced by repeated TNCB challenge in HDC (+/+) mice. On the contrary, H4receptor agonist exacerbated skin lesions exclusively in HDC (−/−) mice. Application of H4receptor agonist induced migration of mast cells and eosinophils in skin lesions, and H4receptor antagonist suppressed these changes. H4receptor was immunohistochemically detected on mast cells in eczematous lesions. Levels of interleukin (IL)‐4, ‐5, and ‐6 in lesions were decreased, whereas levels of interferon‐γ and IL‐12 were increased by H4receptor antagonistic activity. Serum Immunoglobulin E levels rapidly increased with repeated challenge, but decreased with H4receptor antagonist.

Conclusion: Because chronic allergic contact dermatitis is developed by H4receptor stimulation, H4receptor antagonists might represent new candidate drugs for treating chronic allergic contact dermatitis.
Single lung transplantation and fatal fat embolism acquired from the donor: management and literature review
Authors: López‐Sánchez Marta , Alvarez‐Antoñán Carlos , Arce‐Mateos Félix P. , Gómez‐Román José , Quesada‐Suescun Antonio , Zurbano‐Goñi Felipe
Published: November 2009

López‐Sánchez M, Alvarez‐Antoñán C, Arce‐Mateos FP, Gómez‐Román J, Quesada‐Suescun A, Zurbano‐Goñi F. Single lung transplantation and fatal fat embolism acquired from the donor: management and literature review. Clin Transplant 2010: 24: 133–138. © 2009 John Wiley & Sons A/S.

Abstract:  Fat embolism (FE) is a consequence of skeletal trauma that occurs in more than 90% of cases of severe trauma. However, most of these emboli are clinically insignificant. We report the case of a 59‐yr‐old man with massive progressive fibrosis who died from widespread FE after a single‐lung transplantation (SLT). The lung donor was a 22‐yr‐old woman who died from traumatic cerebral injury. She had sustained a closed fracture of the tibia, fibula and pelvis. The PaO2/FiO2 before procurement was 452 mmHg. A left SLT using cardiopulmonary bypass was performed. In the immediate postoperative period, profound pulmonary edema in the transplanted lung developed, with overinflation of the native lung and systemic hypotension. Severe Primary Graft Dysfunction (PGD) was suspected and nitric oxide (NO) and independent lung ventilation (ILV) initiated. Over the next 24 h the patient’s condition deteriorated and extracorporeal membrane oxygenation (ECMO) was initiated. The patient died 45 h after transplantation as cardiovascular and respiratory function continued to decline and massive thoracic bleeding secondary to coagulopathy appeared. Post‐mortem examination revealed both massive FE in the non‐transplanted donor lung and in the allograft lung. Only two previous cases of donor‐acquired FE and PGD after lung transplantation (LT) have been reported. Occult pulmonary FE in a traumatized donor should be considered a cause of PGD.
Focal liver diseases in neonatal and pediatric liver transplant candidates: a pictorial essay
Authors: Caruso Settimo , Mamone Giuseppe , Marrone Gianluca , Milazzo Mariapina , Carollo Vincenzo , Miraglia Roberto , Maruzzelli Luigi , Pasta Armando , Minervini Marta I. , Spada Marco , Riva Silvia , Luca Angelo , Gridelli Bruno
Published: November 2009

Caruso S, Mamone G, Marrone G, Milazzo M, Carollo V, Miraglia R, Maruzzelli L, Pasta A, Minervini MI, Spada M, Riva S, Luca A, Gridelli B. Focal liver diseases in neonatal and pediatric liver transplant candidates: a pictorial essay. Clin Transplant 2009: DOI: 10.1111/j.1399‐0012.2009.01139.x © 2009 John Wiley & Sons A/S.

Abstract:  The aim of this review is to present the wide spectrum of common and uncommon focal liver diseases affecting neonatal and pediatric liver transplant candidates, analyzed using ultrasonography (US), 16‐ or 64‐multidetector row helical CT (MDCT) and 1.5‐T magnetic resonance (MR) fast imaging. Correlation of imaging findings and explanted liver or histology is illustrated in representative cases. Associated uncommon congenital anomalies are shown.
Genetic diversity, population structure and sex‐biased dispersal in three co‐evolving species
Authors: FOITZIK S. , BAUER S. , LAURENT S. , PENNINGS P. S.
Published: November 2009

Genetic diversity and spatial structure of populations are important for antagonistic coevolution. We investigated genetic variation and population structure of three closely related European ant species: the social parasite Harpagoxenus sublaevis and its two host species Leptothorax acervorum and Leptothorax muscorum. We sampled populations in 12 countries and analysed eight microsatellite loci and an mtDNA sequence. We found high levels of genetic variation in all three species, only slightly less variation in the host L. muscorum. Using a newly introduced measure of differentiation (Jost’s Dest), we detected strong population structuring in all species and less male‐biased dispersal than previously thought. We found no phylogeographic patterns that could give information on post‐glacial colonization routes – northern populations are as variable as more southern populations. We conclude that conditions for Thompson’s geographic mosaic of coevolution are ideal in this system: all three species show ample genetic variation and strong population structure.
Should we increase the ratio of plasma/platelets to red blood cells in massive transfusion: what is the evidence?
Authors: Phan H. H. , Wisner D. H.
Published: November 2009

Introduction Based on relatively recent clinical work, considerable enthusiasm has been generated for the increased use of plasma and platelet in the earlier resuscitation of massively transfused patients. The aim of this review was to examine the currently available evidence for the increase in plasma/platelet to red cell transfusion ratio during massive transfusion.

Methods In May of 2009, a systematic review of studies reporting the effects of plasma and platelet to red cell component transfusion ratio on mortality outcome was performed.

Results There were no prospective randomized controlled trials on this topic. Eleven retrospective studies were identified evaluating the effects of plasma : red cell ratio on mortality in massive transfusion after trauma. Most studies demonstrated a survival advantage of increased plasma ratio in massive transfusion. While the majority of the studies suggested the optimal plasma : red cell ratio to be 1 : 2 or higher, others demonstrated the optimal ratio to be lower. Three of these studies also demonstrated a survival advantage with increased platelet : red cell transfusion ratio.

Conclusion Although there is some evidence to support the increase use of plasma and platelets in massive transfusion, the true efficacy of such practice has not yet been proven by prospective randomized controlled trials. The available retrospective studies raise many important questions that need to be addressed in future clinical trials.
Socio‐Spatial Relationships in Dairy Cows
Authors: Gygax Lorenz , Neisen Gesa , Wechsler Beat
Published: November 2009

Farm animals may serve as models for evaluating social networks in a controlled environment. We used an automated system to track, at fine temporal and spatial resolution (once per minute, ±50 cm) every individual in six herds of dairy cows (Bos taurus). We then analysed the data using social network analyses. Relationships were based on non‐random attachment and avoidance relationships in respect to synchronous use and distances observed in three different functional areas (activity, feeding and lying). We found that neither synchrony nor distance between cows was strongly predictable among the three functional areas. The emerging social networks were tightly knit for attachment relationships and less dense for avoidance relationships. These networks loosened up from the feeding and lying area to the activity area, and were less dense for relationships based on synchronicity than on median distance with respect to node degree, relative size of the largest cluster, density and diameter of the network. In addition, synchronicity was higher in dyads of dairy cows that had grown up together and shared their last dry period. This last effect disappeared with increasing herd size. Dairy herds can be characterized by one strongly clustered network including most of the herd members with many non‐random attachment and avoidance relationships. Closely synchronous dyads were composed of cows with more intense previous contact. The automatic tracking of a large number of individuals proved promising in acquiring the data necessary for tackling social network analyses.
Sex differences in self‐reported anxiety in rural adolescents
Authors: Puskar Kathryn , Bernardo Lisa Marie , Ren Dianxu , Stark Kirsti Hetager , Lester Suzanne
Published: November 2009

An anxiety disorder affects 13 out of every 100 children. The purpose of this paper is to determine if there are differences in self‐reported anxiety between male and female rural adolescents. In total, 193 students aged 14–17 years in three western Pennsylvania rural high schools, USA, were surveyed. The majority of participants were Caucasian (86.5%, n = 167), female (53.4%, n = 103), and aged 15.57 years (SD = 0.93). The females' mean self‐reported anxiety score was higher than the males' score (P < 0.0001). The females' mean score was 25.09 (SD = 13.83; a score ≥25 may indicate the need for further evaluation for the presence of a potential anxiety disorder), while the males' mean score was 16.88 (SD = 10.81). Of interest, all the five factor (specific types of anxiety) scores were significantly different between males and females at P < 0.05. Evidence‐based implications for the mental health nurse's practice will be discussed. Anxiety screening is promoted to identify adolescents who may need mental health treatment and referrals, especially rural female adolescents.
The workplace and nurses with a mental illness
Authors: Joyce Terry , McMillan Margaret , Hazelton Michael
Published: November 2009

A qualitative approach was used to explore workplace experiences of nurses who have a mental illness. Interview transcripts from 29 nurses in New South Wales, Australia were subjected to discourse analysis. One significant finding was a theme depicting the need for support and trust. This superordinate theme encompassed four subelements: declaring mental illnesses, collegial support, managerial support, and enhancing support. Most of the participants portrayed their workplace as an unsupportive and negative environment. A number of colleagues were depicted as having little regard for the codes for professional nursing practice. This paper shows how nurses in the study dealt with the workplace support associated with mental illness.
Reductive dehalogenation of brominated ethenes by Sulfurospirillum multivorans and Desulfitobacterium hafniense PCE‐S
Authors: Ye Lidan , Schilhabel Anke , Bartram Stefan , Boland Wilhelm , Diekert Gabriele
Published: November 2009

Sulfurospirillum multivorans and Desulfitobacterium hafniense PCE‐S are anaerobes that can utilize tetrachloroethene (PCE) as an electron acceptor in their energy metabolism. The end‐product of PCE reduction for both organisms is cis‐1,2‐dichloroethene, which is formed via trichloroethene as the intermediate. The bacteria were able to dehalogenate cis‐ and trans‐1,2‐dibromoethene (cDBE and tDBE) in growing cultures and cell extracts. Dibromoethene supported growth of both organisms. The organisms debrominated cDBE and tDBE to vinyl bromide (VB); D. hafniense PCE‐S also produced ethene in addition to VB. The PCE reductive dehalogenases (PCE dehalogenases) of S. multivorans and D. hafniense PCE‐S mediated the debromination of tribromoethene (TBE) and both isomers of 1,2‐DBE, indicating that this enzyme was responsible for the reductive dehalogenation of brominated ethenes. cDBE, tDBE, 1,1‐DBE and VB were formed upon TBE debromination; VB was the major end‐product. The PCE dehalogenase of D. hafniense PCE‐S also formed ethene. With the purified enzymes from both organisms the kinetic properties of dehalogenation of brominated alkenes were studied and compared with those of their chlorinated analogues.
Proposal: a score to select patients for fistulotomy
Authors: Sjödahl R.
Published: November 2009

Traditionally the distance between the inner opening and the anal verge is considered when making the decision to lay open an anal fistula or not. In contrast to this, the score presented here includes the distance to the upper border of the puborectalis muscle or to the external sphincter (anteriorly). In addition this score also takes various aspects of bowel function into consideration.
Effects of intensive insulin therapy alone and with added pioglitazone on renal salt/water balance and fluid compartment shifts in type 2 diabetes
Authors: Mudaliar S. , Chang A. R. , Aroda V. R. , Chao E. , Burke P. , Baxi S. , Griver K. A. , O’Connor D. T. , Henry R. R.
Published: November 2009

Objective: To evaluate the effects of intensive insulin therapy alone or with added pioglitazone on renal salt/water balance and body fluid compartment shifts in type 2 diabetes.

Methods: A total of 25 insulin‐treated, obese patients with type 2 diabetes were randomized to pioglitazone 45 mg (n = 12) or placebo (n = 13) and treated intensively for 12–16 weeks to achieve equivalent glycaemic control. We measured total body water (TBW) and extracellular/intracellular fluid by bioimpedance analysis; plasma/RBC volume with I131albumin; sodium handling by fractional excretion of sodium/lithium (FeNa/FeLi) and other renal/hormonal parameters.

Results: Intensification of insulin therapy and the addition of pioglitazone significantly improved glycaemia (HbA1C 7.8–7.2% and 7.6–7.1%) and increased body weight (1.7 and 4.9 kg) respectively. TBW increased 1.7 l with insulin alone (65% intracellular) and 1.6 l with added pioglitazone (75% extracellular) (p = 0.06 and 0.09 respectively). Plasma volume increased 0.2 ± 0.1 l with insulin alone (p = 0.05) and 0.4 ± 0.1 l with added pioglitazone (p < 0.05). Extravascular, extracellular (interstitial) fluid increased significantly and more with added pioglitazone (0.8 ± 0.2 l, p < 0.01) than with insulin alone (0.4 ± 0.2 l, p = ns). At steady‐state, FeLi (marker of proximal‐tubular sodium delivery to the distal nephron) increased significantly with added pioglitazone (12.4 ± 1.3 to 18.0 ± 3.2%) vs. no significant change with insulin alone (15.4 ± 1.2 to 14.5 ± 2.3%). There were no significant changes in the other parameters.

Conclusion: In intensively insulin‐treated obese type 2 diabetic patients, at equivalent glycaemic control, the addition of pioglitazone causes greater weight gain, but a similar increase in body water that is mainly extracellular and interstitial compared with intracellular increase with insulin therapy alone. Pioglitazone also increases the filtered load of sodium reabsorbed at the distal nephron with no net change in FeNa.
Review of clinical trials: update on oral insulin spray formulation
Authors: Pozzilli Paolo , Raskin Philip , Parkin Christopher G.
Published: November 2009

Large clinical trials have shown that improving glycaemic control significantly reduces the risk of long‐term microvascular complications in type 1 (T1DM) and type 2 (T2DM) diabetes. Achieving optimal glycaemic control often requires the use of multiple daily insulin injections. Current approaches to insulin administration are less than optimal; many T2DM patients view insulin therapy as inconvenient and uncomfortable and may delay starting insulin therapy because of this. A new oral insulin spray formulation and delivery system provides an alternative to injectable and inhaled insulin. The system allows a liquid oral spray insulin formulation to be delivered into the mouth via an aerosolized spray. The oral insulin spray is a tasteless liquid aerosol mist formulation that is administered to the buccal mucosa using a proprietary delivery system. The active pharmaceutical ingredient is recombinant human insulin; however, the formulation behaves in a fashion more similar to the synthetic fast‐acting insulin analogues. In clinical studies of healthy subjects and subjects with T1DM and T2DM, investigators have shown that the oral insulin spray was absorbed in direct relation to the amount given and had a faster onset and a shorter duration of action when compared with regular insulin given subcutaneously. In all of the studies conducted, the oral insulin spray was generally well tolerated. Some healthy individuals and subjects with T1DM experienced transient (1–2 min) mild dizziness during dosing; these symptoms were mild and self‐limited. No changes in vital signs, laboratory values or physical examination results were noted. The ease of use of the insulin spray formulation may increase patient acceptance and treatment compliance, thereby potentially reducing complications and improving quality of life for patients with insulin‐dependent diabetes. This article provides an overview of the safety profile and proposed mechanism of action of this insulin formulation and presents findings from trials which studied its effects in subjects with T1DM and T2DM.
Results of the Southwest Oncology Group phase II evaluation (study S0031) of ZD1839 for advanced transitional cell carcinoma of the urothelium
Authors: Petrylak Daniel P. , Tangen Catherine M. , Van Veldhuizen Peter J. , Goodwin J. Wendall , Twardowski Przemyslaw W. , Atkins James N. , Kakhil Shaker R. , Lange Marianne K. , Mansukhani Mahesh , Crawford E. David
Published: November 2009

Study Type – Prognosis (inception cohort)  Level of Evidence 1b

OBJECTIVE

To evaluate the epidermal growth factor receptor (EGFR)‐targeted agent ZD1839 in patients who failed one previous chemotherapeutic regimen for metastatic transitional cell carcinoma (TCC), and to correlate patterns of response with the expression of EGFR.

PATIENTS AND METHODS

Thirty‐one patients with metastatic TCC of the urothelial tract were treated with ZD1839 500 mg oral daily. Patients were required to have a pretreatment biopsy to assess EGF expression.

RESULTS

The median progression‐free survival was 2 months, with only two patients (6.5%) surviving past 6 months with no disease progression. Thirty patients were evaluable for toxicity; there was grade 4 cerebrovascular ischaemia and an increase in creatinine level. All patients were evaluable for response, with one confirmed partial response (3%; 95% confidence interval, CI, 0–17%) in a patient with pulmonary metastases. All patients have died, and the estimated median (95% CI) survival is 3 (2–7) months.

CONCLUSIONS

ZD1839 is ineffective as a second‐line agent for urothelial carcinoma.
Improved cost‐effectiveness and efficiency with a slower shockwave delivery rate
Authors: Koo Vincent , Beattie Irene , Young Michael
Published: November 2009

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To determine the benefits of a slower shockwave (SW) delivery rate of 70 shocks/min on the treatment efficiency and cost‐effectiveness of extracorporeal SW lithotripsy (ESWL).

PATIENTS AND METHODS

Patients who had ESWL for their upper urinary tract radio‐opaque calculi were categorized into two groups: slow (70 SW/min) and fast (100 SW/min) delivery rate. All treatment was carried out using a lithotripter (Model S, Dornier MedTech, Wessling, Germany) as an outpatient procedure with no anaesthesia or sedation. The groups were followed for ≥6 months. The primary outcomes compared were the stone‐free rate, re‐treatment rate, additional procedure rate, perceived cost and actual cost. Clinical success was defined as stone‐free status or asymptomatic insignificant residual fragments of <3 mm. Perceived cost was defined as the cost of ESWL alone, and actual cost included the cost of additional procedures and overhead costs to result in clinical success.

RESULTS

In all, the study included 102 patients, categorized into the fast (51) and slow (51) rate groups. The groups were comparable in terms of sex, age, body mass index, stone size and stone location. The slow group had a significantly better stone‐free rate (67% vs 25.5%, P = 0.002, chi‐square), fewer mean shocks to clinical success (3045 vs 4414, P < 0.001, U‐test), lower re‐treatment rate (22% vs 45%P = 0.013, chi ‐square), a lower additional procedure rate (12% vs 29%, P = 0.02, chi‐square), greater efficiency quotient (0.51 vs 0.16) than the fast group. The mean perceived cost of ESWL (GB£ 297 vs £394, P = 0.013, U‐test) and the mean actual cost of the slow group were significantly less (£496 vs £1002, P = 0.001, U‐test).

CONCLUSION

Slowing the SW delivery rate to 70/min significantly reduced the actual cost by half and improved treatment efficiency.
Comparison of accuracy of 14‐, 18‐ and 20‐G needles in ex‐vivo renal mass biopsy: a prospective, blinded study
Authors: Breda Alberto , Treat Eric G. , Haft‐Candell Leah , Leppert John T. , Harper Jonathan D. , Said Jonathan , Raman Steven , Smith Robert B. , Belldegrun Arie S. , Schulam Peter G.
Published: November 2009

Study Type – Diagnostic (exploratory cohort)  Level of Evidence 2b

OBJECTIVE

To prospectively determine the accuracy of 14‐, 18‐ and 20‐G core needle biopsies to render the appropriate histological diagnosis of solid, enhancing renal masses, using a controlled, ex‐vivo biopsy technique.

PATIENTS AND METHODS

From March 2007 to September 2007, 31 patients undergoing partial or radical nephrectomy were randomly selected for biopsy. After extirpative surgery, three ex‐vivo biopsies were taken from each lesion with 14‐, 18‐ and 20‐G biopsy needles. One experienced genitourinary pathologist, unaware of patient identifiers and final pathology results, determined the biopsy histology and tumour grade, based on standard haematoxylin and eosin (H&E) techniques and immunohistochemistry.

RESULTS

The final pathological evaluation classified 21 masses (68%) as clear cell renal cell carcinoma (RCC), three (10%) as papillary RCC, three (10%) as chromophobe RCC, three (10%) as oncocytoma and one (3%) as a benign lymphoid infiltrate. The biopsy histology correlated with the final pathology in 29/31 cases (94%) with the 14‐G, 30/31 cases (97%) with the 18‐G and 25/31 cases (81%) with the 20‐G needles. In two cases chromophobe RCC was misdiagnosed with oncocytoma, and vice versa.

CONCLUSION

In this study a minimum of an 18‐G biopsy needle was the most accurate in determining the histological diagnosis. Clear cell and papillary RCCs were accurately diagnosed on biopsy using an 18‐G, whereas oncocytoma and chromophobe RCC were difficult to differentiate using standard H&E techniques and immunohistochemistry.
The value of EZH2, p27kip1, BMI‐1 and MIB‐1 on biopsy specimens with low‐risk prostate cancer in selecting men with significant prostate cancer at prostatectomy
Authors: Wolters Tineke , Vissers Kees J. , Bangma Chris H. , Schröder Fritz H. , Van Leenders Geert J.L.H.
Published: November 2009

OBJECTIVE

To assess the additional prognostic value of the molecular markers EZH2, MIB‐1, p27kip1 and BMI‐1 on needle biopsies from men with low‐risk prostate cancer, as this disease in needle biopsies shows a heterogeneous clinical outcome, and while it is known that the expression of these tissue markers is predictive of the clinical outcome after radical prostatectomy (RP) their value in prostate biopsies is largely unknown.

PATIENTS AND METHODS

The study included men participating in a screening study, diagnosed with low‐risk prostate cancer and subsequently treated with RP. Immunohistochemical staining for EZH2, MIB‐1, p27kip1 and BMI‐1 on the needle biopsies were (semi)quantitatively scored and expression levels were related to significant disease at RP. Clinical low‐risk prostate cancer was defined as a prostate‐specific antigen (PSA) level of ≤10 ng/mL, clinical T‐stage ≤2, biopsy Gleason score ≤6, a PSA density of <0.20 ng/mL/g and two or fewer positive cores. Significant PC at RP was defined as presence of any of extracapsular extension, Gleason pattern 4/5, or tumour volume ≥0.5 mL.

RESULTS

In all, 86 biopsy specimens were included; there was high EZH2 expression (>1.0%) in 42% and a low p27kip expression (<90%) in 63%. Significant disease was present in 44 (51%) RP specimens. A high EZH2 (odds ratio 3.19, P = 0.043) and a low p27kip1 (4.69, P = 0.036) were independent predictors for significant prostate cancer at RP.

CONCLUSIONS

The determination of EZH2 and p27kip1 on diagnostic needle biopsies supports the selection of men with indolent prostate cancer at RP. Especially p27kip1 could improve the pretreatment risk assessment of patients with low‐risk prostate cancer.
Orthotopic sigmoid neobladder after radical cystectomy: assessment of complications, functional outcomes and quality of life in 82 Japanese patients
Authors: Miyake Hideaki , Furukawa Junya , Muramaki Mototsugu , Takenaka Atsushi , Fujisawa Masato
Published: November 2009

Study Type – Therapy (outcomes study) Level of Evidence 2c

OBJECTIVES

To retrospectively review our clinical experience with sigmoid neobladder reconstruction.

PATIENTS AND METHODS

The study included 82 consecutive Japanese patients (64 men and 18 women) with bladder cancer who had a radical cystectomy and orthotopic sigmoid neobladder created using the modified technique described previously. Complications, functional outcomes and health‐related quality of life (HRQL, using the Short‐Form 36 instrument) were evaluated in 80 patients with a mean follow‐up of 55 months, after excluding two who died perioperatively.

RESULTS

There were 45 early complications in 28 patients, including wound infection in 16, ileus in nine and pyelonephritis in eight, with 19 late complications in 15, including neobladder stone in five, uretero‐intestinal stricture in four and entero‐urethral stricture in four. Of the 80 patients, 73 could void spontaneously, and daytime and night‐time continence were achieved in 69 and 46, respectively. The mean maximum flow rate, voided volume and postvoid residual were 18.6 mL/s, 345.3 mL and 24.5 mL, respectively. Severe hyperchloraemic metabolic acidosis occurred in three patients, but none of them developed hypovitaminosis of B12. The HRQL survey after surgery showed no significant differences in five of the eight scale scores between the 80 patients with a sigmoid neobladder and an age‐matched control population in Japan. Furthermore, there were no significant differences in any variables assessed in this study between men and women patients.

CONCLUSIONS

The modified sigmoid neobladder provides satisfactory clinical outcomes after radical cystectomy.
The Power of Knowledge: Learning from ‘Learning by Knowledge‐Intensive Firm’
Authors: Kärreman Dan
Published: November 2009

abstract

This article reviews and discusses the contribution of William Starbuck's ‘Learning by Knowledge‐Intensive Firms’. Apart from situating Starbuck's article in its historical context and contemporary debates it is argued that the concept of esoteric knowledge and the focus on persuasion provides untapped potential for enhancing our understanding of knowledge work and knowledge‐intensive firms. In conclusion, Starbuck's argument is used as input for a reconceptualization of the relationship between power, knowledge work, and knowledge‐intensive firms.