bluuebunny/crossref_metadata_2025 huggingface dataset:
Divergent evolutionary processes associated with colonization of offshore islands
Authors: Martínková Natália , Barnett Ross , Cucchi Thomas , Struchen Rahel , Pascal Marine , Pascal Michel , Fischer Martin C. , Higham Thomas , Brace Selina , Ho Simon Y. W. , Quéré Jean‐Pierre , O'Higgins Paul , Excoffier Laurent , Heckel Gerald , Rus Hoelzel A. , Dobney Keith M. , Searle Jeremy B.
Published: September 2013

Oceanic islands have been a test ground for evolutionary theory, but here, we focus on the possibilities for evolutionary study created by offshore islands. These can be colonized through various means and by a wide range of species, including those with low dispersal capabilities. We use morphology, modern and ancient sequences of cytochrome b (cytb) and microsatellite genotypes to examine colonization history and evolutionary change associated with occupation of the Orkney archipelago by the common vole (Microtus arvalis), a species found in continental Europe but not in Britain. Among possible colonization scenarios, our results are most consistent with human introduction at least 5100 bp (confirmed by radiocarbon dating). We used approximate Bayesian computation of population history to infer the coast of Belgium as the possible source and estimated the evolutionary timescale using a Bayesian coalescent approach. We showed substantial morphological divergence of the island populations, including a size increase presumably driven by selection and reduced microsatellite variation likely reflecting founder events and genetic drift. More surprisingly, our results suggest that a recent and widespread cytb replacement event in the continental source area purged cytb variation there, whereas the ancestral diversity is largely retained in the colonized islands as a genetic ‘ark’. The replacement event in the continental M. arvalis was probably triggered by anthropogenic causes (land‐use change). Our studies illustrate that small offshore islands can act as field laboratories for studying various evolutionary processes over relatively short timescales, informing about the mainland source area as well as the island.
Fire‐induced population reduction and landscape opening increases gene flow via pollen dispersal in Pinus halepensis
Authors: Shohami D. , Nathan R.
Published: September 2013

Population reduction and disturbances may alter dispersal, mating patterns and gene flow. Rather than taking the common approach of comparing different populations or sites, here we studied gene flow via wind‐mediated effective pollen dispersal on the same plant individuals before and after a fire‐induced population drop, in a natural stand of Pinus halepensis. The fire killed 96% of the pine trees in the stand and cleared the vegetation in the area. Thirteen trees survived in two groups separated by ~80 m, and seven of these trees had serotinous (closed) prefire cones that did not open despite the fire. We analysed pollen from closed pre and postfire cones using microsatellites. The two groups of surviving trees were highly genetically differentiated, and the pollen they produced also showed strong among‐group differentiation and very high kinship both before and after the fire, indicating limited and very local pollen dispersal. The pollen not produced by the survivors also showed significant prefire spatial genetic structure and high kinship, indicating mainly within‐population origin and limited gene flow from outside, but became spatially homogeneous with random kinship after the fire. We suggest that postfire gene flow via wind‐mediated pollen dispersal increased by two putative mechanisms: (i) a drastic reduction in local pollen production due to population thinning, effectively increasing pollen immigration through reduced dilution effect; (ii) an increase in wind speeds in the vegetation‐free postfire landscape. This research shows that dispersal can alleviate negative genetic effects of population size reduction and that disturbances might enhance gene flow, rather than reduce it.
Trapping and visualizing intermediate steps in the mismatch repair pathway in vivo
Authors: Lenhart Justin S. , Pillon Monica C. , Guarné Alba , Simmons Lyle A.
Published: September 2013

During mismatch repair, MutS is responsible for mismatch detection and the recruitment of MutL to the mismatch through a mechanism that is unknown in most organisms. Here, we identified a discrete site on MutS that is occupied by MutL in Bacillus subtilis. The MutL binding site is composed of two adjacent phenylalanine residues located laterally in an exposed loop of MutS. Disruption of this site renders MutS defective in binding MutL in vitro and in vivo, while also eliminating mismatch repair. Analysis of MutS repair complexes in vivo shows that MutS mutants defective in interaction with MutL are ‘trapped’ in a repetitive loading response. Furthermore, these mutant MutS repair complexes persist on DNA away from the DNA polymerase, suggesting that MutS remains loaded on mismatch proximal DNA awaiting arrival of MutL. We also provide evidence that MutS and MutL interact independent of mismatch binding by MutS in vivo and in vitro, suggesting that MutL can transiently probe MutS to determine if MutS is mismatch bound. Together, these data provide insights into the mechanism that MutS employs to recruit MutL, and the consequences that ensue when MutL recruitment is blocked.
Effects of an integrated problem‐based learning and simulation course for nursing students
Authors: Roh Young Sook , Kim Sang Suk , Kim Sung Hee
Published: September 2013

The adaptability of high‐fidelity simulations to multiple learning strategies is an essential feature of their effective use, however, little is known about the effects of integration simulations with problem‐based learning. The purpose of this study was to identify the effects of an integrated course with problem‐based learning and simulation by evaluating college‐based stress, student perceptions on their competence and small group learning, and comparing stress and student perceptions level by grade point average. One group post‐test only design was employed with a cohort of 185 second year nursing students who were enrolled in a seven‐block integrated circulo‐respiratory course with problem‐based learning and simulation. Nursing students evaluated their stress as moderate with the academic subdomain as the highest stressor. The students reported favorable student perceptions on competence and small group learning. Nursing students view problem‐based learning with simulations‐based learning favorably irrespective of their course grade. The results of this study indicate that integration of problem‐based learning with simulation should be considered for broader application in nursing education.
HvZIP7 mediates zinc accumulation in barley (Hordeum vulgare) at moderately high zinc supply
Authors: Tiong Jingwen , McDonald Glenn K. , Genc Yusuf , Pedas Pai , Hayes Julie E. , Toubia John , Langridge Peter , Huang Chun Y.
Published: September 2013

High expression of zinc (Zn)‐regulated, iron‐regulated transporter‐like protein (ZIP) genes increases root Zn uptake in dicots, leading to high accumulation of Zn in shoots. However, none of the ZIP genes tested previously in monocots could enhance shoot Zn accumulation. In this report, barley (Hordeum vulgare) HvZIP7 was investigated for its functions in Zn transport.

The functions of HvZIP7 in planta were studied using in situ hybridization and transient analysis of subcellular localization with a green fluorescent protein (GFP) reporter. Transgenic barley lines overexpressing HvZIP7 were also generated to further understand the functions of HvZIP7 in metal transport.

HvZIP7 is strongly induced by Zn deficiency, primarily in vascular tissues of roots and leaves, and its protein was localized in the plasma membrane. These properties are similar to its closely related homologs in dicots. Overexpression of HvZIP7 in barley plants increased Zn uptake when moderately high concentrations of Zn were supplied. Significantly, there was a specific enhancement of shoot Zn accumulation, with no measurable increase in iron (Fe), manganese (Mn), copper (Cu) or cadmium (Cd). HvZIP7 displays characteristics of low‐affinity Zn transport.

The unique function of HvZIP7 provides new insights into the role of ZIP genes in Zn homeostasis in monocots, and offers opportunities to develop Zn biofortification strategies in cereals.
Neural correlates of nondual awareness in meditation
Authors: Josipovic Zoran
Published: September 2013

Dualities such as self versus other, good versus bad, and in‐group versus out‐group are pervasive features of human experience, structuring the majority of cognitive and affective processes. Yet, an entirely different way of experiencing, one in which such dualities are relaxed rather than fortified, is also available. It depends on recognizing, within the stream of our consciousness, the nondual awareness (NDA)—a background awareness that precedes conceptualization and intention and that can contextualize various perceptual, affective, or cognitive contents without fragmenting the field of experience into habitual dualities. This paper introduces NDA as experienced in Tibetan Buddhist meditation and reviews the results of our study on the influence of NDA on anticorrelated intrinsic and extrinsic networks in the brain. Also discussed are preliminary data from a current study of NDA with minimized phenomenal content that points to involvement of a precuneus network in NDA.
Accuracy of acoustic respiration rate monitoring in pediatric patients
Authors: Patino Mario , Redford Daniel T. , Quigley Thomas W. , Mahmoud Mohamed , Kurth C. Dean , Szmuk Peter
Published: September 2013

Background

Rainbow acoustic monitoring (RRa) utilizes acoustic technology to continuously and noninvasively determine respiratory rate from an adhesive sensor located on the neck.

Objective

We sought to validate the accuracy of RRa, by comparing it to capnography, impedance pneumography, and to a reference method of counting breaths in postsurgical children.

Methods

Continuous respiration rate data were recorded from RRa and capnography. In a subset of patients, intermittent respiration rate from thoracic impedance pneumography was also recorded. The reference method, counted respiratory rate by the retrospective analysis of the RRa, and capnographic waveforms while listening to recorded breath sounds were used to compare respiration rate of both capnography and RRa. Bias, precision, and limits of agreement of RRa compared with capnography and RRa and capnography compared with the reference method were calculated. Tolerance and reliability to the acoustic sensor and nasal cannula were also assessed.

Results

Thirty‐nine of 40 patients (97.5%) demonstrated good tolerance of the acoustic sensor, whereas 25 of 40 patients (62.5%) demonstrated good tolerance of the nasal cannula. Intermittent thoracic impedance produced erroneous respiratory rates (>50 b·min−1 from the other methods) on 47% of occasions. The bias ± SD and limits of agreement were −0.30 ± 3.5 b·min−1 and −7.3 to 6.6 b·min−1 for RRa compared with capnography; −0.1 ± 2.5 b·min−1 and −5.0 to 5.0 b·min−1 for RRa compared with the reference method; and 0.2 ± 3.4 b·min−1 and −6.8 to 6.7 b·min−1 for capnography compared with the reference method.

Conclusions

When compared to nasal capnography, RRa showed good agreement and similar accuracy and precision but was better tolerated in postsurgical pediatric patients.
Masson Tumor Arising in a Congenital Vascular Anomaly
Authors: Anderson Jill C. , Brown Katherine K.
Published: September 2013

Congenital and infantile Masson's tumors are rare. We report a case of Masson's tumors arising within a congenital vascular mass in an otherwise healthy infant. The diagnosis was made following surgical excision and supported by histologic staining. There has been no recurrence of the lesions to date.
BB‐UVA vs. NB‐UVB in the treatment of vitiligo: a randomized controlled clinical study (single blinded)
Authors: El‐Mofty Medhat , Mostafa Wedad , Youssef Randa , El‐Fangary Mona , El‐Ramly Amany , Mahgoub Doaa , Fawzy Marwa , El‐Hawary Marwa
Published: September 2013

Background

Vitiligo is an acquired pigmentary disorder that affects between 1% and 2% of the general population. Phototherapy remains the cornerstone of treatment, with NB‐UVB being the most frequently used. BB‐UVA can be a plausible alternative for darker population; skin photo type III and IV.

Patients and Methods

The study was a prospective, randomized, controlled, and single‐blinded clinical trial, conducted on 40 patients with bilateral symmetrical vitiligo. The patients were randomly divided into two equal groups; group (A) received a fixed dose of 15 J/cm2 BB‐UVA, while group (B) received NB‐UVB. The study was conducted for a period of 16 weeks (48 sessions).

Results

The final percentage of clinical improvement was significantly higher (P = 0.047) within the BB‐UVA group (63.82% ± 27.42), than within the NB‐UVB group (44.32% ± 29.78).

Conclusion

BB‐UVA can be considered as an alternative treatment line for vitiligo.
The Emergence of Diverse Organic Consumers: Does a Mature Market Undermine the Search for Alternative Products?
Authors: Lund Thomas Bøker , Andersen Laura Mørch , O'Doherty Jensen Katherine
Published: September 2013

This study uses qualitative and quantitative data as well as household panel data regarding actual purchases of organic food in order to make a psychographic profiling of organic consumers and examine recent developments of organic demand inDenmark. It is shown that contemporary organic consumers have become a heterogeneous group, since three distinct positively minded segments are identified. These positively minded segments hold a very high share of all organic food sales on theDanish market and are also driving demand forward. TheDanish organic market can be said to have matured insofar as positively oriented segments that differ in their food involvement, shopping behaviour and levels of ethical concern have appeared, while marketing and distribution strategies have co‐developed with these trends. We discuss our findings in the light of the attitude‐behaviour gap that is said to exist in regard to organic consumption and the consequences that are thought to follow from the detachment of consumers from organic producers according to the much debated conventionalisation thesis.
Discrimination between cutaneous pigmentation and erythema: Comparison of the skin colorimeters Dermacatch and Mexameter
Authors: Baquié M. , Kasraee B.
Published: September 2013

Background/purpose

Reproducibility and specificity of the present skin colorimeters is still limited as alterations in erythema can bias the measurement of melanin and vice versa. Here, Dermacatch®, a new colorimeter covering the visible light spectrum, has been compared with Mexameter®, an established narrow‐band reflectance spectrophotometer.

Methods

Repeated measurements with both devices were initially collected on colour charts. Then, measures were compared on 12 human volunteers before and after exposure to UVB, and/or modulation of skin erythema.

Results

In vitro sensitivity of Dermacatch to erythema/melanin covered a broader wavelength spectrum than Mexameter while in vivo sensitivity of both devices was similar. Interestingly, Mexameter's melanin and erythema values were falsely affected by an increase in erythema or variation in pigmentation respectively. On the contrary, Dermacatch's melanin and erythema values remained constant in the same circumstances. Furthermore, as Mexameter was at least twice less reproducible than Dermacatch, Mexameter showed an increased risk of a confusion over the detection of erythema or melanin fluctuations.

Conclusion

The analysis of more than 18,000 measures indicated that, Dermacatch has a significantly higher specificity and reproducibility than Mexameter in the measurement of skin pigmentation and erythema.
Numerical Analysis of Vortex Dynamics in a Double Expansion
Authors: Love Allan I. J. , Giddings Donald , Power Henry
Published: September 2013

The turbulent flow through a 3D diffuser featuring a double expansion is investigated using computational fluid dynamics. Time dependent simulations are reported using the stress omega Reynolds stress model available in ANSYS FLUENT 13.0. The flow topography and characteristics over a range of Reynolds numbers from 42,000 to 170,000 is reported, and its features are consistent with those investigated for other similar geometries. A transition from a chaotic separated flow to one featuring one large recirculation in one corner of the diffuser is predicted at a Reynolds number of 80,000. For a Reynolds number of 170,000 a precessing/flapping motion of the main flow field was identified, the frequency of which is consistent with other numerical and experimental studies.
Power of Rare Diseases: Found in Translation
Authors: Fishman Mark C.
Published: September 2013

Trials in homogenous patient populations provide insights into disease pathogenesis that facilitate treatments for rare and common diseases.
Platelet-Activating Factor Receptor Blockade Ameliorates Aggregatibacter actinomycetemcomitans-Induced Periodontal Disease in Mice
Authors: Madeira Mila Fernandes Moreira , Queiroz-Junior Celso Martins , Costa Graciela Mitre , Werneck Silvia Maria Cordeiro , Cisalpino Daniel , Garlet Gustavo Pompermaier , Teixeira Mauro Martins , Silva Tarcília Aparecida , Souza Daniele G.
Published: September 2013

Periodontal disease (PD) is a chronic inflammatory and alveolar bone destructive disease triggered by oral biofilm-producing microorganisms, such asAggregatibacter actinomycetemcomitans. The levels of the phospholipid platelet-activating factor (PAF) in the saliva, gingival crevicular fluid, and periodontal tissues are significantly increased during inflammatory conditions, such as PD, but the exact mechanism that links PAF to alveolar bone resorption is not well understood. In the current study, alveolar bone resorption was induced by experimental PD through the oral inoculation ofA. actinomycetemcomitansin wild-type (WT) and PAF receptor knockout (Pafr−/−) mice.In vitroexperiments usingA. actinomycetemcomitanslipopolysaccharide (LPS)-stimulated RAW 264.7 cells treated with a PAF receptor antagonist (UK74505) were also performed. The expression of lyso-PAF acetyltransferase in periodontal tissues was significantly increased 3 h afterA. actinomycetemcomitansLPS injection in mice. WT andPafr−/−mice that were subjected to oral inoculation ofA. actinomycetemcomitanspresented neutrophil accumulation and increased levels of CXCL-1 and tumor necrosis factor alpha (TNF-α) in periodontal tissues. However,Pafr−/−mice presented less alveolar bone loss than WT mice. Thein vitroblockade of the PAF receptor impaired the resorptive activity ofA. actinomycetemcomitansLPS-activated osteoclasts. In conclusion, this study shows for the first time that the blockade of PAF receptor may contribute to the progression of PD triggered byA. actinomycetemcomitansby directly affecting the differentiation and activity of osteoclasts.
Ecology, Diversity, and Evolution of Magnetotactic Bacteria
Authors: Lefèvre Christopher T. , Bazylinski Dennis A.
Published: September 2013

Magnetotactic bacteria (MTB) are widespread, motile, diverse prokaryotes that biomineralize a unique organelle called the magnetosome. Magnetosomes consist of a nano-sized crystal of a magnetic iron mineral that is enveloped by a lipid bilayer membrane. In cells of almost all MTB, magnetosomes are organized as a well-ordered chain. The magnetosome chain causes the cell to behave like a motile, miniature compass needle where the cell aligns and swims parallel to magnetic field lines. MTB are found in almost all types of aquatic environments, where they can account for an important part of the bacterial biomass. The genes responsible for magnetosome biomineralization are organized as clusters in the genomes of MTB, in some as a magnetosome genomic island. The functions of a number of magnetosome genes and their associated proteins in magnetosome synthesis and construction of the magnetosome chain have now been elucidated. The origin of magnetotaxis appears to be monophyletic; that is, it developed in a common ancestor to all MTB, although horizontal gene transfer of magnetosome genes also appears to play a role in their distribution. The purpose of this review, based on recent progress in this field, is focused on the diversity and the ecology of the MTB and also the evolution and transfer of the molecular determinants involved in magnetosome formation.
Functions, Compositions, and Evolution of the Two Types of Carboxysomes: Polyhedral Microcompartments That Facilitate CO
2
Fixation in Cyanobacteria and Some Proteobacteria
Authors: Rae Benjamin D. , Long Benedict M. , Badger Murray R. , Price G. Dean
Published: September 2013

Cyanobacteria are the globally dominant photoautotrophic lineage. Their success is dependent on a set of adaptations collectively termed the CO
2
-concentrating mechanism (CCM). The purpose of the CCM is to support effective CO
2
fixation by enhancing the chemical conditions in the vicinity of the primary CO
2
-fixing enzyme,
d
-ribulose 1,5-bisphosphate carboxylase/oxygenase (RubisCO), to promote the carboxylase reaction and suppress the oxygenase reaction. In cyanobacteria and some proteobacteria, this is achieved by encapsulation of RubisCO within carboxysomes, which are examples of a group of proteinaceous bodies called bacterial microcompartments. Carboxysomes encapsulate the CO
2
-fixing enzyme within the selectively permeable protein shell and simultaneously encapsulate a carbonic anhydrase enzyme for CO
2
supply from a cytoplasmic bicarbonate pool. These bodies appear to have arisen twice and undergone a process of convergent evolution. While the gross structures of all known carboxysomes are ostensibly very similar, with shared gross features such as a selectively permeable shell layer, each type of carboxysome encapsulates a phyletically distinct form of RubisCO enzyme. Furthermore, the specific proteins forming structures such as the protein shell or the inner RubisCO matrix are not identical between carboxysome types. Each type has evolutionarily distinct forms of the same proteins, as well as proteins that are entirely unrelated to one another. In light of recent developments in the study of carboxysome structure and function, we present this review to summarize the knowledge of the structure and function of both types of carboxysome. We also endeavor to cast light on differing evolutionary trajectories which may have led to the differences observed in extant carboxysomes.
Cellular non-specific interstitial pneumonia masquerading as congestive heart failure
Authors: Saraya Takeshi , Takata Saori , Fujiwara Masachika , Takei Hidefumi
Published: September 2013

A 66-year-old woman with a history of myocardial infarction 2 months prior presented to our respiratory department with several days of dry cough and night sweats. Chest X-ray and thoracic CT showed ground glass opacities or consolidation spreading from the hilar area to the peripheral area, suggesting central redistribution. Although neither rales nor abnormal heart sounds were noted, she was tentatively diagnosed with congestive heart failure based on those radiological findings. However, radiographic lung lesions and her symptoms were refractory to intensive diuretic treatment. Thereafter, video-assisted thoracoscopic surgery was performed, resulting in a diagnosis of cellular non-specific interstitial pneumonia (c-NSIP). After initiating treatment with prednisolone, her symptoms and the radiological findings resolved. In patients with NSIP, a radiological central distribution could rarely occur, especially in cases of c-NSIP. No rales were detected because of its paucity of fibrous components in the lung.
Sarcoid panuveitis associated with etanercept treatment, resolving with adalimumab
Authors: Dragnev D , Barr D , Kulshrestha M , Shanmugalingam S
Published: September 2013

We presented a case of a 54-year-old woman, who developed sarcoidosis uveitis while on treatment with the tumour necrosis factor α (TNFα) antagonist etanercept for rheumatoid arthritis. Her condition improved, but did not recover completely after the medication was stopped. After starting her on another TNFα antagonist, adalimumab, the uveitis recovered completely. Etanercept and adalimumab are from the same class of medication, but have different effects on other mediators and cells, which may explain these discrepancies.
How can socioeconomic inequalities in hospital admissions be explained? A cohort study
Authors: McCartney Gerry , Hart Carole , Watt Graham
Published: September 2013

Objectives

To investigate which antecedent risk factors can explain the social patterning in hospital use.

Design

Prospective cohort study with up to 37 years of follow-up.

Setting

Representative community sample in the West of Scotland.

Participants

7049 men and 8353 women aged 45–64 years were recruited into the study from the general population between 1972 and 1976 (78% of the eligible population).

Primary and secondary outcome measures

Hospital admissions and bed days by cause and by classification into emergency or non-emergency.

Results

All-cause hospital admission rate ratios (RRs) were not obviously socially patterned for women (RR 1.04, 95% CI 0.98 to 1.10) or men (RR 1.0, 95% CI 0.94 to 1.06) in social classes IV and V compared with social classes I and II. However, cardiovascular disease, coronary heart disease and stroke in women, and respiratory disease for men and women were socially patterned, although this attenuated markedly with the addition of baseline risk factors. Hospital bed days were generally socially patterned and the differences were largely explained by baseline risk factors. The overall RRs of mental health admissions in contrast were socially patterned for women (RR 1.77, 95% CI 1.38 to 2.27) and men (RR 1.51, 95% CI 1.11 to 2.06) in social classes IV and V compared with social classes I and II, but the pattern did not attenuate with the addition of baseline risk factors. Emergency hospital admissions were associated with lower social class, but there was an inverse relationship for non-emergency hospital admissions.

Conclusions

Overall admissions to hospital were only marginally socially patterned, and less than would be expected on the basis of the gradient in baseline risk. However, there was marked social patterning in admissions for mental health problems. Non-emergency hospital admissions were patterned inversely according to risk. Further work is required to explain and address this inequitable gradient in healthcare use.
A model for the distribution of daily number of births in obstetric clinics based on a descriptive retrospective study
Authors: Gam Christiane M B , Tanniou Julien , Keiding Niels , Løkkegaard Ellen L
Published: September 2013

Objective

To test whether the relatively unpredictable nature of labour onset can be described by the Poisson distribution.

Design

A descriptive retrospective study.

Setting

From the Danish Birth Registry, we identified births from all seven obstetric clinics in the capital region of Denmark (n=211 290) between 2000 and the end of 2009. On each date, the number of births at each department was registered. Births are categorised based on whether an elective caesarean section or induction of labour has been performed, and among the remaining ‘non-elective births’, acute caesareans were registered.

Methods

After the exclusion of elective caesarean sections and births after induction of labour, only ‘non-elective’ births (n=171 009) were included for the main statistical analysis. Simple descriptive plots and one-way analysis of variance were used to analyse the distribution of ‘non-elective’ births for each day of the week.

Main outcome measures

The daily number of ‘non-elective’ births.

Results

The number of ‘non-elective’ births varies considerably over the days of the week and over the year for each obstetric clinic regardless of clinic size. However, for each fixed day of the week, the variation over the year is well described by a Poisson distribution, allowing simple prediction of the variability. For births at each fixed day of the week, the Poisson distribution is indistinguishable from a normal distribution.

Conclusions

The number of ‘non-elective’ births for each day of the week is well described by a Poisson distribution. Consequently, the Poisson model is suitable for estimating the variation in the daily number of ‘non-elective’ births and could be used for planning of staffing in obstetric clinics. The model can be used in smaller as well as larger clinics.
Cross-sectional survey: smoking among medical, pharmacy, dental and nursing students, University of Health Sciences, Lao PDR
Authors: Sychareun Vanphanom , Hansana Visanou , Choummanivong Molina , Nathavong Soudavanh , Chaleunvong Kongmany , Durham Jo
Published: September 2013

Objectives

To investigate the prevalence of and attitudes to smoking among third year medical, pharmacy, dentistry and nursing students in Lao People’s Democratic Republic (PDR).

Design

A cross-sectional survey conducted among third year university level, health professional students. The survey used a self-administered questionnaire which was originally developed by WHO, and modified to suit the setting.

Setting

The setting was the University of Health Sciences in Vientiane, the capital of Lao PDR. Participants were recruited from the Faculties of Medicine, Pharmacy, Dentistry and Nursing. At the time of the survey, 521 third year students were enrolled.

Primary and secondary outcome measures

The primary outcome measure was prevalence of current cigarette smoking and other tobacco use. Smoking status was categorised as: current smoker, ex-smoker and non-smoker with current smokers defined as those who had smoked cigarettes or used other tobacco on one or more days during the previous 30 days.

Results

In total, 506 respondents completed the questionnaire, giving a response rate of 97.1% to 98.5% across the different faculties. Overall smoking prevalence was 5.07% (95% CI 3.2% to 7.1%), which is lower than previously reported national prevalence rates. Women reported smoking less than men did (OR=0.56, 95% CI=0.013 to 0.242; p=0.003). The majority of students supported tobacco control measures. The number of people who reported receiving formal training in tobacco cessation counselling ranged from 10.9% (95% CI 5.3% to 19.1%) among nursing students to 51.1% (95% CI 40.4% to 61.7%) among medical students.

Conclusions

Smoking prevalence among this cohort was relatively low. Students were supportive of tobacco control policies. Further research is needed to understand what is working in this context, in order to apply lessons learnt in similar settings. In the meantime, health professional students should be provided health education to discourage tobacco use. Information on tobacco control policies needs to be more widely disseminated.
Psychological morbidity among suicide-bereaved and non-bereaved parents: a nationwide population survey
Authors: Omerov Pernilla , Steineck Gunnar , Nyberg Tommy , Runeson Bo , Nyberg Ullakarin
Published: September 2013

Objective

To determine how psychological premorbidity affects the risk of depression in parents who lost a child through suicide.

Design

Population-based survey.

Setting

Sweden, between 2009 and 2010.

Participants

All parents who lost a child, age 15–30, through suicide between 2004 and 2007 according to National population registries. Non-bereaved parents matched for age, sex, living area, marital status, number of children. Exclusion criteria: born outside a Nordic country, not Swedish speaking, contact details missing. Participants: 666 of 915 (73%) suicide-bereaved and 377 of 508 (74%) non-bereaved parents.

Main outcome measures

Depression measured by the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) and study-specific questions to assess psychological premorbidity and experience of the child's presuicidal morbidity.

Results

In all, 94 (14%) suicide-bereaved and 51 (14%) non-bereaved parents (relative risk 1.0; 95% CI 0.8 to 1.4) had received their first treatment for psychological problems or had been given a psychiatric diagnosis more than 10 years earlier. The prevalence of moderate-to-severe depression was 115 (18%) in suicide-bereaved versus 28 (7%) in non-bereaved parents (RR 2.3; 95% CI 1.6 to 3.5). For those without psychological premorbidity, the relative risk was 2.3 (95% CI 1.4 to 3.6). 339 (51%) suicide-bereaved parents expressed worry over the child's psychological health during the month preceding the suicide and 259 (39%) had anticipated the suicide.

Conclusions

In parents who lost a child through suicide in Sweden we did not find a higher prevalence of long-term psychological premorbidity than among parents who had not lost a child; the more than twofold risk of depression among the bereaved can probably be explained by the suicide and the stressful time preceding the suicide.
Healthcare consultation and sick leave before and after neck injury: a cohort study with matched population-based references
Authors: Jöud Anna , Stjerna Johanna , Malmström Eva-Maj , Westergren Hans , Petersson Ingemar F , Englund Martin
Published: September 2013

Objectives

Recent studies based on self-assessed data on exposure and outcome suggest a negative association between poor health before neck injury and recovery. Our aim was to study actual healthcare consultation and work disability before and after neck injury (whiplash).

Design

Cohort study with matched references studied prospectively and retrospectively via regional and national held registers.

Setting

Population-based study in Region Skåne, Sweden (population=1.21 million) including all levels of healthcare.

Participants

1443 participants aged ≥18 (54% women) with acute neck injury, Whiplash, (International Classification of Diseases-10-SE code S13.4*) in 2007 or 2008 and no such diagnosis since 1998. Each patient with a neck injury was assigned four randomly selected population references matched for age, sex and area of residence (97% of the patients and 94% of the references were followed during the whole study period).

Primary and secondary outcome measures

We studied changes in healthcare consultations 3 years before to 3 years after diagnosis as well as sick leave episodes. Analyses were also stratified by preinjury frequency of consultation.

Results

Before the injury, the mean number of total consultations over 36 months among the neck injured (n=1443) and references (n=5772) was 9.3 vs 7.2 (p<0.0001) and postneck injury 12.7 vs 7.8 (p<0.0001). In the group of high-frequent consulters, there were more women compared with frequent and low-frequent consulters (70.6% vs 32.8%; p<0.0001). Among low-frequent and frequent consulters preinjury (n=967, 67% of the cohort), 16% became high-frequent consulters attributable to the injury. The number of days of sick leave preinjury was correlated with the number of preinjury and postinjury consultations (r=0.47 (99% CI 0.38 to 0.49), r=0.32 (99% CI 0.25 to 0.37)).

Conclusions

People with a neck injury constitute a heterogeneous group. The preinjury level of healthcare consultation is associated with the postinjury level of consultation.
Can we simplify the hospital accreditation process? Predicting accreditation decisions from a reduced dataset of focus priority standards and quality indicators: results of predictive modelling
Authors: Guérin Sophie , Le Pogam Marie-Annick , Robillard Benjamin , Le Vaillant Marc , Lucet Bruno , Gardel Christine , Grenier Catherine , Loirat Philippe
Published: September 2013

Objectives

Accreditation in France relies on a mandatory 4-year cycle of self-assessment and a peer review of 82 standards, among which 14 focus priority standards (FPS). Hospitals are also required to measure yearly quality indicators (QIs—5 in 2010). On advice given by the accreditation committee of HAS (Haute Autorité en Santé), based on surveyors proposals and relying mostly on compliance to standards, accreditation decisions are taken by the board of HAS. Accreditation is still perceived by hospitals as a burdensome process and a simplification would be welcomed. The hypothesis was that a more limited number of criteria might give sufficient amount of information on hospitals overall quality level, appraised today by accreditation decisions.

Design

The accuracy of predictions of accreditation decisions given by a model, Partial Least Square-2 Discriminant Analysis (PLS2-DA), using only the results of FPS and QIs was measured. Accreditation decisions (full accreditation (A), recommendations or reservation (B), remit decision or non-accreditation (C)), results of FPS and QIs were considered qualitative variables. Stability was assessed by leave one out cross validation (LOOCV).

Setting and participants

All French 489 acute care organisations (ACO) accredited between June 2010 and January 2012 were considered, 304 of them having a rehabilitation care sector (RCS).

Results

Accuracy of prediction of accreditation decisions was good (89% of ACOs and 91% of ACO-RCS well classified). Stability of results appeared satisfactory when using LOOCV (87% of ACOs and 89% of ACO-RCS well classified). Identification of worse hospitals was correct (90% of ACOs and 97% of ACO-RCS predicted C were actually C).

Conclusions

Using PLS2-DA with a limited number of criteria (QIs and FPS) provides an accurate prediction of accreditation decisions, especially for underperforming hospitals. This could support accreditation committees which give advices on accreditation decisions, and allow fast-track handling of ‘safe’ reports.
Educational interventions to improve prescribing competency: a systematic review
Authors: Kamarudin Gritta , Penm Jonathan , Chaar Betty , Moles Rebekah
Published: September 2013

Objective

To review the literature on educational interventions to improve prescribing and identify educational methods that improve prescribing competency in both medical and non-medical prescribers.

Design

A systematic review was conducted. The databases Medline, International Pharmaceutical Abstracts (IPA), EMBASE and CINAHL were searched for articles in English published between January 1990 and July 2013.

Setting

Primary and secondary care.

Participants

Medical and non-medical prescribers.

Intervention

Education-based interventions to aid improvement in prescribing competency.

Primary outcome

Improvements in prescribing competency (knows how) or performance (shows how) as defined by Miller's competency model. This was primarily demonstrated through prescribing examinations, changes in prescribing habits or adherence to guidelines.

Results

A total of 47 studies met the inclusion criteria and were included in the systematic review. Studies were categorised by their method of assessment, with 20 studies assessing prescribing competence and 27 assessing prescribing performance. A wide variety of educational interventions were employed, with different outcome measures and methods of assessments. In particular, six studies demonstrated that specific prescribing training using the WHOGuide to Good Prescribingincreased prescribing competency in a wide variety of settings. Continuing medical education in the form of academic detailing and personalised prescriber feedback also yielded positive results. Only four studies evaluated educational interventions targeted at non-medical prescribers, highlighting that further research is needed in this area.

Conclusions

A broad range of educational interventions have been conducted to improve prescribing competency. The WHOGuide to Good Prescribinghas the largest body of evidence to support its use and is a promising model for the design of targeted prescribing courses. There is a need for further development and evaluation of educational methods for non-medical prescribers.
Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study
Authors: Joffres Michel , Falaschetti Emanuela , Gillespie Cathleen , Robitaille Cynthia , Loustalot Fleetwood , Poulter Neil , McAlister Finlay A , Johansen Helen , Baclic Oliver , Campbell Norm
Published: September 2013

Objective

Comparison of recent national survey data on prevalence, awareness, treatment and control of hypertension in England, the USA and Canada, and correlation of these parameters with each country stroke and ischaemic heart disease (IHD) mortality.

Design

Non-institutionalised population surveys.

Setting and participants

England (2006 n=6873), the USA (2007–2010 n=10 003) and Canada (2007–2009 n=3485) aged 20–79 years.

Outcomes

Stroke and IHD mortality rates were plotted against countries’ specific prevalence data.

Results

Mean systolic blood pressure (SBP) was higher in England than in the USA and Canada in all age–gender groups. Mean diastolic blood pressure (DBP) was similar in the three countries before age 50 and then fell more rapidly in the USA, being the lowest in the USA. Only 34% had a BP under 140/90 mm Hg in England, compared with 50% in the USA and 66% in Canada. Prehypertension and stages 1 and 2 hypertension prevalence figures were the highest in England. Hypertension prevalence (≥140 mm Hg SBP and/or ≥90 mm Hg DBP) was lower in Canada (19·5%) than in the USA (29%) and England (30%). Hypertension awareness was higher in the USA (81%) and Canada (83%) than in England (65%). England also had lower levels of hypertension treatment (51%; USA 74%; Canada 80%) and control (<140/90 mm Hg; 27%; the USA 53%; Canada 66%). Canada had the lowest stroke and IHD mortality rates, England the highest and the rates were inversely related to the mean SBP in each country and strongly related to the blood pressure indicators, the strongest relationship being between low hypertension awareness and stroke mortality.

Conclusions

While the current prevention efforts in England should result in future-improved figures, especially at younger ages, these data still show important gaps in the management of hypertension in these countries, with consequences on stroke and IHD mortality.
MRI of the cervical nerve roots in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy: a single-institution, retrospective case–control study
Authors: Tanaka Kanta , Mori Nobuyuki , Yokota Yusuke , Suenaga Toshihiko
Published: September 2013

Objective

To systematically evaluate the usefulness of assessing the cervical nerve roots by MRI for the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).

Design

Single-institution, retrospective case–control study.

Setting

A regional referral hospital.

Participants

We retrospectively enrolled 15 consecutive patients with CIDP who satisfied the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) typical and definite criteria and underwent cervical MRI. 30 control patients who had also undergone cervical MRI were included, matched with regard to sex, age and MRI system. The diagnoses of the control patients included cervical spondylosis (n=19), cervical spine trauma (n=2), infection (n=1), malignancies (n=4), demyelinating disorders (n=2) and neurodegenerative disorders (n=2).

Measurement

A radiologist determined the C5–C8 root diameters on the coronal short tau inversion recovery (STIR) images. Signal intensities of these roots were quantified as nerve-to-muscle contrast-to-noise ratios (CNRs), which were calculated using mean signal intensities of the roots and sternocleidomastoid muscle as well as SD of background noise. Statistical analyses were performed to determine the diagnostic accuracy of the diameters and nerve-to-muscle CNRs. Another radiologist reviewed MRI for ensuring reproducibility.

Results

The root diameters showed no significant differences between the patients with CIDP and control patients. The nerve-to-muscle CNRs were significantly higher in the patients with CIDP. We defined the sum of nerve-to-muscle CNRs of C5–C8 roots as the CNR score to serve as an index of overall signal intensity. The area under the receiver operating characteristic curve of CNR scores was 0.731. The reproducibility of the assessment procedure was satisfactory.

Conclusions

Our results suggest that assessment of the cervical nerve roots by MRI is useful for CIDP diagnosis when the signal intensities, rather than the diameters, are paid more attention on STIR images.
Strategies TO reduce time delays in patients with AcuTe coronary heart disease treated with primary PCI—the STOP WATCH study: a multistage action research project
Authors: Tödt Tim , Thylén Ingela , Alfredsson Joakim , Swahn Eva , Janzon Magnus
Published: September 2013

Objective

To identify, evaluate and reduce system delay times in an ST-elevation myocardial infarction (STEMI) network by targeted reorganisation of logistics and personal feedback to staff on time delays.

Design

Multistage action research project. Three study phases were used (exploration, tailored intervention and evaluation).

Setting

Single centre study, Sweden.

Patients

Consecutive patients (N=156) with prehospital STEMI onset treated with primary percutaneous coronary intervention (PCI).

Interventions

Areas of delays were identified through participant observations and collaborative discussions. To increase the awareness of delay factors, continuous feedback on time delays was given. Elements of the logistics’ reorganisation were (1) prioritised ECG recording by emergency medical services personnel, (2) central evaluation of ECG in all patients and (3) start of PCI procedure when two of three PCI team members were on site. Multiple key time measurements were made before (N=67) and after (N=89) the intervention.

Main outcomes

Time difference (minutes) in system delay between the preintervention and postintervention phases.

Results

Time from first medical contact (FMC) to a patent artery and time from FMC-to-catheter laboratory (cath-lab) arrival decreased by 6 and 12 min, respectively (ns). Time from FMC-to-ECG recording remained unchanged after the intervention. Time from ECG to decision for primary PCI was reduced by 6 min, p=0.004 and time from ECG-to-cath-lab arrival by 11 min, p=0.02. Total time from diagnosis to a patent artery decreased by 11 min (ns).

Conclusions

Identification of time delays in an STEMI network with awareness of delay factors, reorganisation of logistics and continuous feedback can reduce system delay times significantly.