bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiology teaching for junior doctors: their expectations, preferences and suggestions for improvement
Authors: Nyhsen Christiane M. , Lawson Cathy , Higginson Jim
Published: January 2011

Objectives

To evaluate radiology teaching offered to junior doctors on general medical/surgical rotations, their preferences regarding teaching methods and self-directed learning tools, and their suggestions for improvement.

Methods

An online questionnaire involving all foundation programme doctors at Sunderland Royal Hospital was carried out. Quantitative analysis of preferences and free text feedback were used.

Results

There was a response rate of 88/90 doctors (98%). The radiology teaching received was mostly informal. Most junior doctors felt that their medical school radiology teaching had been inadequate. The preferred teaching techniques were interactive case-based and system-based discussions. Textbooks and journal articles were not as popular as self-directed learning tools. Online learning material was used quite frequently, with general web content being more popular. Eighty-seven percent cited their motivation for studying radiology as “to become a better doctor”. More guidance from radiologists was desired, particularly regarding the choice of examinations and discussion of cases. Twenty-two percent of doctors were considering radiology as a career.

Conclusions

Interactive elements in radiology teaching are important. Online electronic teaching modules can be integrated into the teaching curriculum, but they must be of high quality to be acceptable and face-to-face interaction is still important. Junior doctors would like more guidance from radiologists.
l‐carnitine and cancer cachexia: Clinical and experimental aspects
Authors: Silvério Renata , Laviano Alessandro , Rossi Fanelli Filippo , Seelaender Marília
Published: January 2011

Cancer cachexia is a multifaceted syndrome characterized, among many symptoms, by extensive muscle wasting. Chronic systemic inflammation, partly triggered and sustained by cytokines, as well as increased oxidative stress contributes to the pathogenesis of this complex metabolic disorder.
l‐carnitine plays a central role in the metabolism of fatty acids and shows important antioxidant and anti‐inflammatory properties. Systemic carnitine depletion has been described in several diseases, and it is characterized by fatigue, muscle weakness, and decreased tolerance to metabolic stress. In cachectic cancer patients, low serum carnitine levels have been reported, and this change has been suggested to play an important contributory role in the development of cachexia. Based on these data, carnitine supplementation has been tested in preliminary studies concerning human cachexia, resulting in improved fatigue and quality of life. We present here a review of clinical and experimental evidence regarding the use of carnitine supplementation in the management of cancer cachexia.
Reparative properties of the traditional Chinese medicine Cordyceps sinensis (Chinese caterpillar mushroom) using HT29 cell culture and rat gastric damage models of injury
Authors: Marchbank Tania , Ojobo Ehighale , Playford Christopher J. , Playford Raymond J.
Published: January 2011

Cordyceps sinensis (CS) is a traditional Chinese medicine and health food used to support many organ systems. It is commercially produced by cultivation in a liquid medium or on a solid (grain/potato) phase. We tested the effects of hot water extracts of liquid-phase and solid-phase commercially grown CS on its ability to influence proliferation (using Alamar blue, an oxidation/reduction indicator), migration (serial-wounded monolayer photomicroscopy), invasion through collagen gel (fluorometric assay) and indomethacin-induced apoptosis (active caspase-3 colorimetric assay) of human colon cancer HT29 cells. An in vivo study used a rat gastric damage model (indomethacin 20 mg/kg and 4 h restraint with oral administration). The CS extract stimulated cell proliferation threefold when added at 10 μg/ml (P < 0·01). Cell migration increased by 69 % and invasion by 17 % when CS was added at 5 mg/ml (P < 0·01). The results also showed that 93 % of the pro-proliferative activity was soluble in ethanol, whereas pro-migratory activity was divided (61:49) into both ethanol-soluble and ethanol-insoluble sub-fractions. Indomethacin-induced apoptosis was not affected by the presence of CS. CS reduced the amount of gastric injury by 63 % when administered orally at 20 mg/ml (P < 0·01), the results being similar to using the potent cytoprotective agent epidermal growth factor at 25 μg/ml (83 % reduction). We conclude that both methods of cultivated CS possess biological activity when analysed using a variety of gut models of injury and repair. Functional foods, such as CS, could provide a novel approach for the prevention and treatment of injury to the bowel.
A whole-grain cereal-rich diet increases plasma betaine, and tends to decrease total and LDL-cholesterol compared with a refined-grain diet in healthy subjects
Authors: Ross Alastair B. , Bruce Stephen J. , Blondel-Lubrano Anny , Oguey-Araymon Sylviane , Beaumont Maurice , Bourgeois Alexandre , Nielsen-Moennoz Corine , Vigo Mario , Fay Laurent-Bernard , Kochhar Sunil , Bibiloni Rodrigo , Pittet Anne-Cécile , Emady-Azar Shahram , Grathwohl Dominik , Rezzi Serge
Published: January 2011

Epidemiological studies have repeatedly found that whole-grain (WG) cereal foods reduce the risk of several lifestyle-related diseases, though consistent clinical outcomes and mechanisms are elusive. To compare the effects of a WG-rich diet with a matched refined-grain (RG) diet on plasma biomarkers and bowel health parameters, seventeen healthy subjects (eleven females and six males) completed an exploratory cross-over study with a 2-week intervention diet based on either WG- or RG-based foods, separated by a washout of at least 5 weeks. Both diets were the same except for the use of WG (150 g/d) or RG foods. Subjects undertook a 4 h postprandial challenge on day 8 of each intervention diet. After 2 weeks, the WG diet tended to decrease plasma total and LDL-cholesterol (bothP = 0·09), but did not change plasma HDL-cholesterol, fasting glucose, C-reactive protein or homocysteine compared with the RG diet. Plasma betaine and alkylresorcinol concentrations were elevated after 1 week of the WG diet (P = 0·01 andP < 0·0001, respectively).Clostridium leptumpopulations in faeces were increased after the WG diet, along with a trend for decreased faecal water pH (P = 0·096) and increased stool frequency (P < 0·0001) compared with the RG diet. A short controlled intervention trial with a variety of commercially available WG-based products tended to improve biomarkers of CVD compared with a RG diet. Changes in faecal microbiota related to increased fibre fermentation and increased plasma betaine concentrations point to both fibre and phytochemical components of WG being important in mediating any potential health effects.
Real-time estimation of daily physical activity intensity by a triaxial accelerometer and a gravity-removal classification algorithm
Authors: Ohkawara Kazunori , Oshima Yoshitake , Hikihara Yuki , Ishikawa-Takata Kazuko , Tabata Izumi , Tanaka Shigeho
Published: January 2011

We have recently developed a simple algorithm for the classification of household and locomotive activities using the ratio of unfiltered to filtered synthetic acceleration (gravity-removal physical activity classification algorithm, GRPACA) measured by a triaxial accelerometer. The purpose of the present study was to develop a new model for the immediate estimation of daily physical activity intensities using a triaxial accelerometer. A total of sixty-six subjects were randomly assigned into validation (n 44) and cross-validation (n 22) groups. All subjects performed fourteen activities while wearing a triaxial accelerometer in a controlled laboratory setting. During each activity, energy expenditure was measured by indirect calorimetry, and physical activity intensities were expressed as metabolic equivalents (MET). The validation group displayed strong relationships between measured MET and filtered synthetic accelerations for household (r 0·907, P < 0·001) and locomotive (r 0·961, P < 0·001) activities. In the cross-validation group, two GRPACA-based linear regression models provided highly accurate MET estimation for household and locomotive activities. Results were similar when equations were developed by non-linear regression or sex-specific linear or non-linear regressions. Sedentary activities were also accurately estimated by the specific linear regression classified from other activity counts. Therefore, the use of a triaxial accelerometer in combination with a GRPACA permits more accurate and immediate estimation of daily physical activity intensities, compared with previously reported cut-off classification models. This method may be useful for field investigations as well as for self-monitoring by general users.
Characteristics of energy under-reporting in children and adolescents
Authors: Lioret Sandrine , Touvier Mathilde , Balin Morgan , Huybrechts Inge , Dubuisson Carine , Dufour Ariane , Bertin Mélanie , Maire Bernard , Lafay Lionel
Published: January 2011

Under-reporting (UR) of food intake is an issue of concern, as it may distort the relationships studied between diet and health. This topic has been scarcely addressed in children. The objective of the study was to assess the extent of UR in French children and investigate associated covariates. A total of 1455 children aged 3–17 years were taken from the nationally representative cross-sectional French étude Individuelle Nationale des Consommations Alimentaires (INCA2) dietary survey (2006–7). Food intake was reported in a 7 d diet record. Socio-economic status, sedentary behaviour, weight perception variables and food habits were collected by questionnaires. Weight and height were measured. Under-reporters were identified according to the Goldberg criterion adapted to children. Multivariate logistic regressions investigated the associations between UR and covariates. Rates of under-reporters were 4·9 and 26·0 % in children aged 3–10 and 11–17 years, respectively (P < 0·0001), without significant differences between boys and girls. Overall, UR was positively associated with a lower socio-economic status, overweight, skipping breakfast and dinner, a higher contribution of proteins to energy intake (EI), and a lower contribution of simple carbohydrates to EI. Under-reporters aged 3–10 years also had a higher sedentary behaviour and a lower snack-eating frequency. In adolescents, UR was also associated with a less-frequent school canteen attendance, a perception of being overweight, a wish to weigh less, and current and past restrictive diets. In conclusion, under-reporters differ from plausible reporters in several characteristics related to diet, lifestyle, weight status and socio-economic status. Therefore, it is important to consider this differential UR bias when investigating diet–disease associations in children.
How much is too much? A case report of nutritional supplement use of a high-performance athlete
Authors: Carlsohn Anja , Cassel Michael , Linné Karsten , Mayer Frank
Published: January 2011

Although dietary nutrient intake is often adequate, nutritional supplement use is common among elite athletes. However, high-dose supplements or the use of multiple supplements may exceed the recommended daily allowance (RDA) of particular nutrients or even result in a daily intake above tolerable upper limits (UL). The present case report presents nutritional intake data and supplement use of a highly trained male swimmer competing at international level. Habitual energy and micronutrient intake were analysed by 3 d dietary reports. Supplement use and dosage were assessed, and total amount of nutrient supply was calculated. Micronutrient intake was evaluated based on RDA and UL as presented by the European Scientific Committee on Food, and maximum permitted levels in supplements (MPL) are given. The athlete's diet provided adequate micronutrient content well above RDA except for vitamin D. Simultaneous use of ten different supplements was reported, resulting in excess intake above tolerable UL for folate, vitamin E and Zn. Additionally, daily supplement dosage was considerably above MPL for nine micronutrients consumed as artificial products. Risks and possible side effects of exceeding UL by the athlete are discussed. Athletes with high energy intake may be at risk of exceeding UL of particular nutrients if multiple supplements are added. Therefore, dietary counselling of athletes should include assessment of habitual diet and nutritional supplement intake. Educating athletes to balance their diets instead of taking supplements might be prudent to prevent health risks that may occur with long-term excess nutrient intake.
Dietary supplementation with selenium and vitamin E improves milk yield, composition and rheological properties of dairy Jonica goats
Authors: Tufarelli Vincenzo , Laudadio Vito
Published: January 2011

The objective of this study was to evaluate the effect of dietary supplementation with selenium (Se) and vitamin E (VitE) on milk yield, composition and renneting parameters in dairy Jonica breed goats. Forty multiparous lactating goats fed the same basal diet were randomly allocated to 1 of 2 dietary treatments: for 135 days, the experimental period. Basal diet was composed by ad libitum mixed vetch-oat hay and a definite amount of a pelleted concentrate. Dietary treatments included: (1) the control diet containing background Se and VitE only, and (2) the experimental diet containing sodium selenite as the Se supplement in concentrate (0·20 mg/head per day of Na-selenite and 20 mg/day per head of VitE). During the trial, no significant differences (P>0·05) were registered in dry matter intake and body weight gain among groups. Goats fed Se-VitE diet showed the highest milk production (P<0·05), and fat (P<0·01) and protein (P<0·05) yields and percentages. Somatic cell count were significantly lower in Se-VitE diet compared with control group (P<0·05). Significant differences (P<0·05) were observed in milk renneting properties. Based on our results, it was concluded that dietary supplementation with SE and VitE led to an increase of milk production and quality in Jonica goat, with positively improvement in milk coagulation aptitude.
Highly transient squeeze-film flows
Authors: MOSS E. A. , KRASSNOKUTSKI A. , SKEWS B. W. , PATON R. T.
Published: January 2011

The aim of this work was to investigate the flow evolution with time of fluid between two parallel disks and the corresponding pressure variations at the centre of the lower disk that occur subsequent to an impact-loading situation arising from dropping a mass onto the upper disk from a chosen height. During the event a fixed amount of energy is dissipated in the fluid between the disks through the action of friction. Therefore, this fundamental system may be regarded as a constant energy one, as distinct from one in which the upper disk is moving at a constant velocity, or is acted upon by a constant force. A test cell was set up to conduct the investigation, for which the separation between the disks was monitored, together with the pressure at the centre of the lower disk, over the duration of the experiment (about 8–10 ms). Glycerine was used as the test fluid. The equation of motion, based on a self-similarity approach, was reduced to a simpler (quasi-steady linear or QSL) form. Measured values of disk separation, velocity and acceleration were substituted as inputs into the full QSL model and two limiting cases, namely an inviscid and a viscous model. The QSL model provided excellent comparisons between the pressure measurements and data generated by a commercial computational fluid dynamics software package, throughout the duration of a typical experiment. The inviscid and viscous models achieved good correlations with measurements for the initial impact (during which disk accelerations exceeding 2 km s−2 occurred) and towards the end of the event, that were characterized by a small and much larger pressure rise, respectively. The former feature appears not to have been previously reported and is likely to typify that which would be observed in impact systems involving squeeze films.
Effect of maternal diet on the epigenome: implications for human metabolic disease
Authors: Lillycrop Karen A.
Published: January 2011

The rapid increase in the incidence of chronic non-communicable diseases over the past two decades cannot be explained solely by genetic and adult lifestyle factors. There is now considerable evidence that the fetal and early postnatal environment also strongly influences the risk of developing such diseases in later life. Human studies have shown that low birth weight is associated with an increased risk of CVD, type II diabetes, obesity and hypertension, although recent studies have shown that over-nutrition in early life can also increase susceptibility to future metabolic disease. These findings have been replicated in a variety of animal models, which have shown that both maternal under- and over-nutrition can induce persistent changes in gene expression and metabolism within the offspring. The mechanism by which the maternal nutritional environment induces such changes is beginning to be understood and involves the altered epigenetic regulation of specific genes. The demonstration of a role for altered epigenetic regulation of genes in the developmental induction of chronic diseases raises the possibility that nutritional or pharmaceutical interventions may be used to modify long-term cardio-metabolic disease risk and combat this rapid rise in chronic non-communicable diseases.
Music-making in the social world of a Cretan town (Heraklion 1900–1960): a contribution to the study of non-commercialrebetiko
Authors: Zaimakis Yiannis
Published: January 2011

Drawing on a range of biographical, historical, ethnographical and musicological sources, this article presents the social and historical factors contributing to the evolution in the early 20th century of a local variant ofrebetikoaround theLakkosbrothel district in Heraklion, the largest city in Crete. It explores the influence of a wider multicultural context on local music-making and reveals the relationship between the social life and economy of theLakkosarea and its musical and stylistic sensibilities. Emphasis is also placed on the musical culture of local subcultural space, particularly with respect to the functions of musical practices in everyday life and the poetics of improvised songs. Investigation of the social world inLakkossuggests that the forerunners ofrebetikocan be explored as a hybrid music scene associated with cross-cultural interaction between different social and ethnic groups and musical traditions. The societal and aesthetic codes of this scene, with its low life themes, coarse melodies and allegedly alien influences were seen by local elites as compromising the moral values of respectable society and subverting efforts to cultivate a national identity.
Using threshold values for cost per quality-adjusted life-year gained in healthcare decisions
Authors: Cleemput Irina , Neyt Mattias , Thiry Nancy , De Laet Chris , Leys Mark
Published: January 2011

Background:In many countries, the incremental cost-effectiveness ratio (ICER) is used to assess whether an intervention is worth its costs. At the same time, policy makers often feel uncomfortable with refusing reimbursement of any intervention purely on the basis of the fact that the ICER exceeds a specific threshold value. Reluctance to define a single threshold value for the ICER seems to have been stronger in social security systems than in national healthcare services systems. This study explores how basic differences between healthcare systems impact upon the potential usefulness of an ICER threshold value.

Methods:This study is a narrative review of literature about the theoretical foundations of the ICER threshold value approach and its practical relevance in different types of healthcare systems.

Results:A single ICER threshold value cannot be maintained, defined, or measured and should not be used as a policy-making tool. None of the solutions presented up until now to make the ICER threshold approach a valuable policy-making tool overcome the important weaknesses of the approach.

Conclusions:ICERs and ICER threshold values are insufficient for assessing interventions' value for money. Rather, they should be considered as one element in the decision-making process. Complete rationalization of the decision-making process by means of quantitative decision criteria is undesirable and not feasible. Increasing transparency in the criteria used for a decision and explicitness about the relative importance of each criterion should, therefore, be the major goal.
The true role of horizon scanning in Australia: Who it informs and why
Authors: Mundy Linda , Hiller Janet , Merlin Tracy
Published: January 2011

The article by O'Malley and Jordan (2009) contains fundamental errors and misunderstands the process it claims to describe (4).

The premise of the paper is that the Australian and New Zealand Horizon Scanning Network (ANZHSN) “was set up to scan the introduction of new and emerging medical technologies into the public sector, with consideration to theprivate sector.” However, the terms of reference of the policy body (HealthPACT) directing the ANZHSN's activities state that its role is to “provide a forum for monitoring, reviewing, and sharing information regarding health technology to inform service planning and policy development in thepublic sector” (1). HealthPACT is largely a jurisdictional committee, with representation from the Australian Government, each of its seven states and territories, the New Zealand Health Ministry and district health boards.
What aspects of the health technology assessment process recommended by international health technology assessment agencies received the most attention in Poland in 2008?
Authors: Kolasa Katarzyna , Dziomdziora Malgorzata , Fajutrao Liberty
Published: January 2011

Objectives:The primary objective of this study was to determine the extent to which international standards on transparency and quality are met by the health technology assessment (HTA) process in Poland. A secondary objective is to describe the outcomes of the HTA process and their associated factors.

Methods:All published online HTA appraisal and meeting proceedings on pharmaceutical products in 2008 were reviewed using a score card developed from international checklists recommended by INAHTA and ECHTA.

Results:The sixty-nine reports reviewed showed that five of nine transparency standards and six of eight quality standards were usually met by the HTA reports. Areas for improvement for transparency include inputs from external stakeholders, availability of English summaries, conclusions, implications of results, and suggested program of action. Areas of improvement for quality include appropriateness of target population and comparator/s, sufficiency of evidence on efficacy and safety, methodological rigor, economic model assumptions, and adaptation to the Polish setting. A consideration of the ethical and social consequences to the healthcare system must also be strengthened.

Conclusions:The study demonstrates that the incorporation and implementation of the HTA appraisal process in Poland has been successful. HTA appraisal reports in Poland have considered most of the international standards of transparency and quality. Recommendations for both HTA users and doers are forwarded for the improvement of the HTA process in the Polish setting.
Improving patient access to cancer drugs in India: Using economic modeling to estimate a more affordable drug cost based on measures of societal value
Authors: Dranitsaris George , Truter Ilse , Lubbe Martie S. , Sriramanakoppa Nitin N. , Mendonca Vivian M. , Mahagaonkar Sangameshwar B.
Published: January 2011

Background: Using multiples of India's per capita gross domestic product (GDP) as the threshold for economic value as suggested by the World Health Organization (WHO), decision analysis modeling was used to estimate a more affordable monthly cost in India for a hypothetical new cancer drug that provides a 3-month survival benefit to Indian patients with metastatic colorectal cancer (mCRC).

Methods: A decision model was developed to simulate progression-free and overall survival in mCRC patients receiving chemotherapy with and without the new drug. Costs for chemotherapy and side-effects management were obtained from both public and private hospitals in India. Utility estimates measured as quality-adjusted life-years (QALY) were determined by interviewing twenty-four oncology nurses using the Time Trade-Off technique. The monthly cost of the new drug was then estimated using a target threshold of US$9,300 per QALY gained, which is three times the Indian per capita GDP.

Results: The base-case analysis suggested that a price of US$98.00 per dose would be considered cost-effective from the Indian public healthcare perspective. If the drug were able to improve patient quality of life above the standard of care or survival from 3 to 6 months, the price per dose could increase to US$170 and US$253 and offer the same value.

Conclusions: The use of the WHO criteria for estimating the cost of a new drug based on economic value for a developing country like India is feasible and can be used to estimate a more affordable cost based on societal value thresholds.
Drug-eluting stents versus bare-metal stents in acute myocardial infarction: A systematic review and meta-analysis
Authors: Suh Hae Sun , Song Hyun Jin , Choi Ji Eun , Jang Eun Jin , Son Hee Jeong , Lee Sang Moo , Kim Jung-Sun , Choi Donghoon
Published: January 2011

Objectives:Recent concerns have been raised for the safety after drug-eluting stents (DES) implantation compared with the use of bare-metal stents (BMS) in patients with ST-elevation acute myocardial infarction (STEMI). The objective of this study was to estimate the relative impact of DES versus BMS on mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) in STEMI patients by performing comprehensive meta-analyses of randomized controlled trials (RCTs) and observational studies.

Methods:We performed an electronic search and manual search of studies presented through September 2009, without language restrictions. An approach of “using systematic reviews” was used. Two independent reviewers extracted prespecified data from each study. A random-effects model was used to combine trials and to perform stratified analyses based on study designs and the duration of follow-up.

Results:Fourteen RCTs were identified (N= 7,654). Compared with BMS, DES significantly reduced TVR (risk ratio [RR], 0.48; 95 percent confidence interval [CI], 0.41–0.56) and MI (RR, 0.77; 95 percent CI, 0.61–0.97), without increasing mortality (RR, 0.88; 95 percent CI, 0.70–1.10) and ST (RR, 0.93; 95 percent CI, 0.72–1.21). Among 35 observational studies (N= 44,849), the use of DES was associated with a significant reduction in mortality (RR, 0.85; 95 percent CI, 0.79–0.91) and TVR (RR, 0.61; 95 percent CI, 0.48–0.77). MI and ST were significantly lower in the DES group within 1-year follow-up, but there were no differences within 2 years of follow-up. There was no evidence of statistical heterogeneity and publication bias.

Conclusions:These data in aggregate suggest that using DES in STEMI patients is safe and efficacious, but there are differences between RCT and observational data comparing DES and BMS.
Addressing issues in health technology assessment promotion: Motives, enablers, and barriers
Authors: Rajan Abinaya , Gutierrez-Ibarluzea Iñaki , Moharra Montse
Published: January 2011

Objectives:The aim of this study was to analyze the motives, enablers, and barriers to promote or initiate health technology assessment (HTA) in different contexts.

Methods:An observational study design was used to address the above question that included a survey questionnaire and a two-phase study. The respondents for the questionnaire and first round of the study were from HTA agencies of high income countries and those low and middle income countries that have managed to establish HTA agencies (n= 50), that are members of International Network of Agencies for Health Technology Assessment (INAHTA), EuroScan, or European network for Health Technology Assessment (EUnetHTA). The second round of the study was exclusively with respondents from low and middle income countries that were manly affiliated to Health Technology Assessment International (HTAi) interest subgroup for low and middle income countries and aimed to initiate HTA activities (n= 34).

Results:Forty-one of fifty HTA agencies answered the survey questionnaire. Thirty-three of fifty individuals belonging to HTA agencies from high income countries and sixteen of thirty-four individuals from low and middle income countries answered in the first and second phases of the study, respectively. In the promotion and/or initiation of HTA, the top three motives were the same for both high income and low and middle income countries. The top three enablers were also similar but the prioritization varies. The top three barriers were more context specific.

Conclusions:HTA promotion or initiation is influenced by the following: (i) key players that affect the time taken to establish HTA agencies; (ii) three models for HTA promotion and initiation: top-down (political interest), bottom-up (academic/research interest), and converging (political and academic/research interests); and (iii) motives, enablers, and barriers at the local context.
Cone synapses in macaque fovea: II. Dendrites of OFF midget bipolar cells exhibit Inner Densities similar to their Outer synaptic Densities in basal contacts with cone terminals
Authors: HERR STEVE , NGO IVY TRAN , HUANG TERESA M. , KLUG KARL , STERLING PETER , SCHEIN STAN
Published: January 2011

As described in the companion paper, the synaptic terminal of a cone photoreceptor in macaque monkey makes an average of 35 or 46 basal contacts with the tips of the dendrites of its OFF midget bipolar cell. Each basal contact has one or more symmetrically thickened dense regions. These “Outer Densities,” averaging 48 or 67 in number, harbor clusters of ionotropic glutamate receptors and are ~0.8μm (and ~1-ms diffusion time) from active zones associated with synaptic ribbons. Here, we show similarly appearing “Inner Densities,” averaging 53 or 74 in number, located more proximally on the dendrites of these OFF midget bipolar cells, ~0.4μm inward from the tips of the dendrites and out of contact with the basal surface of the cone terminal. Compared to desmosome-like junctions, Inner Densities are closer to the terminal and are less dense and less thick. Each Inner Density is shared with another cell, the partners including diffuse bipolar cells, ON midget bipolar cells, and horizontal cells. Given the diversity of the partners, the OFF midget bipolar cells are unlikely to be in a synaptic relationship with the partners. Instead, Inner Densities are near enough to the active zones associated with synaptic ribbons to receive pulses of glutamate at concentrations effective for glutamate receptors. The role of Inner Densities is not known, but they might represent additional clusters of glutamate receptors.
Cone synapses in macaque fovea: I. Two types of non-S cones are distinguished by numbers of contacts with OFF midget bipolar cells
Authors: SCHEIN STAN , NGO IVY TRAN , HUANG TERESA M. , KLUG KARL , STERLING PETER , HERR STEVE
Published: January 2011

L and M cones, divided into two groups by absorption spectra, have not been distinguished by structure. Here, we report what may be such a difference. We reconstructed the synaptic terminals of 16 non-S cones and the dendritic arbors of their ON and OFF midget bipolar cells from high-magnification electron micrographs of serial thin sections of a small region of macaque fovea. Each cone terminal contacted a similar number (~16) of invaginating central elements provided by its ON midget bipolar cell. By contrast, the numbers of connections between a cone terminal and its OFF midget bipolar cell were grouped into two clusters: 30–37 versus 43–50 basal contacts in the triad-associated position and 41–47 versus 61–74 Outer Densities within those basal contacts. The coefficients of variation of these distributions were all in the range of 10% or lower, characteristic of single populations. If these two clusters correspond to M- and L-cone circuits, the results reveal structural differences between M and L cones and between their corresponding OFF midget bipolar cells.
Non-Degenerate Spheres in Three Dimensions
Authors: APFELBAUM ROEL , SHARIR MICHA
Published: January 2011

Let P be a set of n points in ℝ3, and let k ≤ n be an integer. A sphere σ is k-rich with respect to P if |σ ∩ P| ≥ k, and is η-non-degenerate, for a fixed fraction 0 < η < 1, if no circle γ ⊂ σ contains more than η|σ ∩ P| points of P.

We improve the previous bound given in [1] on the number of k-rich η-non-degenerate spheres in 3-space with respect to any set of n points in ℝ3, from O(n4/k5 + n3/k3), which holds for all 0 < η < 1/2, to O*(n4/k11/2 + n2/k2), which holds for all 0 < η < 1 (in both bounds, the constants of proportionality depend on η). The new bound implies the improved upper bound O*(n58/27) ≈ O(n2.1482) on the number of mutually similar triangles spanned by n points in ℝ3; the previous bound was O(n13/6) ≈ O(n2.1667) [1].
Pericardial patch valve in the tricuspid position in an infant
Authors: Sreeram Narayanswami , Mime Lotfi Ben , Bennink Gerardus
Published: January 2011

A 10-month-old infant with severe tricuspid valve disease due to staphylococcal bacterial endocarditis, underwent surgical replacement of the valve. The new valve was fashioned using an autologous pericardial patch. Over 3 years of follow-up, the new valve has functioned satisfactorily, with moderately elevated right atrial pressure.
A comparison of cardiac post-conditioning and remote pre-conditioning in paediatric cardiac surgery
Authors: Luo Wanjun , Zhu Ming , Huang Rimao , Zhang Yangde
Published: January 2011

Background

Remote ischaemic pre-conditioning and cardiac ischaemic post-conditioning provide myocardial protection in cardiac surgery. However, these two endogenous strategies have not been directly compared in a clinical setting. The purpose of this study was to compare the efficacy of remote ischaemic pre-conditioning and post-conditioning in providing myocardial protection to children undergoing cardiopulmonary bypass for surgical repair of ventricular septal defect.

Methods

We randomly assigned 60 paediatric patients scheduled for surgical correction of congenital ventricular septal defect to the post-conditioning group (n = 20), remote pre-conditioning group (n = 20), or control group (n = 20). Post-conditioning consisted of 30 seconds of ischaemia and 30 seconds of reperfusion achieved by clamping and unclamping the aorta, repeated three times over 3 minutes immediately after cardioplegic arrest. Remote ischaemic pre-conditioning consisted of 5 minutes of lower limb ischaemia followed by 5 minutes of reperfusion using a blood-pressure cuff inflated to a pressure of 200 millimetres of mercury, also repeated three times over 30 minutes. We assayed creatine kinase-MB, troponin I.

Results

Mean age, cardiopulmonary bypass times, and aortic cross-clamp times were matched across groups. Both post-conditioning and remote ischaemic pre-conditioning reduced the peak release of creatine kinase-MB (86.1 plus or minus 24.1 units per litre and 92.8 plus or minus 20.6 units per litre, respectively, versus 111.0 plus or minus 44.6 units per litre in the control, p less than 0.05) and troponin I (0.28 plus or minus 0.10 nanogram per millilitre and 0.26 plus or minus 0.09 nanogram per millilitre, respectively, versus 0.49 plus or minus 0.19 nanogram per millilitre in the control group, p less than 0.05).

Conclusions

Our study demonstrates that ischaemic post-conditioning and remote ischaemic pre-conditioning provide comparable myocardial benefit in children undergoing cold blood cardioplegic arrest.
Prevalence and predictors of later feeding disorders in children who underwent neonatal cardiac surgery for congenital heart disease
Authors: Maurer Ilona , Latal Beatrice , Geissmann Hilda , Knirsch Walter , Bauersfeld Urs , Balmer Christian
Published: January 2011

Aim

We thought of assessing the prevalence and predictors of feeding disorders in patients with congenital heart defects after neonatal cardiac surgery.

Methods

Retrospective study of 82 consecutive neonates (48 males, 34 females) who underwent surgery for congenital heart defects from 1999 to 2002. Information was taken from patient charts and nursing notes. The presence of a feeding disorder was assessed by a questionnaire sent to the paediatricians when the child was 2 years of age. A feeding disorder was defined as a need for tube feeding, inadequate food intake for age, or failure to thrive. Data were analysed with descriptive statistics and logistic regression.

Results

Feeding disorders occurred in 22% of the study population. Reoperation and early feeding disorders were identified as independent risk factors for later feeding disorders (odds ratio 5.8, p 0.01; odds ratio 20.7, p 0.02). There was a trend towards more feeding disorders in patients with neurological abnormalities during the first hospital stay.

Conclusion

Feeding disorder is a frequent, long-term sequela after neonatal cardiac surgery. Patients with congenital heart defects who undergo multiple cardiac surgeries and those with early feeding disorders are at risk of developing later feeding disorders. Patients with these risk factors need to be selected for preventive strategies.
Aortic stenosis in a patient with Hurler's syndrome after bone marrow transplantation
Authors: Watanabe Naruhito , Anagnostopoulos Petros V. , Azakie Anthony
Published: January 2011

We describe a case of severe aortic stenosis in a 16-year-old male with Hurler's syndrome who had prior bone marrow transplantation. The excised aortic valve leaflets showed characteristic pathologic findings of Hurler's syndrome. This is the first case report of aortic valve replacement in a patient with Hurler's syndrome treated with bone marrow transplantation that demonstrates progression of the aortic valve disease despite treatment.
Short communicationKey differences between school lunches and packed lunches in primary schools in England in 2009
Authors: Pearce Jo , Harper Clare , Haroun Dalia , Wood Lesley , Nelson Michael
Published: January 2011

Objective

To compare the key differences between school lunches and packed lunches as consumed in a nationally representative sample of primary schools, 6–8 months after the nutrient-based standards for school lunch became mandatory.

Design

Data on 6580 pupils’ school lunches and 3422 pupils’ packed lunches were collected between February and April 2009 from pupils attending primary schools in England. Fieldwork was conducted over five consecutive school days. Fieldworkers randomly selected ten pupils taking a school lunch and five pupils bringing a packed lunch each day at each school, and recorded and weighed all food and drink items consumed, as well as any leftovers.

Setting

A nationally representative sample of 136 state-maintained primary schools in England.

Subjects

A total of 10 002 pupils aged 4–12 years.

Results

Mean intakes of protein, fat, saturated fat and vitamin C from both types of lunch met the nutrient-based standards. Pupils taking school lunches on average consumed significantly more protein, NSP, vitamin A, folate and Zn and less fat, saturated fat, non-milk extrinsic sugars (NMES), Na, Ca, vitamin C and Fe than pupils taking packed lunches. Energy intakes were low in both groups.

Conclusions

Packed lunches were less likely to accord with food-based or nutrient-based standards than school lunches. Higher levels of Na, NMES, fat and percentage energy from saturated fat emphasise the difficulties associated with optimising nutrient intakes from packed lunches.
Molecular mechanisms of genomic imprinting and clinical implications for cancer
Authors: Uribe-Lewis Santiago , Woodfine Kathryn , Stojic Lovorka , Murrell Adele
Published: January 2011

Genomic imprinting is an epigenetic marking of genes in the parental germline that ensures the stable transmission of monoallelic gene expression patterns in a parent-of-origin-specific manner. Epigenetic marking systems are thus able to regulate gene activity independently of the underlying DNA sequence. Several imprinted gene products regulate cell proliferation and fetal growth; loss of their imprinted state, which effectively alters their dosage, might promote or suppress tumourigenic processes. Conversely, global epigenetic changes that underlie tumourigenesis might affect imprinted gene expression. Here, we review imprinted genes with regard to their roles in epigenetic predisposition to cancer, and discuss acquired epigenetic changes (DNA methylation, histone modifications and chromatin conformation) either as a result of cancer or as an early event in neoplasia. We also address recent work showing the potential role of noncoding RNA in modifying chromatin and affecting imprinted gene expression, and summarise the effects of loss of imprinting in cancer with regard to the roles that imprinted genes play in regulating growth signalling cascades. Finally, we speculate on the clinical applications of epigenetic drugs in cancer.
«Wie ein ANP-Team laufen lernt» – Herausforderungen und Chancen von ANP-Teams am Universitätskinderspital Zürich
Authors: Ullmann-Bremi Andrea , Schlüer Anna-Barbara , Finkbeiner Gabriela , Huber Yvonne
Published: January 2011

Im angloamerikanischen und nordeuropäischen Raum wurden verschiedene ANP-Einzelrollen entwickelt, unter anderem die der Clinical Nurse Specialist und der Nurse Practitioner. Diese universitär ausgebildeten Pflegespezialisten sind in der Schweiz weiterhin sehr rar. Um vor diesem Hintergrund die Praxis dennoch nachhaltig weiterentwickeln zu können, wurden in den letzten acht Jahren im Kinderspital Zürich kontinuierlich Advanced-Nursing-Practice-Teams (ANP-Teams) aufgebaut. Dieser Ansatz bewährte sich durch gezielte und angemessene Leistungserbringung in hochkomplexen Situationen. In diesem Artikel wird die Zusammensetzung der ANP-Teams diskutiert, wobei der Personalmix einen Schlüsselfaktor darstellt. Unterstützende Elemente stellen dabei sowohl die Aufgabendefinition als auch Aufgabenteilung in Klinik- und Konzeptteams dar. Die ANP-Teams arbeiten motiviert und zielgerichtet, sie integrieren Pflegende verschiedenster Erfahrungs- und Ausbildungsniveaus, wodurch gegenseitiges Lernen gefördert wird.
Entwicklung und Implementierung eines multidisziplinären pflegegeleiteten Programms zur stationären Betreuung von Patientinnen und Patienten mit Herzinsuffizienz: Das Basler HI-Programm
Authors: Bläuer Cornelia , Mahrer-Imhof Romy , Brunner-La Rocca Hanspeter , Müller Christian , Eze Germaine , Milbich Irene , Spirig Rebecca
Published: January 2011

Bei Patientinnen und Patienten mit einer Herzinsuffizienz (HI) handelt es sich um eine fragile Patientengruppe mit schlechter Prognose und häufigen Hospitalisationen. Verschiedene Forschungen zeigten, dass durch ambulante, multidisziplinäre Betreuungsprogramme Rehospitalisationen und Mortalität vermindert werden und die Lebensqualität verbessert werden konnte. Aus diesem Grund wurde am Universitätsspital Basel ein multidisziplinäres pflegegeleitetes Programm – das Basler HI-Programm – mittels eines Praxisentwicklungsprojekts nach den Prinzipien der Aktionsforschung entwickelt, implementiert und pilotevaluiert. Ziel dieses Artikels ist es, den langen und teilweise schwierigen Weg von der Programmentwicklung bis zum Ausweisen der Wirksamkeit aufzuzeigen. Die literaturgestützte Programmentwicklung und Implementierung wurde von einer Arbeitsgruppe, bestehend aus Pflegenden und zwei Ärzten, unter der Leitung einer Advanced-Practice-Nurse-Studentin durchgeführt. Entwickelt wurden sowohl ein Patientenpfad als auch Leitlinien, welche die Inhalte von Beratung und Trainingsprogramm, sowie die Verantwortlichkeiten und Kompetenzen im multidisziplinären Team regeln. Für Betroffene besteht heute ein individuelles Beratungs- und Trainingsprogramm mit entsprechendem Informations- und Dokumentationsmaterial. Die Patientenaustritte werden frühzeitig und strukturiert geplant und die Betroffenen erhalten individuelle Empfehlungen für zuhause. Für die Pflegenden stellte die Implementierung eine neue Herausforderung von strukturierter Beratung im hektischen Alltag dar, was ein kontinuierliches Coaching erforderte.
SpitexPlus: Assessment und fortgeschrittene Pflegeinterventionen für zuhause lebende alte Menschen und ihre Familien
Authors: Imhof Lorenz , Naef Rahel , Mahrer-Imhof Romy , Petry Heidi
Published: January 2011

Die demografische Entwicklung und die damit verbundene Zunahme chronischer Leiden verlangen neue Versorgungsmodelle für die ältere Bevölkerung. Dazu gehören auch präventive Hausbesuche. Die dafür in der Schweiz durchgeführten Programme konzentrieren sich in ihrer Mehrzahl auf die Altersgruppe bis 75 Jahre – mit dem Ziel, funktionale Gesundheit zu erhalten und einen Pflegeheimeintritt zu verhindern. Chronisch kranke Personen und hochaltrige Personen werden jedoch zu wenig berücksichtigt. Der verwendete Fokus auf die Patienten reicht zudem nicht aus und vernachlässigt die bedeutende Rolle familialer Systeme im Alltag dieser Menschen. Das APN-Projekt «SpitexPlus» richtet sich deshalb an Personen im Alter über 80 Jahren, unabhängig vom Gesundheitszustand, und berücksichtigt die vorhandenen familialen Unterstützungssysteme. Ziel des Programms ist eine verbesserte Selbstpflegefähigkeit, welche es allen Beteiligten erlaubt, besser mit den Herausforderungen im Alltag umzugehen. Erwartet wird eine erhöhte Lebensqualität für die Personen 80+ und ihre Familien. Die für dieses Programm entwickelten pflegerischen Interventionen orientieren sich an den Prinzipien der Gesundheitsförderung, des Empowerment, der Familienzentrierung und der Partnerschaft. Die Entwicklung dieses Programms, die Interventionen und die Rolle der APN werden beschrieben und der Nutzen für die Pflegepraxis wird dargestellt.
dlexDB – eine lexikalische Datenbank für die psychologische und linguistische Forschung
Authors: Heister Julian , Würzner Kay-Michael , Bubenzer Johannes , Pohl Edmund , Hanneforth Thomas , Geyken Alexander , Kliegl Reinhold
Published: January 2011

Zusammenfassung. Mit der lexikalischen Datenbank dlexDB stellen wir der psychologischen und linguistischen Forschung im World Wide Web online statistische Kennwerte für eine Vielzahl von verarbeitungsrelevanten Merkmalen von Wörtern zur Verfügung. Diese Kennwerte umfassen die durch CELEX ( Baayen, Piepenbrock und Gulikers, 1995 ) bekannten Variablen der Häufigkeiten von Wortformen und Lemmata in Texten geschriebener Sprache. Darüber hinaus berechnen wir eine Reihe neuer Kennwerte wie die Häufigkeiten von Silben, Morphemen, Zeichenfolgen und Mehrwortverbindungen sowie Wortähnlichkeitsmaße. Die Datengrundlage bildet das Kernkorpus des Digitalen Wörterbuchs der deutschen Sprache (DWDS) mit über 100 Millionen laufenden Wörtern. Wir illustrieren die Validität dieser Kennwerte mit neuen Ergebnissen zu ihrem Einfluss auf Fixationsdauern beim Lesen von Sätzen.