bluuebunny/crossref_metadata_2025 huggingface dataset:
C3 grasses have higher nutritional quality than C4 grasses under ambient and elevated atmospheric CO2
Authors: Barbehenn Raymond V. , Chen Zhong , Karowe David N. , Spickard Angela
Published: September 2004

Grasses with the C3 photosynthetic pathway are commonly considered to be more nutritious host plants than C4 grasses, but the nutritional quality of C3 grasses is also more greatly impacted by elevated atmospheric CO2 than is that of C4 grasses; C3 grasses produce greater amounts of nonstructural carbohydrates and have greater declines in their nitrogen content than do C4 grasses under elevated CO2. Will C3 grasses remain nutritionally superior to C4 grasses under elevated CO2 levels? We addressed this question by determining whether levels of protein in C3 grasses decline to similar levels as in C4 grasses, and whether total carbohydrate : protein ratios become similar in C3 and C4 grasses under elevated CO2. In addition, we tested the hypothesis that, among the nonstructural carbohydrates in C3 grasses, levels of fructan respond most strongly to elevated CO2. Five C3 and five C4 grass species were grown from seed in outdoor open‐top chambers at ambient (370 ppm) or elevated (740 ppm) CO2 for 2 months. As expected, a significant increase in sugars, starch and fructan in the C3 grasses under elevated CO2 was associated with a significant reduction in their protein levels, while protein levels in most C4 grasses were little affected by elevated CO2. However, this differential response of the two types of grasses was insufficient to reduce protein in C3 grasses to the levels in C4 grasses. Although levels of fructan in the C3 grasses tripled under elevated CO2, the amounts produced remained relatively low, both in absolute terms and as a fraction of the total nonstructural carbohydrates in the C3 grasses. We conclude that C3 grasses will generally remain more nutritious than C4 grasses at elevated CO2 concentrations, having higher levels of protein, nonstructural carbohydrates, and water, but lower levels of fiber and toughness, and lower total carbohydrate : protein ratios than C4 grasses.
Phylogenetic relationships between disjunctly occurring groups of Tristicha trifaria (Podostemaceae)
Authors: Kita Yoko , Kato Masahiro
Published: September 2004

Aim  To reveal the phylogeographic relationship of disjunct specimens of Tristicha trifaria (Bory ex Willd.) Spreng., a member of the Podostemaceae river‐weed family, which is distributed exceptionally widely, but disjunctly, in Africa and the Americas.

Location  Brazil, Mexico, Ghana, Tanzania and Madagascar.

Methods  The chloroplast matK and rbcL genes, a trnK intron, the trnS‐trnG intergenic spacer (IGS), the two IGSs of trnT‐trnL‐trnF, a trnL intron, and nuclear ribosomal ITS regions were sequenced and analysed. Phylogenetic analyses were conducted using maximum likelihood and maximum parsimony methods.

Results  The T. trifaria samples analysed were separated into two groups in a rooted tree based on a combined matK/rbcL/ITS dataset; one contained the West African and all of the American samples, and the other contained the East African and Madagascan samples. An unrooted tree obtained from a combined analysis of all the chloroplast DNA and nuclear ITS data showed that a sample from West Africa was sister to an American T. trifaria group.

Main conclusions  The American and West African T. trifaria are closely related, despite the great distance between their locations. This observation, along with a tree of the whole Tristichoideae subfamily and estimated divergence times, suggests that an ancestor of T. trifaria migrated from Asia to Africa during the early Tertiary, and that this was followed by further westward migration to the Americas at the end of the Miocene or in the early Pliocene.
Evolution and biogeography of the austral genusPhyllocladus(Podocarpaceae)
Authors: Wagstaff Steven J.
Published: September 2004

Aim To infer evolutionary relationships within the genusPhyllocladusand among its close relatives by phylogenetic analysis of DNA sequences. Interpret the inferred relationships in association with the fossil record to examine the origin and diversification of the genus.

Location Australasia.

Methods Phylogenetic analyses ofrbcL,matKand internal transcribed spacer (ITS) sequences representing all of the extant species ofPhyllocladusand a selection of outgroups from Podocarpaceae and Araucariaceae.

Results TherbcLandmatKsequences exhibit little variation withinPhyllocladus, but ally its members to Podocarpaceae although its immediate sister remains unclear. The ITS sequences resolve all five species ofPhyllocladusand two intraspecific ecotypes ofP. alpinus.

Main conclusions Phyllocladusforms a distinct lineage that diverged early in the evolutionary history of Podocarpaceae. The fossil record indicates that the genus was more widely distributed and morphologically diverse during the early Tertiary than at present. Although of Mesozoic origin, the level of sequence variation withinPhyllocladussuggests that the extant species radiated during the late Tertiaryc.6.3 ± 0.9 Ma. New Zealand is the present centre of species diversity.
An evaluation of methods for modelling species distributions
Authors: Segurado Pedro , Araújo Miguel B.
Published: September 2004

Aim  Various statistical techniques have been used to model species probabilities of occurrence in response to environmental conditions. This paper provides a comprehensive assessment of methods and investigates whether errors in model predictions are associated to specific kinds of geographical and environmental distributions of species.

Location  Portugal, Western Europe.

Methods  Probabilities of occurrence for 44 species of amphibians and reptiles in Portugal were modelled using seven modelling techniques: Gower metric, Ecological Niche Factor Analysis, classification trees, neural networks, generalized linear models, generalized additive models and spatial interpolators. Generalized linear and additive models were constructed with and without a term accounting for spatial autocorrelation. Model performance was measured using two methods: sensitivity and Kappa index. Species were grouped according to their spatial (area of occupancy and extent of occurrence) and environmental (marginality and tolerance) distributions. Two‐way comparison tests were performed to detect significant interactions between models and species groups.

Results  Interaction between model and species groups was significant for both sensitivity and Kappa index. This indicates that model performance varied for species with different geographical and environmental distributions. Artificial neural networks performed generally better, immediately followed by generalized additive models including a covariate term for spatial autocorrelation. Non‐parametric methods were preferred to parametric approaches, especially when modelling distributions of species with a greater area of occupancy, a larger extent of occurrence, lower marginality and higher tolerance.

Main conclusions  This is a first attempt to relate performance of modelling techniques with species spatial and environmental distributions. Results indicate a strong relationship between model performance and the kinds of species distributions being modelled. Some methods performed generally better, but no method was superior in all circumstances. A suggestion is made that choice of the appropriate method should be contingent on the goals and kinds of distributions being modelled.
Biogeographical analysis of species of the tribe Cytiseae (Fabaceae) in the Iberian Peninsula and Balearic Islands
Authors: Gómez‐González Susana , Cavieres Lohengrin A. , Teneb Ernesto A. , Arroyo Juan
Published: September 2004

Aim  To analyse quantitatively the biogeographical distribution pattern of species of the Cytiseae Bercht. & J. Presl (= Genisteae Benth.) tribe in the Iberian Peninsula and the Balearic Islands, and to identify environmental variables related to the distributional patterns.

Location  Iberian Peninsula and Balearic Islands, using the 61 administrative provinces as operational geographical units.

Methods  In order to identify chorotypes (groups of species with similar geographical distribution), we performed a upgma classification based on the similarity index of Baroni‐Urbani & Buser. The method of McCoy et al. [Ecology67 (1986), 749] enabled us to detect the significant groups and to differentiate them from those groupings that could be generated at random. Logistic regression analyses and environmental gradient analyses (DCA and CCA) were performed in order to find the relationships between the environmental variables and the observed distributional patterns.

Results  Sixteen chorotypes were obtained between the Cytiseae species of the Iberian Peninsula and the Balearic Islands. The thermal variables showed the greatest influence in species distribution. Specifically, temperatures (maximum, minimum and mean) of the coldest months were associated with the majority of the chorotypes.

Main conclusions  The species of the Cytiseae tribe were not randomly distributed in space, and can be classified in groups of species with common distributional patterns. The importance of cold tolerance in the distribution of these species, as well as their preference for acidic soils, was demonstrated. Certain general tendencies seem to exist with respect to the distribution of the biota in the Iberian Peninsula, and these seem to be independent of the taxonomic groups involved and to be determined by convergent macroclimatic factors.
Distributional modelling and parsimony analysis of endemicity of Senecio in the Mediterranean‐type climate area of Central Chile
Authors: Rovito Sean M. , Arroyo Mary T.K. , Pliscoff Patricio
Published: September 2004

Aim  Floristic blocks and areas of endemism resulting from a parsimony analysis of endemicity (PAE) using raw floristic data versus data generated from distributional modelling for 130 species in the genus Senecio Tourn. ex L. distributed in the Mediterranean‐type climate area of Central Chile were compared, and the results were used to identify conservation priorities for the flora of the region.

Location  Central Chile, between 30° and 38° S.

Methods  Using herbarium records, a species × area matrix consisting of presence/absence data was constructed from a 0.5° × 0.5° grid. Distributional modelling techniques incorporating vegetation formations, elevation and the contagion index were used to interpolate floristic composition of poorly known areas. Parsimony analysis of endemicity was used to identify floristic blocks and areas of endemism.

Results  Using the number of most parsimonious trees as an index, distributional modelling greatly optimized the results of the PAE analysis. Three floristic blocks and four areas of endemism were suggested based on the PAE results using potential distribution data not incorporating the contagion index, while four blocks and two areas of endemism were suggested from the PAE results using potential distribution data incorporating the contagion index. Floristic blocks for the northern coast, southern Andes, and northern/central Andes were found, with some blocks showing divisions within them representing distinct geographic subunits. Major breaks between and within floristic blocks were identified at 32.5°–33° S and 34.5°–35° S.

Main conclusions  The floristic blocks identified with the distributional modelling and PAE correspond well to results from some previous studies and support hypothesized biogeographic divisions within Central Chile. The results were similar to those obtained from parallel analysis of the entire tree flora of Central Chile. The vegetative formation‐based distributional modelling produced robust and reproducible results when used along with PAE, especially when the contagion index was incorporated, and is a useful technique for area classification. The results demonstrate the utility of Senecio as an indicator genus for biogeography and conservation in southern South America.
Amplified fragment length polymorphism (AFLP) suggests old and recent immigration into the Alps by the arctic‐alpine annual Comastoma tenellum (Gentianaceae)
Authors: Schönswetter Peter , Tribsch Andreas , Niklfeld Harald
Published: September 2004

Aim  This study aims to elucidate the phylogeography of the arctic‐alpine annual Comastoma tenellum (Rottb.) Toyok. (Gentianaceae) and to unravel the history of its immigration into the Alps.

Location  Although samples from Alaska and Central Asia were also included, our study focusses on Europe, especially on the Alps.

Methods  We applied amplified fragment length polymorphism (AFLP) fingerprinting on 37 populations (162 individuals) of C. tenellum and analysed the results phenetically.

Results  As C. tenellum is mainly inbreeding, there is typically little to no intrapopulational genetic variation. Two populations from Alaska and Altai are strongly separated from all other accessions. The majority of the populations from the Alps group together with high bootstrap support. They fall into an unsupported Alps I group (northwards of Gran Paradiso) and a well‐supported Alps II group (south‐western Alps). The remaining European populations form a weakly‐supported branch constituting accessions from the Carpathians, Scandinavia and two populations from the Eastern Alps.

Main conclusions  Comastoma tenellum reached the Alps at least twice. The first immigration event resulted in a lineage that is clearly separated from the other European accessions. The immigration must have occurred well before the last glaciation because this lineage shows further phylogeographical structuring into two groups (Alps II in the south‐western Alps and Alps I in the rest of the Alps). This pattern is presumably due to isolation in different glacial refugia. In addition to the old immigration event, the species reached the Alps in recent times either from Scandinavia or from the Carpathians via long‐distance dispersal. These immigrations resulted in (at least) two populations that are spatially small and poor in individuals.
Diversity and distribution of ferns in sub‐Saharan Africa, Madagascar and some islands of the South Atlantic
Authors: Aldasoro J. J. , Cabezas F. , Aedo C.
Published: September 2004

Aim This paper reports the diversity and endemism patterns of African ferns, and explores the potential role of diversity refuges and environmental and historical factors in the shaping of these patterns.

Material and locations The extant fern taxa occupying Africa south of the Sahara, Madagascar and some islands of the South Atlantic.

Methods The number of taxa in each area or operational geographical unit (OGU) was scored, and the correlation between this number and physical and climatic variables analysed by standard pairwise and stepwise multiple regression analysis (SPR and SMR). The effects of biological factors such as dispersal capacity, reproductive biology, genetic features and certain physiological adaptations were evaluated by comparing the number of species in each OGU. Floral affinities among OGUs were analysed using non‐metric multi‐dimensional scaling (NMS) and parsimonic analysis of dispersion (PAD), and compared withβ‐turnover and inter‐OGU distances.

Results OGU area, elevation and the distance between refuges determined the composition of local floras, but only greater OGU area and the existence of higher maximum elevations increased species richness. The distance between refuges also affected the number of endemic species, especially on islands. The biological features studied only slightly influenced fern distribution. The main climatic predictor of species number was humidity. SPR and SMR revealed three main groups of ferns with different ecological trends. NMS and PAD analyses separated the four areas of highest diversity in Africa, three of which are inhabited by ferns with distinct ecological requirements. The fourth area was Madagascar, which shows an accumulation of endemic and relict diversity that is not easy to explain.

Main conclusions The distribution of ferns in Africa has been influenced by refuges. These probably allowed many species to recolonize the neighbouring areas after the extinctions of the Pleistocene. Three major components were detected in the African flora: Guinea‐Congolian thermophilous, cold‐tolerant Afro‐montane, and Southern drought‐tolerant elements. These are related to the three main refuge areas, i.e. the Gulf of Guinea area, the eastern tropical region, and the Cape region. Endemicity in ferns was found to be lower than that of seed plants due to the higher dispersability of fern spores. The distance between OGUs seems to be the main predictor of the number of endemic fern species these areas contain.
A preliminary account of patterns of endemism in Namibia's Sperrgebiet – the succulent karoo
Authors: Burke Antje
Published: September 2004

Aim  This study investigated spatial patterns of endemism in the flora of Namibia's succulent karoo in order to generate information for conservation planning.

Location  The study area, the Sperrgebiet, comprises the majority of Namibia's portion of the succulent karoo biome which is the south‐west corner of the country. This is an arid area that has been off limits to public access, farming and tourism for nearly a century due to restrictions imposed by the diamond industry.

Methods  Based on existing distribution records, areas of high concentrations of endemic plants were identified using numbers of endemics and weighted endemics according to area of occupancy. The resolution of the available data was quarter degree squares (15‐min intervals of latitude and longitude grids).

Results  At the scale of this study straight numbers of endemics generated similar results to the endemics weighted according to area of occupancy, which gives sparsely distributed species a higher weighting. Based on the current distribution records, 17.7% (184 species) of the Sperrgebiet's spermatophyte flora is endemic. The ‘hotspots of endemism’ comprised from north to south: Lüderitz‐Kowisberge, Klinghardt Mountains, Aurusberge‐Heioab, Witpütz, Skorpion and Obib‐Schakalsberge. Taking also areas into account that stand out because of their high proportion of local endemics, this adds Grillental and the central coastal area from Pomona to Baker's Bay to the areas of importance for plant endemism.

Main conclusions  The Sperrgebiet's endemic flora is special in taxonomic composition in that it does not present a subset of the total flora of this area, but shows a remarkably high representation of the families Mesembryanthemaceae and Liliaceae (sensu lato). Compared with other arid areas, the level of endemism in the Sperrgebiet is high, but not compared with the succulent karoo in general or other hotspots in the succulent karoo biome, such as the Richtersveld. The proportion of local endemics (13.5%) is high compared with some endemism hotspots in southern Africa. Hotspots of plant endemism provide an important tool to contribute to conservation planning studies. This study also highlighted the importance of centralized data bases without which these analyses would not have been possible. Further plant collecting is required to fill presently data‐deficient areas and studies at a finer spatial resolution taking habitat requirements into account are needed to elucidate some of the factors contributing to plant endemism in this area.
Local ecology and geographic ranges of plants in the Bishop Creek watershed of the eastern Sierra Nevada, California, USA
Authors: Kimball Sarah , Wilson Paul , Crowther Jack
Published: September 2004

Aim  The physiological requirements and tolerances of a species partially determine both its habitat preferences within a community and its broader geographic range. Therefore, we predicted that local ecology should be correlated with geographic distribution. We tested for a correlation between local ecology and range size, and we attempted to account for this correlation by the climate of the range.

Location  Bishop Creek Watershed, on the eastern side of the Sierra Nevada, California.

Methods  We recorded all plant species growing in each of 263 plots in the montane to alpine zones of the watershed. The local habitat preferences of 282 species were described in terms of wetness, elevation, soil, and amount of shade. The size and centre of the geographic range for each species were determined from regional floras.

Results  Wetness preference within the watershed was significantly correlated with range size. Specifically, plants of wet sites had larger ranges that extend to the north, whereas plants of dry sites tended to have smaller ranges centred to the east. The correlation between local wetness preference and range size was entirely explained by the location of the range centre of the species.

Main conclusions  A possible reason for the large ranges of mesophilic plants in our study area is that mesic habitats are continuous throughout the western Cordillera, while dry alpine habitats are isolated by valleys to the east. The correspondence between local ecology and geographic distributions implies evolutionary stasis in the niches of these plant species.
Plasma and platelet‐derived vascular endothelial growth factor and angiopoietin‐1 in hypertension: effects of antihypertensive therapy
Authors: Nadar S. K. , Blann A. D. , Lip G. Y. H.
Published: September 2004

Background.  Platelets carry angiogenic growth factors vascular endothelial growth factor (VEGF) and angiopoietin‐1 (Ang‐1). Although platelet‐derived growth factors are important in the pathogenesis and metastasis of malignancy, their role in the pathogenesis of complications and the response to treatment in hypertension is less known.

Objective.  To test the hypotheses that there are differences in VEGF and Ang‐1 in the plasma and within platelets from patients with hypertension, and that levels change with successful treatment.

Methods.  We recruited 42 previously untreated patients with hypertension (25 male; mean age 53 years) and 30 age‐ and sex‐matched controls. Plasma VEGF, Ang‐1 and soluble P‐selectin (sPsel, an index of platelet activation), and total platelet [platelet VEGF (pVEGF) and platelet Ang‐1 (pAng‐1)] were measured by ELISA. The patients were then treated for 6 months with amlodipine‐based antihypertensive therapy, achieving a mean blood pressure below 140/80 mmHg.

Results.  Patients with hypertension had significantly higher levels of plasma sPsel (P =0.01), VEGF (P < 0.001) and Ang‐1 (P = 0.01), as well as pVEGF (P < 0.001) and pAng‐1 (P =0.02). The levels of plasma and platelet angiogenic growth factors were significantly reduced after antihypertensive treatment (VEGF, P = 0.01; pVEGF, P < 0.001; Ang‐1, P < 0.001; pAng‐1, P = 0.04). There were no correlations with blood pressure or the levels of sPsel.

Conclusion.  Levels of plasma and intra‐platelet VEGF and Ang‐1 are increased in hypertension and are decreased with treatment. Platelet levels of VEGF and Ang‐1 may be related to platelet activation but may also involve other mechanisms (for example, the general vascular and haemodynamic changes) that are seen in hypertension.
Abnormal glucose tolerance – a common risk factor in patients with acute myocardial infarction in comparison with population‐based controls
Authors: Bartnik M. , Malmberg K. , Hamsten A. , Efendic S. , Norhammar A. , Silveira A. , Tenerz Å. , Öhrvik J. , Rydén L.
Published: September 2004

Background.  A high prevalence of newly detected diabetes and impaired glucose tolerance (abnormal glucose tolerance) was recently reported in patients with acute myocardial infarction. It is important to verify whether this finding is specific for the patients or attributable to the population, from which they were recruited.

Objective.  To verify whether abnormal glucose tolerance is more prevalent in patients than in controls chosen from the same population and to compare metabolic characteristics between the two groups.

Design and subjects.  The metabolic state was assessed in patients (n = 181) admitted with acute myocardial infarction and no history of diabetes before discharge and after 3 months. Sex‐ and age‐matched controls (n = 185) without previously known diabetes or cardiovascular disease except hypertension were recruited from the general population.

Main outcome measures.  Oral glucose tolerance test, glucosylated haemoglobin A1c (HbA1c), insulin, proinsulin, lipid profile, fibrinolytic function and inflammatory markers.

Results.  Abnormal glucose tolerance was more common (number/all classified) in patients at discharge 113/168 (67%) and after 3 months 95/145 (66%) than in controls 65/185 (35%) (P < 0.001). Dyslipidaemia (70% vs. 29%; P < 0.001) and previously treated hypertension (32% vs. 18%; P = 0.028) were more frequent amongst patients whilst obesity (18% vs. 24%) did not differ significantly. Blood glucose, HbA1c, proinsulin, proinsulin/insulin ratio, triglycerides, insulin resistance (by HOMA) and fibrinogen were consistently higher in patients than controls (P < 0.01).

Conclusions.  Abnormal glucose tolerance was almost twice as common amongst patients with acute myocardial infarction as in matched controls. Impaired glycaemic control accompanied by insulin resistance, dyslipidaemia, hypertension, together with increased plasma fibrinogen and proinsulin levels were main features characterizing patients.
Oxidative stress and its association with coronary artery disease and different atherogenic risk factors
Authors: Vassalle C. , Petrozzi L. , Botto N. , Andreassi M. G. , Zucchelli G. C.
Published: September 2004

Objective.  It is well known that free radicals contribute to endothelial dysfunction and are involved in the pathogenesis and development of cardiovascular diseases, such as atherosclerosis. The aim of this study was to provide evidence for enhanced oxidative stress in coronary artery disease (CAD).

Methods.  Plasma levels of 8‐isoprostane (8‐epiPGF2α), marker of lipid peroxidation, were measured in 68 subjects (age: 60 ± 2 years, mean ± SEM). Subjects included 30 healthy control subjects and 38 patients with angiographically proven CAD. In addition, the total antioxidant power (PAO) was evaluated in a subgroup (40 subjects, 12 healthy and 28 CAD).

Results.  Levels of 8‐epiPGF2α increased with the number of affected vessels (one‐ and multi‐vessel disease versus control subjects, P < 0.001) and considering different risk determinants for atherosclerosis (i.e. hypertension, gender, hypercholesterolaemia, P < 0.01). In multivariate regression models the number of affected vessels was independently correlated with 8‐epiPGF2α (P < 0.05). PAO values significantly decreased with increased number of affected vessels (P < 0.05) and in hypertensive patients when compared with those without hypertension (P < 0.05). In multivariate regression models the number of affected vessels resulted an independent determinant for PAO (P < 0.05). Concentration of 8‐epiPGF2α and PAO also correlated with the number of cardiovascular risk factors (P < 0.01 and P = 0.07, respectively).

Conclusion.  These findings indicate that elevated levels of plasma 8‐epiPGF2α and reduced antioxidant capacity are associated with the extent and the severity of CAD and with the occurrence and number of different atherogenic risk factors. This observation may assist in providing more information as to how oxidative stress may predispose to atherogenesis and suggest attractive therapeutic strategies in the prevention and treatment of cardiovascular disease.
Improved adherence to practice guidelines yields better outcome in high‐risk patients with acute coronary syndrome without ST elevation: findings from nationwide FINACS studies
Authors: Vikman S. , Airaksinen K. E. J. , Tierala I. , Peuhkurinen K. , Majamaa‐Voltti K. , Niemelä M. , Tuunanen H. , Nieminen M. S. , Niemelä K.
Published: September 2004

Abstract.  Vikman S, Airaksinen KEJ, Tierala I, Peuhkurinen K, Majamaa‐Voltti K, Niemelä M, Tuunanen H, Nieminen MS, Niemelä K (Tampere University Hospital, Tampere; University of Turku, Turku; University of Helsinki, Helsinki; University of Kuopio, Kuopio; and University of Oulu, Oulu; Finland). Improved adherence to practice guidelines yields better outcome in high‐risk patients with acute coronary syndrome without ST elevation: findings from nationwide FINACS studies. J Intern Med 2004; 256: 316–323.

Objectives.  Treatment options for acute coronary syndrome (ACS) without ST elevation have evolved rapidly during the recent years, but the successful implementation of practice guidelines incorporating new treatments into practice has been challenging. In this study, we evaluate whether targeted educational intervention could improve adherence to treatment guidelines of ACS without ST elevation.

Design, setting and subjects.  A previous study, FINACS I, evaluated the treatment and outcome of 501 consecutive non‐ST elevation ACS patients that were referred in early 2001 to nine hospitals, covering nearly half of the Finnish population. That study revealed poor adherence to ESC guidelines, so targeted educational intervention on optimal practice was arranged before the second study (FINACS II), which was performed in the same hospitals using the same protocol as FINACS I. FINACS II, undertaken in early 2003, evaluated 540 consecutive patients.

Interventions.  Targeted educational programmes on optimal practice.

Main outcome measures.  The use of evidence‐based therapies in non‐ST elevation ACS patients. In‐hospital event‐free (death, new myocardial infarction, refractory angina, readmission with unstable angina and transient cerebral ischaemia/stroke) survival, and event‐free survival at 6 months.

Results.  Baseline characteristics and risk markers were similar in both studies, and no significant changes in resources were seen. In 2003, the in‐hospital use of statins, ACE‐inhibitors, clopidogrel and glycoprotein (GP) IIb/IIIa receptor antagonists increased significantly, and in‐hospital angiography was performed more often, especially in high‐risk patients (59% vs. 45%, P < 0.05); waiting time also shortened (4.2 ± 5.5 vs. 5.8 ± 4.7 days, P < 0.01). Overall no significant change was seen in the frequency of death either in‐hospital (2% vs. 4%, P = NS) or at 6 months (7% vs. 10%, P = NS) in FINACS II. However, the survival of high‐risk patients improved both in‐hospital (95% vs. 90%, P = 0.05) and at 6 months (89% vs. 78%, P = 0.05).

Conclusion.  In patients with non‐ST elevation ACS‐targeted educational interventions appeared to be associated with improved adherence to practical guidelines, which yielded a better outcome in high‐risk ACS patients.
Oral quinolones in hospitalized patients: an evaluation of a computerized decision support intervention*
Authors: Hulgan T. , Rosenbloom S. T. , Hargrove F. , Talbert D. A. , Arbogast P. G. , Bansal P. , Miller R. A. , Kernodle D. S.
Published: September 2004

Objective.  To determine whether a computerized decision support system could increase the proportion of oral quinolone antibiotic orders placed for hospitalized patients.

Design.  Prospective, interrupted time‐series analysis.

Setting.  University hospital in the south‐eastern United States.

Subjects.  Inpatient quinolone orders placed from 1 February 2001 to 31 January 2003.

Intervention.  A web‐based intervention was deployed as part of an existing order entry system at a university hospital on 5 February 2002. Based on an automated query of active medication and diet orders, some users ordering intravenous quinolones were presented with a suggestion to consider choosing an oral formulation.

Main outcome measure.  The proportion of inpatient quinolone orders placed for oral formulations before and after deployment of the intervention.

Results.  There were a total of 15 194 quinolone orders during the study period, of which 8962 (59%) were for oral forms. Orders for oral quinolones increased from 4202 (56%) before the intervention to 4760 (62%) after, without a change in total orders. In the time‐series analysis, there was an overall 5.6% increase (95% CI 2.8–8.4%; P < 0.001) in weekly oral quinolone orders due to the intervention, with the greatest effect on nonintensive care medical units.

Conclusions.  A web‐based intervention was able to increase oral quinolone orders in hospitalized patients. This is one of the first studies to demonstrate a significant effect of a computerized intervention on dosing route within an antibiotic class. This model could be applied to other antibiotics or other drug classes with good oral bioavailability.
Sodium intake affects urinary albumin excretion especially in overweight subjects
Authors: Verhave J. C. , Hillege H. L. , Burgerhof J. G. M. , Janssen W. M. T. , Gansevoort R. T. , Navis G. J. , de Zeeuw D. , de Jong P. E. ,   The PREVEND study group
Published: September 2004

Objectives.  To examine the relationship between sodium intake and urinary albumin excretion, being an established risk marker for later cardiovascular morbidity and mortality.

Design.  Cross‐sectional cohort study using linear regression analysis.

Setting.  University hospital outpatient clinic.

Subjects.  A cohort drawn from the general population, consisting of 7850 subjects 28–75 years of age, all inhabitants of the city of Groningen, the Netherlands. The cohort is enriched for the presence of subjects with elevated urinary albumin concentration.

Results.  The results show a positive relationship between dietary sodium intake and urinary albumin excretion. The association was independent of other cardiovascular risk factors (such as sex, age, blood pressure, body mass index (BMI), waist‐to‐hip ratio, serum cholesterol, plasma glucose and smoking) and other food constituents (calcium, potassium and protein). The relationship between sodium intake and urinary albumin excretion was steeper in subjects with a higher BMI compared with a lower BMI.

Conclusions.  Sodium intake is positively related to urinary albumin excretion. This relation is more pronounced in subjects with a higher BMI. These results suggest that high sodium intake may unfavourably influences cardiovascular prognosis especially in overweight and obese subjects.
Publication of clinical trials: accountability and accessibility
Authors: Tumber M. B. , Dickersin K.
Published: September 2004

Publication of findings from clinical trials is a necessary step in the research continuum, to provide a record of the work done, convey information to the community, and support translation of research into clinical practice. Systematic reviews of randomized controlled trials are now widely regarded as the highest level of evidence in determining the effect of an intervention on an outcome. They largely depend on internationally accessible, published reports of all trials undertaken. Investigators and their institutions or organizations have responsibility for reporting their clinical trials accurately and completely, including disclosure of potential conflicts of interest. To ensure evidence‐based health care, issues relating to accessibility and accountability of clinical trial results require immediate action.
Air pollution and sudden infant death syndrome: a literature review
Authors: Tong Shilu , Colditz Paul
Published: September 2004

Although the rate of sudden infant death syndrome (SIDS) has been reduced with the ‘Back to Sleep’ campaign, SIDS is still a common cause of death in infancy. A range of environmental factors may interact to contribute to the adverse health conditions conducive to SIDS. Nine studies have evaluated the association between exposure to air pollution and the incidence of SIDS. The available evidence is inadequate to come to any conclusion about a relationship between air pollution and SIDS, although the body of evidence appears to suggest that air pollution (especially particles and some gaseous pollutants) may play a certain role in the occurrence of SIDS. We suggest that future studies should focus on the research design, role of indoor air quality and the effect of smaller particles, particularly those in the ultrafine range.
A prospective study of maternal serum C‐reactive protein (CRP) concentrations and risk of gestational diabetes mellitus
Authors: Qiu Chunfang , Sorensen Tanya K. , Luthy David A. , Williams Michelle A.
Published: September 2004

Low‐grade systemic inflammation is associated with an increased risk of type 2 diabetes mellitus. Limited available data suggest inflammatory factors are predictive of gestational diabetes (GDM), a condition that is biochemically similar to type 2 diabetes. We examined the association between C‐reactive protein (CRP) and GDM risk. Women were recruited before 16 weeks gestation and were followed until delivery. Maternal serum CRP (collected at 13 weeks’ gestation, on average) was measured by a competitive immunoassay. We used generalised linear models to derive estimates of relative risks and 95% confidence intervals [CI]. Approximately 4.5% of the cohort (38 of 851) developed GDM. Elevated CRP was positively associated with GDM risk (P for trend = 0.007). After adjusting for maternal prepregnancy body mass index (BMI), family history of type 2 diabetes and nulliparity, women with CRP in the highest tertile experienced a 3.5‐fold increased risk of GDM [95% CI 1.2, 9.8] as compared with those in the lowest tertile. The association between CRP and GDM was evident when analyses were restricted to lean women (BMI < 25 kg/m2). Lean women with CRP ≥ 5.3 mg/L experienced a 3.7‐fold increased risk of GDM [95% CI 1.6, 8.7] as compared with women with CRP < 5.3 mg/L. Systemic inflammation is associated with an increased risk of GDM, and the association is independent of maternal prepregnancy adiposity.
Intergenerational effects on size at birth in South India
Authors: Veena S. R. , Kumaran K. , Swarnagowri M. N. , Jayakumar M. N. , Leary S. D. , Stein C. E. , Cox V. A. , Fall C. H. D.
Published: September 2004

Several studies have shown that a baby's birthweight correlates with the birthweight and adult size of both its parents, but more strongly with those of its mother, suggesting that both the ‘maternal environment’ and inherited genes influence size at birth. There are no previous such intergenerational data from India. Holdsworth Memorial Hospital (HMH), Mysore, South India, has preserved birth records containing the birthweight, length and head circumference of all newborns since 1934. We identified 468 mother–offspring and 341 father–offspring pairs born in the hospital.

Daughters and sons (born 1990–95) were heavier at birth than their mothers and fathers, respectively, with a mean (SD) increase in birthweight of 121 g (24 g) between the two generations. The birthweight of both parents predicted offspring birthweight equally (mother: regression slope β  = 255 g/kg; father β  = 251 g/kg; P < 0.001 for both). Paternal birth length had a stronger effect than maternal birth length on offspring birth length. The mother's adult body mass index (BMI) had a greater effect than paternal BMI on offspring birthweight (mother: 18 g/kg/m2; P < 0.001; father: 15 g/kg/m2; P = 0.04). In a regression model including data for both parents (available for 57 children) this difference was greater (mother: 46 g/kg/m2; P < 0.001; father: −10 g/kg/m2; ns). In contrast, paternal height had stronger effects than maternal height on offspring birth length (mother: 0.8 mm/cm; ns; father: 1.5 mm/cm; P < 0.001). In conclusion, size at birth is influenced by a combination of environmental and genetic factors. Both maternal and paternal birthweight correlate with offspring size at birth. Maternal nutritional status (BMI) influences birthweight. Paternal factors appear to contribute to neonatal skeletal size.
Fetal alcohol syndrome prevention in Washington State: evidence of success
Authors: Astley Susan J.
Published: September 2004

Fetal alcohol syndrome (FAS) is a permanent birth defect syndrome caused by maternal consumption of alcohol during pregnancy. It is characterised by growth deficiency, central nervous system damage/dysfunction, and a unique cluster of minor facial anomalies. To assess the effectiveness of fetal alcohol syndrome prevention efforts, one must be able to estimate accurately the prevalence of fetal alcohol syndrome over time in population‐based samples. With the establishment of the Washington State Fetal Alcohol Syndrome Diagnostic and Prevention Network of clinics, the development of the Fetal Alcohol Syndrome Facial Photographic Analysis Software, the creation of the Fetal Alcohol Spectrum Disorders (FASD) 4‐Digit Diagnostic Code, the establishment of the Foster Care Fetal Alcohol Syndrome Screening Program, and the collection of Pregnancy Risk Assessment Management System data on maternal use of alcohol during pregnancy, the tools, methods and infrastructure for assessing the effectiveness of fetal alcohol syndrome primary prevention efforts in Washington State are in place. A cross‐sectional study was conducted to determine whether the prevalence of fetal alcohol syndrome among children in a foster care population, born between 1993 and 1998, decreased with the documented decrease in prevalence of maternal use of alcohol during pregnancy from 1993 and 1998 in Washington State.

The prevalence of maternal drinking during pregnancy in Washington State declined significantly (P < 0.001) from 1993 to 1998 as did the prevalence of fetal alcohol syndrome among foster children born 1993–98 (P < 0.03). These observations support the likelihood that fetal alcohol syndrome prevention efforts in Washington State are working successfully.
Mortality due to sudden infant death syndrome in Northern Italy, 1990–2000: a baseline for the assessment of prevention campaigns
Authors: Montomoli Cristina , Monti Maria C. , Stramba‐Badiale Marco , Marinoni Alessandra , Foglieni Nives , Carreri Vittorio , Amigoni Maurizio , Schwartz Peter J.
Published: September 2004

The aim of this paper is to estimate the infant mortality rate and the incidence of sudden infant death syndrome (SIDS) in Lombardy, Northern Italy, in the period 1990–2000 and to provide basic information for a subsequent comparison of the SIDS incidence before and after the risk‐intervention campaign. A retrospective epidemiological study was carried out using all deaths of resident infants occurring up to 1 year of age as recorded by the health districts mortality registries of the Lombardy region, between 1990 and 2000.

The infant mortality rate was 4.1 per 1000 live births, with a significant decreasing trend. This decrease is mainly due to the fall in mortality for congenital malformations and perinatal diseases. The SIDS incidence rate was 0.13 per 1000 live births; the annual incidence of SIDS during the study period decreased significantly by 60% from 0.20 to 0.08 deaths per 1000 live births (P = 0.001). When ‘possible SIDS deaths’, not directly labelled as SIDS, were also considered, the rate of SIDS was 0.54 per 1000 live births. The incidence of SIDS in Northern Italy appears much lower than anticipated. SIDS remains the single leading cause of death in the first year of life after the early neonatal period.
Revitalising the Metropolit 1953 Danish male birth cohort: background, aims and design
Authors: Osler Merete , Andersen Anne‐Marie Nybo , Lund Rikke , Batty G. David , Hougaard Charlotte Ørsted , Damsgaard Mogens Trab , Due Pernille , Holstein Bjørn E.
Published: September 2004

Recent research indicates that factors operating during childhood are related to adult health. Thus, longitudinal studies with information on subsequent phases may be key to understanding later health outcomes. The main objective of this paper is to describe the history and design of a Danish birth cohort, and its revitalisation. In 1965, information from birth certificates for 11 591 of a total of 12 270 males born in 1953 in the Metropolitan area of Copenhagen, Denmark were traced. These boys were the study population of a sociological investigation conducted with the aim of describing social mobility. At age 12 years, 9537 of these cohort members completed a questionnaire in school, which included cognitive measures and information on social aspirations and leisure time activities. In 1966 educational performance tests were administered for these boys and, in 1968, mothers of 2890 cohort members were interviewed regarding family social backgrounds.

With the establishment of the Civil Registration System (CRS) in 1968, it was possible to identify 11 532 cohort members. In 2002 we began the process of revitalising this study with the aim of investigating the influence of early life factors on later health. We succeeded in ascertaining the vital status of all subjects in the CRS. This showed that 863 subjects had died between 1968 and 2002. Linkages to the Register of Causes of Death, the National Hospital Register, Psychiatric Central Register and Danish Cancer Registry have been completed. In total, 7969 cohort members had been hospitalised for any somatic illness and, according to the Psychiatric Central Register, 1382 men had been admitted to a psychiatric hospital or ward. In the Cancer Registry we found 363 of our study participants. Analyses exploring the influence of social conditions in early life, birth dimensions, and childhood cognition on adult health experience are at various stages of completion. A questionnaire‐based postal follow‐up survey is planned. Thus, the Metropolit study provides an important opportunity to examine the processes by which factors that operate over the life course influence adult health.
A simple patient‐initiated intervention to increase antenatal detection of breech presentation at term
Authors: Roberts Christine L. , Cameron Carolyn A. , Nassar Natasha , Raynes‐Greenow Camille H.
Published: September 2004

Antenatal detection of breech presentations at 35–37 weeks is necessary to allow adequate time for decision making about external cephalic version (ECV) and/or caesarean section. This study aimed to increase antenatal detection of breech presentation and referral for ECV using an inexpensive patient prompt (a simple brochure encouraging pregnant women to ask how their baby is presenting) and posters reminding clinicians to assess presentation. The interventions were evaluated using a before‐after (single time series) study design. The records of women who had a breech presentation in late pregnancy were audited for 12 months before (n = 122) and 12 months after (n = 129) the introduction and implementation of the intervention.

There was a statistically significant increase in women with a breech presentation who were assessed antenatally for ECV eligibility, from 75 (61%) before the intervention to 100 (78%) after the intervention. In the before‐intervention period, 55 (60%) were identified as eligible for ECV and of these 32 (58%) had an ECV. After the intervention, 80 (75%) were identified as eligible for ECV and 46 (58%) had an ECV. A number of unanticipated events occurred during the study period, so although there was better identification of women eligible for ECV during the after‐intervention phase we cannot be sure whether this is an intervention effect or attributable to other reasons. Further, there was no increase in the uptake of ECV nor a reduction in caesarean sections for breech presentation. The difficulties associated with before‐after studies are highlighted.