bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors that facilitate and hinder the manageability of living with amyotrophic lateral sclerosis in both patients and next of kin
Authors: Olsson Ozanne Anneli , Graneheim Ulla H , Persson Lennart , Strang Susann
Published: August 2011

Aim and objectives.  This study aims to illuminate factors that facilitate and hinder the manageability of living with amyotrophic lateral sclerosis in patients and next of kin. Fourteen patients and 13 next of kin were interviewed.

Background.  The whole family becomes affected when a person gets the disease. Therefore, it is important to identify strategies for managing the life situation among both patients and their next of kin.

Design.  A qualitative descriptive study.

Method.  This study based on individual interviews was performed in spring 2007. The interviews were subjected to qualitative content analysis.

Results.  The results indicate constant fluctuation between opportunities and limitations in individual ability – of patients and family members – to manage the life situation. Both patients and next of kin devised strategies to manage their situations through acceptance, living in the present and perceiving real presence and support from family, friends and authorities. Dysfunctional relationships with family members, friends, or authorities reduced the manageability of the situation. Furthermore, patients experienced difficulties managing their situations when forced into passivity and increased dependence. Next of kin experienced decreased ability to manage because of burden, lack of own time and feelings of being controlled.

Conclusion.  The fluctuations in manageability and the similarities and differences between the pairs, indicate the importance of support, both for the individual and the family.

Relevance to clinical practice.  Fluctuations in manageability and similarities and differences between approaches to managing the situation suggest a need for input from caregivers, for the whole family. Family members need support and time for their own needs and also the opportunity to increase their awareness and understanding of the needs of other family members. This study may give health personnel insight into how to help families devise strategies to manage a complex life situation.
Density‐dependent pollen limitation and reproductive assurance in a wind‐pollinated herb with contrasting sexual systems
Authors: Hesse Elze , Pannell John R.
Published: August 2011

1. Wind pollination is thought to have evolved in response to selection for mechanisms to promote pollination success, when animal pollinators become scarce or unreliable. We might thus expect wind‐pollinated plants to be less prone to pollen limitation than their insect‐pollinated counterparts. Yet, if pollen loads on stigmas of wind‐pollinated species decline with distance from pollen donors, seed set might nevertheless be pollen‐limited in populations of plants that cannot self‐fertilize their progeny, but not in self‐compatible hermaphroditic populations.

2. Here, we test this hypothesis by comparing pollen limitation between dioecious and hermaphroditic (monoecious) populations of the wind‐pollinated herb Mercurialis annua.

3. In natural populations, seed set was pollen‐limited in low‐density patches of dioecious, but not hermaphroditic, M. annua, a finding consistent with patterns of distance‐dependent seed set by females in an experimental array. Nevertheless, seed set was incomplete in both dioecious and hermaphroditic populations, even at high local densities. Further, both factors limited the seed set of females and hermaphrodites, after we manipulated pollen and resource availability in a common garden experiment.

4. Synthesis. Our results are consistent with the idea that pollen limitation plays a role in the evolution of combined vs. separate sexes in M. annua. Taken together, they point to the potential importance of pollen transfer between flowers on the same plant (geitonogamy) by wind as a mechanism of reproductive assurance and to the dual roles played by pollen and resource availability in limiting seed set. Thus, seed set can be pollen‐limited in sparse populations of a wind‐pollinated species, where mates are rare or absent, having potentially important demographic and evolutionary implications.
Tissue/fluid correlation study for the depletion of sulfadimethoxine in bovine kidney, liver, plasma, urine, and oral fluid
Authors: CHIESA O. A. , LI H. , KIJAK P. J. , LI J. X. , LANCASTER V. , SMITH M. L. , HELLER D. N. , THOMAS M. H. , Von BREDOW J.
Published: August 2011

Chiesa, O. A., Li, H., Kijak, P. J., Li, J. X., Lancaster, V., Smith, M. L., Heller, D. N., Thomas, M. H., von Bredow, J. Tissue/fluid correlation study for the depletion of sulfadimethoxine in bovine kidney, liver, plasma, urine, and oral fluid. J. vet. Pharmacol. Therap. 35, 249–258.

Sulfonamides are among the oldest, but still effective, antimicrobial veterinary medicines. In steers and dairy cows, the sulfonamides are effective in the treatment of respiratory disease and general infections. Sulfadimethoxine (SDM) has been approved by US Food and Drug Administration (FDA) for use in steers and dairy cows with a tolerance of 100 ng/g (ppb) in edible tissues and 10 ppb in milk. The detection of SDM residue above tolerance in the animal slaughtered for food process will result in the whole carcass being discarded. This report describes a comprehensive depletion study of SDM (and its main metabolite) in plasma, urine, oral fluid, kidney, and liver. In this study, nine steers were injected intravenously with the approved dose of SDM; the loading dose was 55 mg/kg, followed by 27.5 mg/kg dose at 24 h and again at 48 h. Fluids (blood, urine, and saliva) and tissue (liver and kidney) samples were collected at intervals after the last dose of SMD. The combination of laparoscopic serial sampling technique with the liquid chromatography/mass spectrometry method provided the data to establish the tissue/fluid correlation in the depletion of SMD. A strong correlation and linearity of the log‐scale concentration over time in the depletion stage has been confirmed for kidney, liver, and plasma.
Feasibility of neonatal dried blood spot retrieval amid evolving state policies (2009–2010): a Children's Oncology Group study
Authors: Linabery Amy M. , Slater Megan E. , Spector Logan G. , Olshan Andrew F. , Stork Susan K. , Roesler Michelle A. , Reaman Gregory H. , Ross Julie A.
Published: August 2011

Linabery AM, Slater ME, Spector LG, Olshan AF, Stork SK, Roesler MA, Reaman GH, Ross JA. Feasibility of neonatal dried blood spot retrieval amid evolving state policies (2009–2010): a Children's Oncology Group study. Paediatric and Perinatal Epidemiology 2011; 25: 549–558.

Dried blood spots (DBS) are collected uniformly from US newborns to test for metabolic and other disorders. Because evidence exists for prenatal origins of some diseases, DBS may provide unique prenatal exposure records. Some states retain residual DBS and permit their use in aetiological studies. The primary study aim was to assess the feasibility of obtaining residual DBS from state newborn screening programmes for paediatric and adolescent cancer patients nationwide with parental/subject consent/assent. Families of leukaemia and lymphoma patients aged ≤21 years diagnosed from 1998 to 2007 at randomly selected Children's Oncology Group institutions across the US were questioned (n = 947). Parents/guardians and patients aged ≥18 years were asked to release DBS to investigators in spring 2009. DBS were then requested from states. Overall, 299 families (32%) released DBS. Consenting/assenting patients were born in 39 US states and 46 DBS were obtained from five states; 124 DBS were unobtainable because patients were born prior to dates of state retention. State policies are rapidly evolving and there is ongoing discussion regarding DBS storage and secondary research uses. Currently, population‐based DBS studies can be conducted in a limited number of states; fortunately, many have large populations to provide reasonably sized paediatric subject groups.
Salinity reflux and dolomitization of southern Australian slope sediments: the importance of low carbonate saturation levels
Authors: RIVERS JOHN M. , KURT KYSER T. , JAMES NOEL P.
Published: August 2011

Anomalously saline waters in Ocean Drilling Program Holes 1127, 1129, 1130, 1131 and 1132, which penetrate southern Australian slope sediments, and isotopic analyses of large benthic foraminifera from southern Australian continental shelf sediments, indicate that Pleistocene–Holocene meso‐haline salinity reflux is occurring along the southern Australian margin. Ongoing dolomite formation is observed in slope sediments associated with marine waters commonly exceeding 50‰ salinity. A well‐flushed zone at the top of all holes contains pore waters with normal marine trace element contents, alkalinities and pH values. Dolomite precipitation occurs directly below the well‐flushed zone in two phases. Phase 1 is a nucleation stage associated with waters of relatively low pH (ca 7) caused by oxidation of H2S diffusing upward from below. This dolomite precipitates in sediments < 80 m below the sea floor and has δ13C values consistent with having formed from normal sea water (− 1‰ to + 1‰ Vienna Pee Dee Belemnite). The Sr content of Phase 1 dolomite indicates that precipitation can occur prior to substantial metastable carbonate dissolution (< 300 ppm in Holes 1129 and 1127). Dolomite nucleation is interpreted to occur because the system is undersaturated with respect to the less stable minerals aragonite and Mg‐calcite, which form more readily in normal ocean water. Phase 2 is a growth stage associated with the dissolution of metastable carbonate in the acidified sea water. Analysis of large dolomite rhombs demonstrates that at depths > 80 m below the sea floor, Phase 2 dolomite grows on dolomite cores precipitated during Phase 1. Phase 2 dolomite has δ13C values similar to those of the surrounding bulk carbonate and high Sr values relative to Phase 1 dolomite, consistent with having formed in waters affected by aragonite and calcite dissolution. The nucleation stage in this model (Phase 1) challenges the more commonly accepted paradigm that inhibition of dolomitization by sea water is overcome by effectively increasing the saturation state of dolomite in sea water.
Organic‐facies determination: a key for understanding facies distribution in the basal peat layer of the Holocene Rhine‐Meuse delta, The Netherlands
Authors: BOS INGWER J. , BUSSCHERS FREEK S. , HOEK WIM Z.
Published: August 2011

Peat and gyttja (organic lake sediment) are important indicators for past environmental conditions; they form in areas where the supply of clastic sediment is insufficient to fill the accommodation space. Previous studies of delta sediments, however, have focused mainly on clastic deposits, whereas organics have received only minimal attention. Identification of organic facies can be of value for understanding delta formation as it provides insight into, for example, palaeoenvironmental conditions and compaction susceptibility of these layers. Currently, however, field characteristics of organics are not well‐documented for the full range of facies present in delta plains. In this study, a field method – a classification key – for identifying organic facies in delta plains was developed based on concisely described organic facies in selected cores from the Rhine‐Meuse delta, The Netherlands. This method was tested on archived borehole descriptions of the diachronous basal peat layer in the distal Holocene Rhine‐Meuse delta; this was done by means of a semi‐automated procedure to select and classify samples from a database. The resulting data set was used for mapping organic facies in the basal peat layer by means of indicator kriging and inverse distance weighting. The resulting facies distribution map shows consistent and geologically meaningful patterns, which were interpreted in terms of hydrological regimes. The formation of the basal peat layer, which marks the onset of Holocene aggradation, has been controlled by marine‐dominated, fluvial‐dominated and seepage‐dominated environments. Before 9000 cal yr bp, marine processes influenced the initial stage of organic accumulation in the western part of The Netherlands. After 9000 cal yr bp, on the flanks of topographical higher regions, seepage‐dominated mesotrophic organic facies characterized the onset of accumulation. Simultaneously, nutrient‐rich organic facies could develop in the Rhine‐Meuse valley: gyttja formed in the sediment‐limited Meuse realm, whereas reed peat accumulated in the Rhine realm, indicating lower water depths and thus a higher elevated surface level. It is concluded that the classification key for identifying organic facies is a strong tool to better recognize peat and gyttja types on the basis of macroscopic field characteristics. Application of the key on archived boreholes also proved to be feasible. Identification of organic facies and determination of their spatial distribution at delta scale, as is shown in this study, contributes to understanding delta evolution.
Interplay between river discharge and topography of the basin floor in a hyperpycnal lacustrine delta
Authors: OLARIU CORNEL , BHATTACHARYA JANOK P. , LEYBOURNE MATTHEW I. , BOSS STEPHEN K. , STERN ROBERT J.
Published: August 2011

Basin‐floor topography influences the flow path of hyperpycnal plumes and delta morphology during progradation of the Red River delta in Lake Texoma, USA. The Red River discharge is typically a hyperpycnal plume due to elevated total dissolved solids. Because the river plume is a bottom‐hugging hyperpycnal flow, lake bathymetry and topography strongly influence deposition and subsequent delta morphology. In addition to elevated total dissolved solid concentrations compared with Lake Texoma water, the density contrast of the Red River outflow is increased by high suspended‐sediment concentrations during high‐discharge events. Steep lateral slopes in the Lake Texoma basin deflect hyperpycnal river plumes and, subsequently, change the delta progradation direction before the delta reaches the opposite bank of the lake. Analysis of multi‐temporal aerial and satellite images indicates that the hyperpycnal delta follows the steepest lake‐bottom gradients, corresponding to the pre‐impoundment river thalweg (i.e. bypassing shallow parts of the lake). An analytical model for the hyperpycnal‐plume trajectory indicates plume deflection during low‐discharge or high‐discharge events, towards the deepest part of the basin. The magnitude of plume deflection is a function of river discharge and basin‐margin gradients. Plume deflection can vary between 10° and 80° from the channel axis towards the old river thalweg. The high deflection appears in the case of maximum basin side gradients of 12·8° and in conditions of low river discharge. During low‐discharge periods, the Red River delta builds a lobate shape with multiple terminal distributary channels whereas, during high‐discharge periods the Red River delta builds an elongate shape with a single large distributary channel. The elongate morphology of the delta is formed through the development of a single distributary channel and abandonment of the other distributaries. Therefore, the lobate shaped delta is expected to be preserved in the rock record.
Emergency obstetric care availability: a critical assessment of the current indicator
Authors: Gabrysch Sabine , Zanger Philipp , Campbell Oona M. R.
Published: August 2011

Monitoring progress in reducing maternal and perinatal mortality requires suitable indicators. The density of emergency obstetric care (EmOC) facilities has been proposed as a potentially useful indicator, but different UN documents make inconsistent recommendations, and its current formulation is not associated with maternal mortality. We compiled recently published indicator benchmarks and distinguished three sources of inconsistency: (i) use of different denominator metrics (per birth and per population), (ii) different assumptions on need for EmOC and for EmOC facilities and (iii) failure to specify facility capacity (birth load). The UN guidelines and handbook require fewer EmOC facilities than the World Health Report 2005 and do not specify capacity for deliveries or staffing levels. We recommend (i) always using births as the denominator for EmOC facility density, (ii) clearly stating assumptions on the proportion of deliveries needing basic and comprehensive emergency obstetric care and the desired proportion of deliveries in EmOC facilities and (iii) specifying facility capacity and staffing and adapting benchmarks for settings with different population density to ensure geographical accessibility.
Adaptive immune responses in Staphylococcus aureus biofilm–associated chronic rhinosinusitis
Authors: Foreman A. , Holtappels G. , Psaltis A. J. , Jervis‐Bardy J. , Field J. , Wormald P. ‐J. , Bachert C.
Published: August 2011

To cite this article: Foreman A., Holtappels G., Psaltis A.J., Jervis‐Bardy J., Field J., Wormald P.‐J., Bachert C. Adaptive immune responses in Staphylococcus aureus biofilm–associated chronic rhinosinusitis. Allergy 2011; 66: 1449–1456.

Background:  The etiopathogenesis of chronic rhinosinusitis (CRS) is currently an area of intense debate. Recently, biofilms have been proposed as a potential environmental trigger in this disease. In particular, Staphylococcus aureus biofilms appear to be a predictor of severe disease recalcitrant to current treatment paradigms. However, direct causal links between biofilms and host immune activation are currently lacking. This study aimed to document both the adaptive immune responses that characterize S. aureus biofilm–associated CRS and the relative contributions of staphylococcal superantigens and S. aureus biofilms in the inflammatory make‐up of this disease.

Methods:  A total of 53 disease subjects and 15 controls were recruited. Sinonasal mucosa was collected for the determination of S. aureus and Haemophilus influenzae biofilms and presence of total and superantigen‐specific IgE and for the measurement of cytokines that characterize the T‐helper pathways.

Results:  Staphylococcus aureus biofilms and superantigens are significantly associated in CRS patients, suggesting the biofilm may be a nidus for superantigen‐eluting bacteria. The presence of S. aureus biofilms is associated with eosinophilic inflammation, across the spectrum of CRS, on the back of a T‐helper2 skewing of the host’s adaptive immune response (elevated Eosinophilic Cationic Protein and IL‐5). This can be distinguished from the superantigenic effect resulting in the induction of IgE.

Conclusion:  This study provides novel evidence of a link between S. aureus biofilms and skewing of the T‐cell response toward the T‐helper2 pathway that is independent of superantigen activities. Further research is required to confirm the cause–effect relationship of this association.
Response to a selective COX‐2 inhibitor in patients with urticaria/angioedema induced by nonsteroidal anti‐inflammatory drugs
Authors: Doña I. , Blanca‐López N. , Jagemann L. R. , Torres M. J. , Rondón C. , Campo P. , Gómez A. I. , Fernández J. , Laguna J. J. , Rosado A. , Blanca M. , Canto G.
Published: August 2011

To cite this article: Doña I, Blanca‐López N, Jagemann LR, Torres MJ, Rondón C, Campo P, Gómez AI, Fernández J, Laguna JJ, Rosado A, Blanca M, Canto G. Response to a selective COX‐2 inhibitor in patients with urticaria/angioedema induced by nonsteroidal anti‐inflammatory drugs. Allergy 2011; 66: 1428–1433.

Background:  In subjects with hypersensitivity reactions with cross‐intolerance to nonsteroidal anti‐inflammatory drugs (NSAIDs), tolerance to selective COX‐2 inhibitors has not been evaluated in large series of well‐phenotyped cases.

Methods:  We evaluated 252 patients with urticaria and/or angioedema caused by hypersensitivity owing to cross‐intolerance to NSAIDs. In addition to the clinical history, diagnosis was confirmed by provocation to an alternative NSAID. Two groups were considered: (A) patients with cross‐intolerance to NSAIDs and intolerance to paracetamol and (B) patients with cross‐intolerance to NSAIDs and good tolerance to paracetamol. Etoricoxib was administered to Group A patients and to a representative sample of Group B patients. In the event of a positive response, serum tryptase levels were determined and skin biopsy was performed in five patients in each group.

Results:  Ibuprofen was the most commonly implicated drug, followed by acetylsalicylic acid (ASA). Urticaria was the most common manifestation, followed by angioedema. Most of the patients developed symptoms within 1 h. Twenty‐five percent in Group A (n = 47) and 6% in Group B (n = 50) were intolerant to etoricoxib. Skin biopsy showed mast cell activation with the release of tryptase to the extracellular space but without the increase in serum tryptase levels.

Conclusion:  Selective COX‐2 inhibitors may be unsafe in subjects with urticaria and/or angioedema caused by hypersensitivity reactions to NSAIDs with cross‐intolerance if they are intolerant to paracetamol. A quarter of patients who were intolerant to this drug were also intolerant to etoricoxib. In subjects with hypersensitivity to NSAIDs and intolerance to paracetamol, selective COX‐2 inhibitors should be administered as a controlled, incremental dose provocation test to assess tolerance.
The Phenomenon of Blood Stem Cell Mobilisation
Authors: Simmons P.J. , Levesque J‐P. , Takamatsu Y. , To L.B.
Published: August 2011

The use of mobilised blood to effect haematological rescue now exceeds that of bone marrow. Despite the now broad application of blood stem cells (BSC) in a variety of clinical settings little is known of the precise mechanisms responsible for their release into the peripheral circulation. Under steady state conditions, primitive haemopoietic progenitor cells (HPC) are restricted to the bone marrow and circulate at low to undetectable levels. Although the basis for this specific retention of HPC within the BM remains to be defined, adhesive interactions between HPC and their surrounding stromal cell and ECM environment are hypothesised to play a major role.

Mobilisation occurs in response to a variety of perturbations including physical exercise, following myelosupressive chemotherapy and following administration of a number of different cytokines. The kinetics of release may vary from as little as a few minutes to several weeks. Such observations suggest that a single unifying mechanism is therefore unlikely to be responsible for mobilisation in all cases and in all likelihood the predominant mechanism(s) will vary according to the mobilising agent employed. Nevertheless, mobilising agents are proposed to act to a greater or lesser extent by perturbing the function of the various cell adhesion molecules (CAM) or ligands which restrict HPC to the BM. In accord with this notion, studies by other have shown that antibody induced perturbation of VLA‐4 function results in mobilisation of HPC in primates.

How therefore do cytokines, the most commonly mobilising agents, result in HPC release? The most frequently employed agent to induce HPC release is granulocyte colony‐stimulating factor (G‐CSF). We have previously demonstrated that in vitro exposure of human CD34+ cells (HPC) to G‐CSF, in common with several cytokines including IL‐3, GM‐CSF and SCF, results in transient increases in the affinity of the β1 integrins VLA‐4 and VLA‐5 for their ligands fibronectin (FN) and VCAM‐1. Thus in addition to the well documented mitogenic effects of cytokines these molecules also regulate the adhesive properties of HPC. Data will therefore be presented which examine the regulation of integrin function on human HPC and its relevance to the phenomenon of mobilisation. In addition we will also review recent observations in man and in a murine model which suggest an unanticipated link between bone turnover and BSC release. Collectively these studies provide some novel insights into the phenomenon of mobilisation but also suggest that the actual mechanisms involved are more complex than is currently appreciated.
Risk Management in Blood Transfusion Services
Authors: Whyte G.
Published: August 2011

Risk is usually simplistically defined as the probability of an adverse outcome, under‐recognising the importance of perception. The intuitive centre of the risk structure is 1 in a million (10−6), the background risk of death in developed countries. In Australia, current risks of transmission of HIV and HCV by blood transfusion are about 10−6, the risk is higher for HBV and lower for HTLV1, but the risk of death from the infections is much less, particularly for HTLV1. When blood service professionals take risk related actions, their judgement must be tempered by contemporary political and social realities and the public's real and disproportionate horror of catastrophe
Mechanisms of skin adherence and invasion by dermatophytes
Authors: Baldo A. , Monod M. , Mathy A. , Cambier L. , Bagut E. T. , Defaweux V. , Symoens F. , Antoine N. , Mignon B.
Published: August 2011

Dermatophytes are keratinophilic fungi that can be pathogenic for humans and animals by infecting the stratum corneum, nails, claws or hair. The first infection step consists of adherence of arthroconidia to the stratum corneum. The mechanisms and the kinetics of adherence have been investigated using different in vitro and ex vivo experimental models, most notably showing the role of a secreted serine protease from Microsporum canis in fungal adherence to feline corneocytes. After germination of the arthroconidia, dermatophytes invade keratinised structures that have to be digested into short peptides and amino acids to be assimilated. Although many proteases, including keratinolytic ones, have been characterised, the understanding of dermatophyte invasion mechanisms remains speculative. To date, research on mechanisms of dermatophyte infection focused mainly on both secreted endoproteases and exoproteases, but their precise role in both fungal adherence and skin invasion should be further explored.
Transfusion‐related acute lung injury in a neutropenic patient
Authors: Finlayson J. , Grey D. , Kavanagh L. , Witt C.
Published: August 2011

Transfusion‐related acute lung injury (TRALI) is a leading cause of transfusion related morbidity and mortality. Current concepts regarding the pathogenesis of this disorder imply a “two‐hit” model in which neutrophils are sequestered in the pulmonary capillary bed, and subsequently activated by substances in the transfused blood product. We report a case of TRALI in a patient with neutropenia and discuss the possible factors contributing to the respiratory symptoms in this patient. We also emphasise the importance of recognising mild cases of TRALI in order to investigate the implicated donor/s appropriately, and to minimise the risk for more severe episodes in other patients.
How we mobilize haemopoietic stem cells
Authors: Herbert K. E. , Levesque J.‐P. , Mills A. K. , Gottlieb D. J. , Cooney J. , Szer J. , Rasko J. , To L. B.
Published: August 2011

Mobilization and collection of haemopoietic stem and progenitor cells (HSPC) is the cornerstone of autologous and allogeneic stem cell transplantation for a wide variety of haematological and some non‐haematological malignancies. Centres providing this service face the challenge of optimizing the likelihood of successful collection of transplantable doses of cells, while maximizing the efficiency of the apheresis unit and minimizing the risk of toxicity as well as mobilization failure. Recent developments in the understanding of the molecular mechanisms of mobilization have led to the emergence of novel strategies for HSPC mobilization, which may assist in meeting these imperatives. The task for clinicians is how to incorporate the use of these strategies into practice, in the light of emerging evidence for efficacy and safety of these agents. Herein, the literature is reviewed, and a proposed algorithm for HSPC mobilization is presented.
Cystatin C: influence of perfusion and myocardial injury on early (<24 h) renal function after pediatric cardiac surgery
Authors: Vassalos Antony , Young David , MacArthur Kenneth , Pollock James , Lyall Fiona , Danton Mark H.D.
Published: August 2011

Background:  Cardiopulmonary bypass (CPB)‐associated renal dysfunction following cardiac surgery is well recognized. In patients with renal disease, cystatin C has emerged as a new biomarker which in contrast to creatinine (Cr) is sensitive to minor changes in glomerular filtration rate (GFR).

Aim:  We utilized cystatin C to investigate the association of CPB perfusion parameters with acute renal injury after pediatric cardiac surgery.

Methods:  Twenty children, aged 4–58 months (AVSD, n = 7; VSD, n = 9; and ASD, n = 4), were prospectively studied. Glomerular filtration rate was quantified postoperatively by creatinine clearance (first and second 12‐h periods; CrCl0–12 and CrCl12–24). Serum cystatin C and Cr were measured preoperatively and on days 0–3. Recorded CPB parameters included bypass duration (BP), perfusion pressure (PP), lowest pump flow (Qmin), lowest hematocrit, and corresponding lowest oxygen delivery (DO2 min). Myocardial injury was determined by troponin‐I.

Results:  Postoperatively, GFR remained unchanged (CrCl0–12 63.6 ± 37.0 vs CrCl12–24 65.1 ± 27.5; P = 0.51) and only correlated with cystatin C (CrCl0–12 vs cystatin CDay0 [r = 0.58, P = 0.018] and CrDay0 [r = 0.09, P = 0.735]). Cr and cystatin C increased postoperatively to peak on days 2 and 3, respectively (CrPreOp 31 ± 6.9 vs CrDay2 36.9 ± 12.2, P = 0.03; cystatin CDay0 0.83 ± 0.27 vs cystatin CDay3 1.45 ± 0.53, P = 0.02). Increased cystatin C was significantly associated with BP (P = 0.001), mean PP (P = 0.029), Qmin (P = 0.005), troponin‐I (P < 0.001), and DO2min <300 ml·min−1·m−2 (P = 0.007). Receiver–operator cutoff >1.044 mg·l−1 for cystatin C exhibited 100% sensitivity and 67% specificity for detecting renal dysfunction, defined as GFR <55 ml·min−1·1.73 m−2.

Conclusions:  Cystatin C is a sensitive marker of early renal dysfunction following pediatric heart surgery. Variations in bypass parameters, myocardial injury, and ultimately critical oxygen delivery are significantly associated with the degree of renal impairment.
Managing fistula‐in‐ano with ligation of the intersphincteric fistula tract procedure: the Western Hospital experience
Authors: Ooi K. , Skinner I. , Croxford M. , Faragher I. , McLaughlin S.
Published: August 2011

Aim  To review the preliminary results of the ligation of the intersphincteric fistula tract (LIFT) technique in treating complex anal fistulas at our hospital.

Method  Between March and November 2010, patients with cryptoglandular anal fistulas were recruited prospectively from the colorectal clinic and treated using the LIFT procedure. A database was set up to collect information on demographics, past surgical treatments, fistula characteristics, MRI scan results, operative data and follow‐up findings. The primary end‐point measured was cure of the disease. The secondary end‐point was the degree of postoperative continence. Preoperative and postoperative incontinence rates were recorded using Wexner’s Incontinence Scale.

Results  Twenty‐five patients (eight women and 17 men; median age, 40 years) underwent the LIFT procedure. Ten patients had recurrent fistulas and previous fistula surgery. The median operating time was 39 min. No intraoperative complications were documented. The median follow‐up duration was 22 (3–43) weeks. Primary healing was observed in 17 (68.0%) patients and the median healing time was 6 weeks; one wound remained incompletely healed. Seven patients (28.0%) had disease recurrence presenting between 7 and 20 weeks postoperatively. No patients reported any incontinence postoperatively.

Conclusion  The LIFT procedure has favourable healing rates with little or no risk of incontinence. This operation is safe and easy to learn. The early results from this pilot study show promise and affirm some of the findings of other researchers. These results will suggest opportunities to conduct further controlled studies comparing the LIFT procedure with standard therapies.
J‐pouch vs side‐to‐end coloanal anastomosis after preoperative radiotherapy and total mesorectal excision for rectal cancer: a multicentre randomized trial
Authors: Doeksen A. , Bakx R. , Vincent A. , van Tets W. F. , Sprangers M. A. G. , Gerhards M. F. , Bemelman W. A. , van Lanschot J. J. B.
Published: August 2011

Aim  Comparison of functional and surgical outcome of the J‐pouch with the side‐to‐end coloanal anastomosis after preoperative radiotherapy and total mesorectal excision in rectal cancer patients.

Method  In a multicentre study, patients with a carcinoma of the lower two‐thirds of the rectum were randomized to either a J‐pouch or a side‐to‐end reconstruction. Primary outcome was function of the neorectum 1 year after surgery. A functional outcome [COloREctal Functional Outcome (COREFO)] questionnaire, and two quality of life questionnaires (EORTC‐QLQ‐CR38 and SF‐36) were to be completed by all participants preoperatively, and 4 and 12 months postoperatively. Independent data managers recorded surgical outcome. A group size of 30 patients in each group was calculated based on a 15‐point difference of the COREFO scale.

Results  In total, 107 patients were randomized, 55 in the J‐pouch group and 52 in the side‐to‐end anastomosis group. The COREFO incontinence scale at 4 months and the total functional outcome at 4 and 12 months showed better results for the J‐pouch group in comparison with the side‐to‐end anastomosis group. The remaining COREFO scales (frequency, social impact, stool‐related aspects and bowel medication), surgical outcome (complications, reoperations, length of hospital stay, readmissions and mortality) and quality of life did not show significant differences between treatment groups.

Conclusion  The overall results of a coloanal J‐pouch and a side‐to‐end anastomosis are comparable, although functional results are slightly better with a J‐pouch. The side‐to‐end anastomosis is technically less demanding and therefore a justified alternative in sphincter‐saving surgery.
Transanal endoscopic microsurgery for rectal carcinoids: the largest reported United States experience
Authors: Kumar A. S. , Sidani S. M. , Kolli K. , Stahl T. J. , Ayscue J. M. , Fitzgerald J. F. , Smith L. E.
Published: August 2011

Aim  Rectal carcinoids are often inadequately resected by snare excision during colonoscopy. Transanal endoscopic microsurgery is a minimally invasive procedure with low morbidity that offers full‐thickness excision with a low rate of negative margins. It presents an excellent alternative to radical surgery for mid and proximally located lesions. We report the largest United States (US) experience in the use of transanal endoscopic microsurgery for rectal carcinoids.

Method  Data of patients who had undergone transanal endoscopic microsurgery for rectal carcinoids were prospectively collected and retrospectively analyzed. Patient and tumour characteristics, operative and perioperative details, as well as oncological outcomes were reviewed.

Results  Over a 12‐year period, 24 patients underwent transanal endoscopic microsurgery for rectal carcinoids. Of these, six (25%) were primary surgical resections and 18 (75%) were performed after incomplete snare excisions during colonoscopy. Three (17%) patients who underwent full‐thickness resection after snare excision had residual tumour on histopathological examination. Negative margins were obtained in all cases. No recurrences were noted.

Conclusion  Transanal endoscopic microsurgery is effective and safe for the surgical resection of rectal carcinoids < 2 cm in diameter, with typical features and located more than 5 cm from the anal verge. Transanal endoscopic microsurgery can be used for primary resection or for resection after incomplete colonoscopic snare excision.
Deconstructing the native–exotic richness relationship in plants
Authors: Bartomeus Ignasi , Sol Daniel , Pino Joan , Vicente Paloma , Font Xavier
Published: August 2011

Aim  Classic theory suggests that species‐rich communities should be more resistant to the establishment of exotic species than species‐poor communities. Although this theory predicts that exotic species should be less diverse in regions that contain more native species, macroecological analyses often find that the correlation between exotic and native species richness is positive rather than negative. To reconcile results with theory, we explore to what extent climatic conditions, landscape heterogeneity and anthropogenic disturbance may explain the positive relationship between native and exotic plant richness.

Location  Catalonia (western Mediterranean region).

Methods  We integrated floristic records and GIS‐based environmental measures to make spatially explicit 10‐km grid cells. We asked whether the observed positive relationship between native and exotic plant richness (R2= 0.11) resulted from the addition of several negative correlations corresponding to different environmental conditions identified with cluster analysis. Moreover, we directly quantified the importance of common causal effects with a structural equation modelling framework.

Results  We found no evidence that the relationship between native and exotic plant richness was negative when the comparison was made within environmentally homogeneous groups. Although there were common factors explaining both native and exotic richness, mainly associated with landscape heterogeneity and human pressure, these factors only explained 17.2% of the total correlation. Nevertheless, when the comparison was restricted to native plants associated with human‐disturbed (i.e. ruderal) ecosystems, the relationship was stronger (R2= 0.52) and the fraction explained by common factors increased substantially (58.3%).

Main conclusions  While our results confirm that the positive correlation between exotic and native plant richness is in part explained by common extrinsic factors, they also highlight the great importance of anthropic factors that – by reducing biotic resistance – facilitate the establishment and spread of both exotic and native plants that tolerate disturbed environments.
Socialization of Physical and Social Aggression in Early Adolescents' Peer Groups: High‐status Peers, Individual Status, and Gender
Authors: Shi Bing , Xie Hongling
Published: August 2011

The influence of high‐status peers on a target individual's physical and manipulative social aggression in peer groups was examined in a diverse sample of seventh‐grade students. A total of 245 individual members belonging to 65 groups were included in analyses. Aggression was assessed by peer and victim nominations in the fall and spring semesters of seventh grade. High‐status peers rather than low‐status peers in a group had a strong influence on individual members' physical and social aggression. High‐status peers were particularly influential on low‐status individual members' social aggression. A similar pattern was found for physical aggression in boys' groups. These findings imply that high‐status members' aggression rather than the average of all members' may better represent the group norm. Special attention needs to be given to high‐status aggressive adolescents in future intervention and prevention of aggression in schools.
Explaining health marginalisation of the lower educated: the role of cross‐national variations in health expenditure and labour market conditions
Authors: Gesthuizen Maurice , Huijts Tim , Kraaykamp Gerbert
Published: August 2011

Several studies have shown ample cross‐national variation in the risk that lower educated people run to be in poor health. However, explanations for this cross‐national variation are still scarce. In this article we aim at filling this lacuna by investigating to what extent cross‐national variation in the health gap between the lower and higher educated in Europe is explained by governmental health expenditure, namely, how much governments contribute to a country’s total healthcare costs, and labour market conditions, that is, unemployment rates and modernisation of the labour market. We used information from the European Social Survey (ESS) 2002–2008 on more than 90,000 individuals in 32 European nations, and estimated hierarchical models with cross‐level interactions to test our expectations. Our results show that the relative risk of being in poor health of lower educated individuals is smaller in countries where the government spends much on healthcare and with a highly modernised labour market.
Policies and practices of ability grouping in New Zealand intermediate schools
Authors: HORNBY GARRY , WITTE CHRYSTAL , MITCHELL DAVID
Published: August 2011

There is an extensive international research literature on the impact of ability grouping (e.g. streaming or banding) on children's academic and behavioural outcomes. However, it is questionable to what extent the findings of research on this topic have influenced the practice of pupil ability grouping in New Zealand intermediate schools. Nine intermediate schools in Christchurch were surveyed regarding their policies and practices on pupil grouping. All were co‐educational state schools. Principals were interviewed about the types of grouping used in academic subject areas, what they saw to be the benefits and disadvantages of this grouping and also what they saw to be the consequences of these arrangements for average pupils, gifted pupils, pupils with special needs and Maori and Pacific Island pupils. Reported grouping practices, and the views of principals about these, are compared with findings from the literature on ability grouping. The need for schools to adopt more evidence‐based strategies for ability grouping are discussed and suggestions for further research are outlined.
The tenacity of special schools in an inclusive policy environment: the New Zealand situation 1996–2010
Authors: MCMENAMIN TRISH
Published: August 2011

Special school provision for children and young people with special educational needs is an anomaly that exists in many inclusive education systems; this type of educational provision has proved to be resilient even though, with reference to children and young people with special educational needs, there is almost universal acceptance of the principle of inclusion. This article examines special school provision in New Zealand in the period since the implementation of the country's first official ‘special education policy’ to the present, newly released, special education initiative, Success for All – Every School, Every Child. Possible reasons for the tenacity of this type of provision in New Zealand, and in other jurisdictions, will be discussed. Arguments will be presented to support the proposition that this type of provision is likely to remain a feature of the inclusive education systems of many jurisdictions for some time yet.
Supporting children with reading difficulties within the New Zealand English curriculum
Authors: MCNEILL BRIGID C. , BUCKLEY‐FOSTER PHILIPPA , GILLON GAIL
Published: August 2011

The longer‐term effectiveness of phonological awareness intervention for children with reading difficulty is likely to be influenced by the quality of general classroom instruction. This descriptive project used a case study design to follow the literacy progress of three children aged six and seven years with speech and language impairment after responding strongly to an intensive phonological awareness intervention. The study analysed the opportunities provided in the children's general classroom programme within the New Zealand English curriculum for ongoing facilitation of phonological awareness skills. Findings indicated that the classroom environment provided multiple opportunities for implicit teaching of phonological awareness skills which may have contributed to the children's ability to maintain skills taught within the intervention. Children with significant reading difficulties underpinned by poor phonological awareness are likely to require ongoing access to intensive intervention in addition to quality classroom instruction.
Behavioural/attentional problems and literacy learning difficulties in children from non‐English language/cultural backgrounds
Authors: EVERATT JOHN , AL‐SHARHAN ABIR , AL‐AZMI YOUSUF , AL‐MENAYE NASSER , ELBEHERI GAD
Published: August 2011

This article reports the findings of studies of the relationship between off‐task behaviours and measures of educational achievement. The work focused on children from an Arabic‐speaking/cultural background rarely studied in the literature. The first study involved children within a mainstream school context and found that measures of literacy and mathematics were related to scores on questionnaires designed to assess poor levels of attention and high levels of hyperactivity/impulsivity. The second study focused on intervention work in a special school for children with learning disabilities (LD). The data indicated that interventions designed to reduce off‐task behaviours while targeting spelling improvements showed good gains in learning. Overall, the findings are consistent with negative relationships between learning and behaviour problems that may be reduced by combined education‐behavioural intervention methods.
Zinc l‐pyrrolidone carboxylate inhibits the UVA‐induced production of matrix metalloproteinase‐1 by in vitro cultured skin fibroblasts, whereas it enhances their collagen synthesis
Authors: Takino Y. , Okura F. , Kitazawa M. , Iwasaki K. , Tagami H.
Published: August 2011

Synopsis

Reduced collagen matrix in the dermis constitutes one of the characteristic features of chronologically aged skin, which is further enhanced on the sun‐exposed portions of the body by chronic ultraviolet light (UV) irradiation, inducing the unique changes associated with skin photoageing. The zinc salt of l‐pyrrolidone carboxylate (Zinc PCA) has long been used as a cosmetic ingredient, because of its astringent and anti‐microbial properties. In the present study, by employing cultured normal human dermal fibroblasts, we found that Zinc PCA suppressed UVA‐induced activation of activator protein‐1 (AP‐1) and reduced matrix metalloproteinase‐1 production in these cells, which is thought to be involved in collagen degradation in photoaged skin. Moreover, Zinc PCA treatment of the cells increased the expression of an ascorbic acid transporter mRNA, SVCT2, but not SVCT1, resulting in the enhanced production of type I collagen. Based on these in vitro findings, we consider Zinc PCA to be a promising candidate for an anti‐skin ageing agent.
Imported leprosy in Italy
Authors: Massone C. , Brunasso A.M.G. , Noto S. , Campbell T.M. , Clapasson A. , Nunzi E.
Published: August 2011

Background  Leprosy is far from being eliminated with more than 200 000 new cases detected (NCD)/year.

Objective  Retrospective analysis between 2003 and 2009 to compare the New Case Detected Rate (NCDR) observed in Italy in the immigrant population with the NCDR of the same population in their country of origin to verify if the cases observed are those expected or not.

Methods  Leprosy statistics were retrieved from the Italian leprosy register and from official WHO data.

Results  The NCD in Italy were lower than expected, from 2003 when the expected number of NCD was 40.5 between the legally resident immigrants, but only one case was diagnosed (98% of lower from the expected), to 2009 when four NCD were diagnosed and 41 were expected (90% lower from expected).

Conclusions  This study points out a discrepancy between the observed and the expected cases of leprosy in Italy. Specifically, the number of NCD was less than expected for each studied year. Of course our data do not represent a validation, but only an indication of the leprosy diagnosis in Italy. Difficulty in accessing the health systems, fear of segregation, ignorance and illegal immigrant status with consequent fear of police arrest are possible explaining factors. The critical issue anyhow is the medical expertise. The role of the dermatologist is fundamental. For these reasons, there is still a need for wide spread leprosy teaching programmes. Although with few limitations, this study represents a first approach to validate the accuracy in leprosy diagnosis in Italy.