bluuebunny/crossref_metadata_2025 huggingface dataset:
When gatekeepers meet the sentinel: the impact of a prior authorization requirement for cefuroxime on the prescribing behaviour of community‐based physicians
Authors: Kahan Natan R. , Chinitz David P. , Waitman Dan‐Andrei , Kahan Ernesto
Published: January 2006

Aims

Prior authorization (PA), the requirement of physicians to obtain pre‐approval as a prerequisite for coverage, may decrease drug utilization via a ‘sentinel effect’, a decrease in utilization caused by external review of prescribing. The purpose of this study was to assess the affect a PA restriction had on the utilization patterns of cefuroxime tablets in a managed care organization (MCO) in Israel.

Methods

Physician prescribing patterns were evaluated by conducting a retrospective drug utilization analysis. Data were derived from the electronic patient records of the MCO studied. All prescriptions for solid state antibiotics for patients diagnosed with an infectious disease written during three parallel 3‐month segments, before, during and after a PA restriction for cefuroxime was enforced, were included. Frequency and proportion of antibiotic prescriptions for cefuroxime tablets, distribution of infectious diseases treated with cefuroxime, and the request rejection rate when PA was required were calculated.

Results

Prescriptions for cefuroxime declined from 5538 prescriptions (8.0% of eligible antibiotic prescriptions, 95% CI 7.8, 8.2) in the initial period to 1036 (1.2%, 95% CI 1.1, 1.3) during the PA period, rising to 3961 (4.3%, 95% CI 4.2, 4.4) in the post‐PA period. Changes in the distribution of diseases treated with cefuroxime during the PA stage tended to regress after revocation to those observed in the pre‐PA period. The rejection rate was found to be 8.5% (95% CI = 6.9, 10.1).

Conclusions

The implementation of a prior authorization requirement for cefuroxime tablets markedly reduced the use of this drug, probably due to a ‘sentinel effect’.
Comparison of ecosystem water‐use efficiency among Douglas‐fir forest, aspen forest and grassland using eddy covariance and carbon isotope techniques
Authors: PONTON STÉPHANE , FLANAGAN LAWRENCE B. , ALSTAD KARRIN P. , JOHNSON BRUCE G. , MORGENSTERN KAI , KLJUN NATASCHA , BLACK T. ANDREW , BARR ALAN G.
Published: January 2006

Comparisons were made among Douglas‐fir forest, aspen (broad leaf deciduous) forest and wheatgrass (C3) grassland for ecosystem‐level water‐use efficiency (WUE). WUE was defined as the ratio of photosynthetic CO2 assimilation rate and evapotranspiration (ET) rate. The ET data measured by eddy covariance were screened so that they overwhelmingly represented transpiration. The three sites used in this comparison spanned a range of vegetation (plant functional) types and environmental conditions within western Canada. When compared in the relative order Douglas‐fir (located on Vancouver Island, BC), aspen (northern Saskatchewan), grassland (southern Alberta), the sites demonstrated a progressive decline in precipitation and a general increase in maximum air temperature and atmospheric saturation deficit (Dmax) during the mid‐summer. The average (±SD) WUE at the grassland site was 2.6±0.7 mmol mol−1, which was much lower than the average values observed for the two other sites (aspen: 5.4±2.3, Douglas‐fir: 8.1±2.4). The differences in WUE among sites were primarily because of variation in ET. The highest maximum ET rates were approximately 5, 3.2 and 2.7 mm day−1 for the grassland, aspen and Douglas‐fir sites, respectively. There was a strong negative correlation between WUE and Dmax for all sites. We also made seasonal measurements of the carbon isotope ratio of ecosystem respired CO2 (δR) in order to test for the expected correlation between shifts in environmental conditions and changes to the ecosystem‐integrated ratio of leaf intercellular to ambient CO2 concentration (ci/ca). There was a consistent increase in δR values in the grassland, aspen forest and Douglas‐fir forest associated with a seasonal reduction in soil moisture. Comparisons were made between WUE measured using eddy covariance with that calculated based on D and δR measurements. There was excellent agreement between WUE values calculated using the two techniques. Our δR measurements indicated that ci/ca values were quite similar among the Douglas‐fir, aspen and grassland sites, despite large variation in environmental conditions among sites. This implied that the shorter‐lived grass species had relatively high ci/ca values for the D of their habitat. By contrast, the longer‐lived Douglas‐fir trees were more conservative in water‐use with lower ci/ca values relative to their habitat D. This illustrates the interaction between biological and environmental characteristics influencing ecosystem‐level WUE. The strong correlation we observed between the two independent measurements of WUE, indicates that the stable isotope composition of respired CO2 is a useful ecosystem‐scale tool to help study constraints to photosynthesis and acclimation of ecosystems to environmental stress.
Carbon respired by terrestrial ecosystems – recent progress and challenges
Authors: TRUMBORE SUSAN
Published: January 2006

Net ecosystem production is the residual of two much larger fluxes: photosynthesis and respiration. While photosynthesis is a single process with a well‐established theoretical underpinning, respiration integrates the variety of plant and microbial processes by which CO2 returns from ecosystems to the atmosphere. Limits to current capacity for predicting ecosystem respiration fluxes across biomes or years result from the mismatch between what is usually measured – bulk CO2 fluxes – and what process‐based models can predict – fluxes of CO2 from plant (autotrophic) or microbial (heterotrophic) respiration. Papers in this Thematic Issue and in the recent literature, document advances in methods for separating respiration into autotrophic and heterotrophic components using three approaches: (1) continuous measurements of CO2 fluxes and assimilation of these data into process‐based models; (2) application of isotope measurements, particularly radiocarbon; and (3) manipulation experiments. They highlight the role of allocation of C fixed by plants to respiration, storage, growth or transfer to other organisms as a control of seasonal and interannual variability in soil respiration and the oxidation state of C in the terrestrial biosphere. A second theme is the potential for comparing C isotope signatures in organic matter, CO2 evolved in incubations and microbial biomarkers to elucidate the pathways (respiration, recycling, or transformation) of C during decomposition. Together, these factors determine the continuum of timescales over which C is returned to the atmosphere by respiration and enable testing of theories of plant and microbial respiration that go beyond empirical models and allow predictions of future respiration responses to future change in climate, pollution and land use.
Effects of patch quality and network structure on patch occupancy dynamics of a yellow‐bellied marmot metapopulation
Authors: OZGUL ARPAT , ARMITAGE KENNETH B. , BLUMSTEIN DANIEL T. , VANVUREN DIRK H. , OLI MADAN K.
Published: January 2006

The presence/absence of a species at a particular site is the simplest form of data that can be collected during ecological field studies. We used 13 years (1990–2002) of survey data to parameterize a stochastic patch occupancy model for a metapopulation of the yellow‐bellied marmot in Colorado, and investigated the significance of particular patches and the influence of site quality, network characteristics and regional stochasticity on the metapopulation persistence.

Persistence of the yellow‐bellied marmot metapopulation was strongly dependent on the high quality colony sites, and persistence probability was highly sensitive to small changes in the quality of these sites.

A relatively small number of colony sites was ultimately responsible for the regional persistence. However, lower quality satellite sites also made a significant contribution to long‐term metapopulation persistence, especially when regional stochasticity was high.

The northern network of the marmot metapopulation was more stable compared to the southern network, and the persistence of the southern network depended heavily on the northern network.

Although complex models of metapopulation dynamics may provide a more accurate description of metapopulation dynamics, such models are data‐intensive. Our study, one of the very few applications of stochastic patch occupancy models to a mammalian species, suggests that stochastic patch occupancy models can provide important insights into metapopulation dynamics using data that are easy to collect.
Opioids and opiates: analgesia with cardiovascular, haemodynamic and immune implications in critical illness
Authors: MOLINA P. E.
Published: January 2006

Traumatic injury, surgical interventions and sepsis are amongst some of the clinical conditions that result in marked activation of neuroendocrine and opiate responses aimed at restoring haemodynamic and metabolic homeostasis. The central activation of the neuroendocrine and opiate systems, known collectively as the stress response, is elicited by diverse physical stressor conditions, including ischaemia, glucopenia and inflammation. The role of the hypothalamic–pituitary–adrenal axis and sympathetic nervous system in counterregulation of haemodynamic and metabolic alterations has been studied extensively. However, that of the endogenous opiates/opioid system is still unclear. In addition to activation of the opiate receptor through the endogenous release of opioids, pharmacotherapy with opiate receptor agonists is frequently used for sedation and analgesia of injured, septic and critically ill patients. How this affects the haemodynamic, cardiovascular, metabolic and immune responses is poorly understood. The variety of opiate receptor types, their specificity and ubiquitous location both in the central nervous system and in the periphery adds additional complicating factors to the clear understanding of their contribution to the stress response to the various physical perturbations. This review aims at discussing scientific evidence gathered from preclinical studies on the role of endogenous opioids as well as those administered as pharmacological agents on the host cardiovascular, neuroendocrine, metabolic and immune response mechanisms critical for survival from injury in perspective with clinical observations that provide parallel assessment of relevant outcome measures. When possible, the clinical relevance and corresponding scenarios where this evidence can be integrated into our understanding of the clinical implications of opiate effects will be examined. Overall, the scientific basis to enhance clinical judgment and expectations when using opioid sedation and analgesia in the management of the injured, septic or postsurgical patient will be discussed.
Intra‐abdominal abscess in a patient with tumour necrosis factor receptor‐associated periodic syndrome
Authors: STJERNBERG‐SALMELA S. , KIVISAARI A. , PUOLAKKAINEN P. , FÄRKKILÄ M. , KEMPPAINEN E. , RANKI A. , PETTERSSON T.
Published: January 2006

Tumour necrosis factor (TNF) receptor‐associated periodic syndrome (TRAPS) is an autoinflammatory disorder characterized by periodic attacks of fever and inflammation, due to mutations in the gene coding for the TNF type I receptor (TNFRSF1A). A 16‐year‐old patient with the diagnosis of TRAPS was admitted to hospital because of fever and abdominal pain. Initially, the symptoms were interpreted as manifestations of another TRAPS attack, but the patient's condition worsened, despite treatment with corticosteroids and antibiotics. A repeated computer tomography revealed an intra‐abdominal abscess, which necessitated urgent surgical intervention. This case stresses the importance of differential diagnostic vigilance when dealing with patients with rare genetic diseases.
Aspergillus nidulans class V and VI chitin synthases CsmA and CsmB, each with a myosin motor‐like domain, perform compensatory functions that are essential for hyphal tip growth
Authors: Takeshita Norio , Yamashita Shuichi , Ohta Akinori , Horiuchi Hiroyuki
Published: January 2006

The polarized synthesis of cell wall components such as chitin is essential for the hyphal tip growth of filamentous fungi. The actin cytoskeleton is known to play important roles in the determination of hyphal polarity in Aspergillus nidulans. Previously, we suggested that CsmA, a chitin synthase with a myosin motor‐like domain (MMD), was involved in polarized chitin synthesis in a manner dependent on the interaction between the MMD and the actin cytoskeleton. The genome database indicates that A. nidulans possesses another gene encoding another chitin synthase with an MMD. In this study, we characterized this gene, which we designated csmB. The csmB null mutants examined were viable, although they exhibited defective phenotypes, including the formation of balloons and intrahyphal hyphae and the lysis of subapical regions, which were similar to those obtained with csmA null mutants. Moreover, csmA csmB double null mutants were not viable. Mutants in which csmB was deleted and the expression of csmA was under the control of the alcA promoter were viable but severely impaired in terms of hyphal growth under alcA‐repressing conditions. We revealed that CsmB with three copies of a FLAG epitope tag localized at the hyphal tips and forming septa, and that the MMD of CsmB was able to bind to actin filaments in vitro. These results suggest that CsmA and CsmB perform compensatory functions that are essential for hyphal tip growth.
Borrelia burgdorferi lipoproteins are secreted to the outer surface by default
Authors: Schulze Ryan J. , Zückert Wolfram R.
Published: January 2006

Borrelia spirochaetes are unique among diderm bacteria in their abundance of surface‐displayed lipoproteins, some of which play important roles in the pathogenesis of Lyme disease and relapsing fever. To identify the lipoprotein‐sorting signals in Borrelia burgdorferi, we generated chimeras between the outer surface lipoprotein OspA, the periplasmic oligopeptide‐binding lipoprotein OppAIV and mRFP1, a monomeric red fluorescent reporter protein. Localization of OspA and OppAIV point mutants showed that Borrelia lipoproteins do not follow the ‘+2’ sorting rule which targets lipoproteins to the cytoplasmic or outer membrane of Gram‐negative bacteria via the Lol pathway. Fusions of mRFP1 to short N‐terminal lipopeptides of OspA, and surprisingly OppAIV, were targeted to the spirochaetal surface. Mutagenesis of the OspA N‐terminus defined less than five N‐terminal amino acids as the minimal secretion‐facilitating signal. With the exception of negative charges, which can act as partial subsurface retention signals in certain peptide contexts, lipoprotein secretion occurs independent of N‐terminal sequence. Together, these data indicate that Borrelia lipoproteins are targeted to the bacterial surface by default, but can be retained in the periplasm by sequence‐specific signals.
Sensation and distribution of stress and deformation in the human oesophagus
Authors: Frøkjær J. B. , Andersen S. D. , Lundbye‐christensen S. , Funch‐jensen P. , Drewes A. M. , Gregersen H.
Published: January 2006

Abstract  Evaluation of the distribution of stresses and strains in relation to distension‐induced sensation in the human oesophagus is valuable for understanding oesophageal biomechanics and mechano‐sensation. In 12 healthy volunteers a specially designed oesophageal bag containing an endoscopic ultrasound probe was inflated to the moderate pain level. Ultrasound images, bag pressure and perceived sensation were recorded before and after pharmacological relaxation of the smooth muscle with butylscopolamine. The oesophagus was assumed to be circular and thick‐walled. Distension induced a tensile circumferential stretch, radial compression and longitudinal shortening. Both circumferential strain and stress were highest at the mucosal surface and decreased throughout the wall. The stiffness increased throughout the wall and was highest at the outer surface (P < 0.001). The decrease in stiffness in response to butylscopolamine was non‐significant. The infused volume (P = 0.012) and circumferential stress (P < 0.001) were most closely associated with the distension‐induced sensation (adjusted R2 = 0.88). The perceived sensation was highly individual but was unaffected by butylscopolamine (P > 0.08). The present study provides a method for computation of the stress–strain distribution throughout the wall and the mechano‐sensory interaction in the human oesophagus. In the future, this may be useful for understanding of mechanoreceptor responses and generation of symptoms in visceral organs in health and in disease.
Ano‐rectal motility responses to pelvic, hypogastric and pudendal nerve stimulation in the Göttingen minipig
Authors: Andersen I. S. , Buntzen S. , Rijkhoff N. J. M. , Dalmose A. L. , Djurhuus J. C. , Laurberg S.
Published: January 2006

Abstract  We investigated the effect of efferent stimulation of the pelvic (PN), hypogastric (HGN) and pudendal (PuN) nerves on ano‐rectal motility in Göttingen minipigs using an impedance planimetry probe. Changes in the rectal cross‐sectional area (CSA) at five axial positions and pressures in the rectum and anal canal were investigated simultaneously. Pelvic nerve stimulation elicited a CSA decrease in the proximal part of the rectum and a simultaneous CSA increase in its distal part. Anal pressure also decreased. Hypogastric nerve and PuN stimulation elicited an increase in anal pressure, but no rectal response. Severing the HGN produced a persistent reduction in resting anal pressure, but no change was observed when the PN and the PuN were severed. Stimulation of the distal part of all three nerves produced a persistent response. Administration of phentolamine and pancouronium eliminated the response to stimulation of the HGN and the PuN, respectively.

Conclusion:  Rectal responses to PN stimulation vary more than previously suggested. The HGN has an excitatory effect on the internal anal sphincter, and the PuN on the external anal sphincter. However, the PuN plays no major role in maintaining basal anal pressure.
A multicentre study of the management of disorders of defecation in patients with spina bifida
Authors: Lemelle J. L. , Guillemin F. , Aubert D. , Guys J. M. , Lottmann H. , Lortat‐jacob S. , Moscovici J. , Mouriquand P. , Ruffion A. , Schmitt M.
Published: January 2006

Abstract  Patients with spinal dysraphism may have severe constipation and faecal incontinence. The impact of antegrade colonic enema (ACE) in the management of patients with spina bifida (SB) is analysed. In a multicentre cross‐sectional study, constipation, faecal incontinence and faecal management were described. Cases surgically treated were identified. Data were collected from 423 patients, of whom 230 did not use any manoeuvre or laxatives to assist evacuation. Conventional treatment was used in 193 patients, including digital extraction in 39%, retrograde enema in 21% and oral laxatives in 52%. For intractable constipation and overflow of faecal incontinence, 47 patients were treated with ACE, of whom 41 used the method at a mean time of interview of 4.1 ± 1.9 years after ACE operation; six abandoned ACE for conventional management. With ACE, faecal continence was significantly improved compared with conventional management, and neither retrograde rectal enema nor digital extraction were required. The conduit was fashioned to the right colon in 32 cases and to the left colon in nine cases. This study provides information on a multicentre experience in bowel management in SB patients. Whatever the technique used, ACE has improved faecal status compared with conventional therapy.
Effects of nitrogen, phosphorus, potassium and calcium nutrition on strawberry anthracnose
Authors: Nam M. H. , Jeong S. K. , Lee Y. S. , Choi J. M. , Kim H. G.
Published: January 2006

The effects of a range of concentrations of four nutrients – nitrogen, phosphorus, potassium and calcium – in fertilizer solutions on the severity of anthracnose on strawberry cv. Nyoho cultivated under a noncirculation hydroponics system were determined after inoculation with Colletotrichum gloeosporioides. Crop growth and tissue nitrogen, phosphorus, potassium and calcium contents of the entire above‐ground parts of the plant were also investigated. Elevated nitrogen and potassium concentrations in the fertilizer solution increased disease severity in contrast to phosphorus and calcium. Treatment with either NH4 or NO3 nitrogen was not significantly different. The dry weight of the strawberry plants increased significantly with elevated concentrations of nitrogen (R2 = 0·9078) and phosphorus (R2 = 0·8842), but was not influenced by the elevated amounts of potassium (R2 = 0·8587) and calcium (R2 = 0·6526) concentrations.
Effects of weather variables on grain mould of sorghum in South Africa
Authors: Tarekegn G. , McLaren N. W. , Swart W. J.
Published: January 2006

Effects of weather variables of mould development on sorghum grain were studied over three consecutive seasons in South Africa. Five sorghum hybrids planted at different dates ensured developing seeds were exposed to different weather conditions. Incidence of grain mould fungi was determined at harvest by incubating seeds on 2% malt extract agar. Averages of different weather variables (maximum and minimum temperatures, maximum relative humidity, total precipitation and frequency of precipitation) were determined for all permutations of weekly time intervals for a 2‐month postflowering period to identify when these variables and pathogen incidence were significantly correlated. Significant correlations were used to develop models to quantify relationships between variables. Significant positive correlations were observed between the incidence of mould fungi and weather 4–6 weeks after flowering in the shorter season hybrid cv. Buster, and 5–8 weeks after flowering in the remaining hybrids. In most hybrids, correlations between the incidence of grain mould pathogens, including Alternaria alternata, Curvularia spp. (C. lunata and C. clavata), Fusarium spp. (F. proliferatum and F. graminearum), and Drechslera sorghicola, and average minimum temperature, total rainfall and frequency of rainfall were significant (P = 0·05). In four hybrids, models showing a linear relationship between the logarithm of pathogen incidence and minimum temperature, and in one hybrid, between pathogen incidence and rainfall frequency, were developed. Depending on the hybrid, models that used minimum temperature as predictor described 60–82% of variation in the incidence of pathogens. Frequency of rainfall explained 93% of the variation in pathogen incidence in one sorghum hybrid genotype. Evaluation of the models using an independent data set yielded average prediction errors near zero, indicating that the models were acceptable.
Survival of Leptosphaeria maculans in soil on residues of Brassica napus in South Australia
Authors: Sosnowski M. R. , Scott E. S. , Ramsey M. D.
Published: January 2006

The survival of Leptosphaeria maculans, which causes phoma stem canker (blackleg), on oilseed rape residues (Brassica napus) in South Australia was investigated. Using a quantitative polymerase chain reaction (PCR) assay for L. maculans DNA, the pathogen was mainly detected in the upper 5 cm of the soil profile, including residues on the soil surface. As the size of organic matter particles in the soil decreased, so did the quantity of L. maculans detected in them. To obtain representative data for a field, at least 30 subsamples needed to be collected over the 0·81 ha area studied. In a survey of 49 commercial fields in South Australia, most L. maculans was detected in fields 1 year after oilseed rape had been grown, with less detected after 2 years and negligible amounts 3 years or more after cropping. The diagnostic DNA‐based assay for L. maculans reduced the time and cost of studying L. maculans survival in soil and increased the sensitivity and accuracy of results compared with estimates of propagule number of colony‐forming units on a semiselective medium.
Seed production of Raphanus raphanistrum following herbicide application during reproduction and effects on wheat yield
Authors: MADAFIGLIO G P , MEDD R W , CORNISH P S , VAN DE VEN R
Published: January 2006

The influence of weather and agronomic factors on the activity of six selective herbicides applied at reproductive stages of development for the reduction in seed production of Raphanus raphanistrum in wheat was evaluated. The herbicides used in this way generally reduced seed production by between 80% and 100%. Triasulfuron and mixtures of triasulfuron + MCPA consistently provided the greatest reduction in seed production. This was greater when herbicides were applied at the bud and early flowering stages of R. raphanistrum and the efficacy of the herbicides increased as maximum temperature on the day of spraying increased over the range 14–24°C. An applied model developed from these results predicts the reduction in seed production of R. raphanistrum, for each herbicide, given the stage of weed development and maximum temperature on the day of its application. Wheat yield was significantly reduced as densities of R. raphanistrum increased, with predicted losses at low densities being approximately half of those reported in the literature. There was no consistent evidence that the late application of herbicides had any negative effect on wheat yield through crop injury, nor was there any indication of yield improvement. It is concluded that certain herbicides applied during the reproductive phase of development have considerable potential to reduce R. raphanistrum seed production in wheat crops. As part of an integrated strategy, such late post‐emergence application of selective herbicides to regulate seed production has a likely role for managing weed seedbanks, but little or no value for counteracting weed competition.
Evaluation of herbicides against Phalaris minor in wheat in north‐western Indian plains
Authors: CHHOKAR R S , SHARMA R K , CHAUHAN D S , MONGIA A D
Published: January 2006

Phalaris minor, the most serious weed in wheat in north‐western India, has developed extensive isoproturon resistance due to continuous isoproturon use. For its control, alternative herbicides (flufenacet, metribuzin and sulfosulfuron) at different application rates and timing were evaluated in wheat. In addition, herbicide carryover risk onto rotational crops (sorghum; maize and green gram, Vigina radiata) was also assessed. Isoproturon at 1 and 2 kg a.i. ha−1 provided only 10.5% and 51.8%P. minor control respectively. Of the other herbicides, early post‐emergent [15–21 days after sowing (DAS)] flufenacet at 180–480 g a.i. ha−1 provided acceptable control of P. minor, but failed to control broad‐leaved weeds and was phytotoxic to the wheat crop. Metribuzin at 210 g a.i. ha−1 was effective in controlling both Phalaris and dicotyledonous weeds. Mixtures of both flufenacet and metribuzin at reduced rates were better than flufenacet for weed control and grain yield. The efficacy of flufenacet and metribuzin was drastically reduced with later growth stages of P. minor (four to five leaf). Whereas sulfosulfuron at 25–30 g a.i. ha−1, applied either early post‐emergence (19 DAS) or post‐emergence (30–42 DAS), was quite effective. Overall, sulfosulfuron was the most effective treatment with regard to weed control and crop yield. However, maize and sorghum grown in rotation after harvest of sulfosulfuron‐treated wheat plots showed 65–73% crop biomass inhibition. The residual effect of sulfosulfuron was also noticed on Trianthema portulacastrum (Horse purslane), causing 73.5% dry matter reduction. By contrast, no carryover damage with flufenacet was observed on maize, sorghum and green gram. Glasshouse pot experiments and field trials investigating crop sensitivity to pre‐plant applications of sulfosulfuron found the decreasing order: sorghum > maize > green gram. The risk of carryover onto rotational crops should be considered when choosing alternative herbicides for P. minor control in wheat.
Oral and facial piercings: a case series and review of the literature
Authors: López‐Jornet Pía , Navarro‐Guardiola Cristina , Camacho‐Alonso Fabio , Vicente‐Ortega Vicente , Yánez‐Gascon Josefa
Published: January 2006

Introduction  Piercing is popular among young people, who view this practice as a sign of marginality, beauty, or group identity. This study is performed on healthy individuals with oral and facial piercings.

Materials and methods  Seventy oral and facial piercings were evaluated (17 in the tongue, 13 in the lower lip, 18 in the nostril, 7 in the eyebrow, and 15 in the ear). A specifically designed protocol was used to assess possible complications (inflammatory reactions, pain, dental alterations). Nonparametric tests were used for the statistical analysis of the results.

Results  The general complications recorded comprised pain (60% of cases), inflammatory reactions (34.3%), bleeding (24%), dental fractures or fissures (20%), and gingival damage (26.7%).

Conclusion  Tongue piercing is associated with pain, inflammatory reactions, and dental problems.
Apert syndrome
Authors: Freiman Anatoli , Tessler Oren , Barankin Benjamin
Published: January 2006

Apert syndrome or acrocephalosyndactyly is a rare autosomal dominant malformation syndrome characterized by craniosynostosis, symmetric severe syndactyly, and a variety of abnormalities of the skin, skeleton, brain, and visceral organs. A case of Apert syndrome and the clinical and specific cutaneous manifestations of this condition are reviewed.
Plant–fungus mutualism affects spider composition in successional fields
Authors: Finkes Laura K. , Cady Alan B. , Mulroy Juliana C. , Clay Keith , Rudgers Jennifer A.
Published: January 2006

Mutualistic symbionts are widespread in plants and may have strong, bottom‐up influences on community structure. Here we show that a grass–endophyte mutualism shifts the composition of a generalist predator assemblage. In replicated, successional fields we manipulated endophyte infection byNeotyphodium coenophialumin a dominant, non‐native plant (Lolium arundinaceum). We compared the magnitude of the endophyte effect with manipulations of thatch biomass, a habitat feature of known importance to spiders. The richness of both spider families and morphospecies was greater in the absence of the endophyte, although total spider abundance was not affected. Thatch removal reduced both spider abundance and richness, and endophyte and thatch effects were largely additive. Spider families differed in responses, with declines in Linyphiidae and Thomisidae due to the endophyte and declines in Lycosidae due to thatch removal. Results demonstrate that the community impacts of non‐native plants can depend on plants’ mutualistic associates, such as fungal endophytes.
Publication rate of abstracts presented at the British Association of Urological Surgeons Annual Meeting
Authors: RAO AMRITH RAJ , BEATTY JOHN D. , LANIADO MARC , MOTIWALA HANIF G. , KARIM OMER M.A.
Published: January 2006

OBJECTIVE

To determine the number of peer‐reviewed publications arising from the abstracts presented at the annual meetings of the British Association of Urological Surgeons (BAUS), and to assess urological trainees’ attitudes to research in relationship to the pursuit of Specialist Registrar (SpR) training numbers and their perception of academic urology in the UK.

METHODS

Publications resulting from presentations at the annual meetings of the BAUS 2001 and 2002 were searched for using the PubMed database. Variables that might influence the subsequent publication of abstracts in peer‐reviewed journals were analysed. Whether institutions from other countries had similar publication rates to those in the UK was also assessed. SpRs were interviewed about their motivation to convert presentations to publications before and after their appointment to SpR training.

RESULTS

In July 2004, 142 of 449 abstracts presented at BAUS 2001 and 2002 were published, giving a publication rate of ≈ 42% on Kaplan‐Meier analysis. The rate of publication appeared to continue to the end of the period of searching for publications. The publication rate arising from UK presentations was lower than that from the non‐UK presentations (hazard ratio 0.75, 95% confidence interval 0.49–1.15, P = 0.14). Publication rates from podium and poster presentations were similar. Urology journals accounted for 75% of the publications. Of the SpRs evaluated, 83% did research and presented papers to obtain a training number rather than because of an inherent interest to pursue an academic career.

CONCLUSIONS

The conversion rate from BAUS presentation to peer‐reviewed publication at 36 months was similar on Kaplan‐Meier analysis to that of the American Urological Association (AUA, 38%). Interestingly, the rate of publication from the AUA seems to be faster than from BAUS. In addition, presentations from outside the UK appeared to be published faster than those from the UK. Delegates attending these conferences need to consider this when deciding whether a particular presentation will influence their practice. British urology requires academics who are interested in pursuing high‐quality research, and which is presented at major conferences with an intention to publish it in peer‐reviewed journals.
Re‐exploration of the acute scrotum
Authors: BEN‐MEIR DAVID , DESHPANDE ANIRUDDH , HUTSON JOHN M.
Published: January 2006

OBJECTIVE

To investigate children and adolescents who had scrotal exploration more than once.

PATIENTS AND METHODS

Between 1994 and 2004, 64 of 840 (7.6%) boys had more than one scrotal exploration at our institution. The age, laterality of the explorations, the interval between and findings at operation, whether the testes were managed by orchidopexy and how, and the complications, were reviewed from the medical records and the operating reports of the patients. All the boys were followed at the outpatient clinic 2–4 weeks after surgery.

RESULTS

The median (range) age of the patients was 11.5 (2–15) years; 61 had two scrotal explorations and three were explored three times. Of the patients, 32 presented with right testicular pain, 31 had left pain, and one had bilateral testicular pain. In the second exploration, 56 of 64 had the contralateral testis explored, five had an ipsilateral exploration and three had bilateral exploration. Forty‐eight of the 64 boys (70%) had torsion of the contralateral appendix testis at the second exploration, and 5.3% (45/840) of the total number of children operated for acute scrotum had metachronous torsion of the appendix testis. The median interval between the first and second exploration was 8 months (1 day to 10.5 years). Two boys had three scrotal explorations, and three of 64 (4.7%) boys developed complications that required re‐exploration.

CONCLUSIONS

Most indications for recurrent scrotal exploration in this study are because of a twisted contralateral appendix testis, but the risk of developing this pathology is similar to the complication rate of repeat scrotal exploration. These data support our policy that the contralateral testis should not be routinely explored nor its appendix removed unless there is ipsilateral testicular torsion.
The epidemiology of trauma of the genitourinary system after traffic accidents: analysis of a register of over 43 000 victims
Authors: PAPAREL PHILIPPE , N’DIAYE AMINA , LAUMON BERNARD , CAILLOT JEAN‐LOUIS , PERRIN PAUL , RUFFION ALAIN
Published: January 2006

OBJECTIVE

To analyse the frequency and type of injury to the genitourinary system, by user category, after traffic accidents.

PATIENTS AND METHODS

The register which forms the basis of this study is unique in Europe and includes 43 056 victims of road traffic accidents, and was compiled between 1996 and 2001. The categories of road users included: motorists, motorcyclists, cyclists, pedestrians, van and bus users, and roller skaters. The urological complication rate was analysed for each category.

RESULTS

In all, 199 cases of trauma of the genitourinary system (0.46%) were recorded. The most frequent urological complications were renal (43%) and testicular trauma (24%), the former most frequent in motorists (65%) and pedestrians (29%), and the latter in motorcyclists (41%).

CONCLUSIONS

An analysis of this register provides better knowledge of the urogenital injuries after traffic accidents. Renal and testicular injuries are the most frequent.
Pharmacokinetic and pharmacodynamic features of dapoxetine, a novel drug for ‘on‐demand’ treatment of premature ejaculation
Authors: ANDERSSON KARL‐ERIK , MULHALL JOHN P. , WYLLIE MICHAEL G.
Published: January 2006

Associate Editor

Michael G. Wyllie

Editorial Board

Ian Eardley, UK

Jean Fourcroy, USA

Sidney Glina, Brazil

Julia Heiman, USA

Chris McMahon, Australia

Bob Millar, UK

Alvaro Morales, Canada

Michael Perelman, USA

Marcel Waldinger, Netherlands

OBJECTIVE

To describe the relationship between the pharmacokinetic and pharmacodynamic properties of dapoxetine, a drug specifically developed for treating premature ejaculation (PE).

METHODS

Data from various stages of the clinical development programme were analysed using validated methods for assessing ejaculatory latency. The clinical characteristics were then compared with the pharmacokinetic profile, determined from measured plasma drug concentrations.

RESULTS

Pharmacodynamic and pharmacokinetic measurements confirm that ‘on demand’ dapoxetine has a rapid onset of action and is rapidly cleared after sexual intercourse.

CONCLUSION

Dapoxetine may represent the first of a new category of selective serotonin transport inhibitors. Although dapoxetine has pharmacological similarities to other selective serotonin transport inhibitors, its efficacy after acute administration sets it apart and suggests a different mode of action. Its physicochemical and pharmacokinetic properties and its clinical efficacy make dapoxetine suitable for on‐demand treatment of PE.
What is the effect of overactive bladder symptoms on woman's quality of life during and after first pregnancy?
Authors: VAN BRUMMEN HENRIETTE JORIEN , BRUINSE HEIN W. , VAN DE POL GEERTE , HEINTZ A. PETER M. , VAN DER VAART C. HUUB
Published: January 2006

OBJECTIVE

To evaluate the effect of overactive bladder symptoms (OAB) on women's quality of life (QoL) during and after the first pregnancy, using self‐reported symptom‐based QoL questionnaires.

PATIENTS AND METHODS

In a prospective cohort study, 474 women were asked to complete four self‐reported questionnaires. Urogenital symptoms were assessed with the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). A women was considered to experience ‘dry’ OAB if she replied positively to the following two questions: ‘do you experience a strong feeling of urgency to empty your bladder?’; and ‘do you experience frequent urination?’. A women was considered to experience ‘wet’ OAB if she replied positively to all of the following questions: ‘do you experience a strong feeling of urgency to empty your bladder?’; ‘do you experience frequent urination?’; and ‘do you experience urine leakage related to the feeling of urgency?’.

RESULTS

In all, 344 (72.6%) women who returned all four questionnaires were included in the analysis. After first childbirth there was a rapid decline in the prevalence of dry OAB (45.2% to 7.9%, P < 0.001). In pregnancy the prevalence of wet OAB increased significantly, but a year after childbirth the prevalence of wet OAB decreased and was similar to that at 12 weeks of gestation (P = 0.289). Women with wet OAB had higher scores on all IIQ domains than those with no OAB symptoms at 36 weeks of gestation. Women with dry or wet OAB all had higher scores on the mobility domain than those with no OAB. The scores on the physical, social and emotional functioning domains were low, suggesting a minimal restriction of lifestyle.

CONCLUSION

OAB symptoms are common during pregnancy; dry OAB had no negative effect on QoL, whereas wet OAB compromised QoL both during and after pregnancy, mainly in the ‘mobility’ and ‘embarrassment’ domains. The urge urinary incontinence symptom in wet OAB seems to profoundly compromise QoL. Apparently, in young mothers with wet OAB, limitations in mobility are especially stressful and these symptoms can be embarrassing.
Interstitial cells and cholinergic signalling in the outer muscle layers of the guinea‐pig bladder
Authors: GILLESPIE JAMES I. , MARKERINK‐VAN ITTERSUM MARJANNE , DE VENTE JAN
Published: January 2006

OBJECTIVES

To explore the relationship between cholinergic mechanisms and interstitial cells (ICs) in the outer muscle layer of the bladder.

MATERIALS AND METHODS

In bladder tissue from male guinea‐pigs, ICs were identified by their response to nitric oxide (NO) with a rise in cGMP. Sections of the lateral bladder wall were incubated in Krebs’ solution containing 1 mm of the nonspecific phosphodiesterase inhibitor isobutyl‐methyl‐xanthene. Tissues were then exposed to 100 µm of the NO donor NONOate for 10 min, control tissues remained in Krebs’ solution. Tissues were then processed for immunohistochemistry for cGMP, choline acetyltransferase (ChAT), neurofilament protein, and the nonspecific neuronal marker protein gene product (PGP) 9.5.

RESULTS

cGMP‐positive ICs were found mainly in the outer muscle layers of the bladder wall. Three types were identified based on location; on the outer surface of the bladder wall, on the surface of the muscle bundles, and within the muscle bundles. Some of the intramuscular ICs stained for ChAT, but they did not stain with PGP 9.5. Nerve fibres were seen in close contact with the ChAT‐positive intramuscular ICs, and these nerves expressed ChAT and neurofilament protein.

CONCLUSIONS

A subpopulation of intramuscular ICs can synthesise acetylcholine, and might release acetylcholine onto the underlying muscle. These cells are in close contact with nerves, suggesting that they might be activated by neural inputs. Thus there may be a system in the detrusor involving cholinergic nerves acting on ICs which can activate the smooth muscle via a complex cholinergic input.
Urinary retention in women: its causes and management
Authors: KAVIA RAJESH B.C. , DATTA SOUMENDRA N. , DASGUPTA RANAN , ELNEIL SOHIER , FOWLER CLARE J.
Published: January 2006

Urinary retention in women is a diagnostic and therapeutic challenge to urologists and to all involved in the treatment of the condition. The patients referred to a single institution with this condition over a 4‐year period were audited and the data are presented. The importance of Fowler's syndrome is described, as is the value of sacral nerve stimulation in this condition. In another paper, authors from France present evidence of occult dysautonomia in Fowler's syndrome.

OBJECTIVE

To report the experience of the last 4 years from a centre to which women with voiding difficulties and urinary retention were referred nationally, describing what investigations were helpful in making a diagnosis and the management strategies used

PATIENTS AND METHODS

Women with voiding difficulties and urinary retention remain a diagnostic and management challenge, and those with no anatomical or neurological basis for their symptoms may be dismissed, assuming that their retention has a psychogenic basis. The finding of an electromyographic (EMG) abnormality of the striated urethral sphincter explaining their disorder (Fowler's syndrome) has led to the referral of women for consideration of that diagnosis. Thus we audited the referrals to the centre over a 4‐year period of such women.

RESULTS

In all, 247 women (mean age 35 years) with complete (42%) or partial retention (58%) were referred; 175 (71%) had urethral pressure profilometry, 141 (57%) had a transvaginal ultrasonographic measurement of the sphincter volume, and 95 (39%) had sphincter EMG. The mean maximum urethral closure pressure difference between patients with an EMG abnormality (101.5 cmH2O) and the patients with known other causes of voiding dysfunction (66.2 cmH2O) was 35.3 cmH2O (P < 0.05). In patients with complete retention there was a significant difference in sphincter volume between those who were EMG‐positive (2.14 mL) or EMG‐negative (1.64 mL) (P < 0.05).

CONCLUSION

These investigations helped to classify the cause of retention in two‐thirds of cases. The commonest diagnosis was Fowler's syndrome, in which sacral nerve stimulation is the only intervention that restores voiding.
The perception of self‐efficacy in coping with economic risks among young adults: an application of psychological theory and research
Authors: Engelberg Elisabeth
Published: January 2006

The present study was prompted by the paucity of research about the perception among young people of their ability to cope with economic risks of contemporary society. The variables used in this exploration were attitudes to money. The variable of emotion management was included on the rationale that stress and negative emotions tend to arise from demands to manage economic aspects of life. The links between a sense of economic self‐efficacy and these variables were examined using a questionnaire filled out by 120 respondents. The findings revealed considerable correspondence between economic self‐efficacy and the notion of adhering to meticulous saving plans as well as firmer self‐control of emotions. Profiles that successfully discriminated between low and high sense of economic self‐efficacy were identified. The results further our understanding of the interplay between psychological factors and the self‐perception of efficacy in dealing with economic change.
An empirical study of the impact of consumer perceived risk on purchase likelihood: a modelling approach
Authors: Yeung Ruth M.W. , Morris Joe
Published: January 2006

Drawing on an extensive literature review, a conceptual model incorporating marketing and psychometric paradigms for assessing consumer purchase behaviour is developed in the context of a hazardous and harmful risk associated with potentially contaminated food. An empirical study of 200 respondents was carried out to test this conceptual model. Structural equation modelling using LISREL 8.30 confirmed the link between perceived risk characteristics and risk perception, and that the latter appears to influence purchase behaviour. Concern about potential consequences, long‐term adverse impacts and the involuntariness of exposure were key shapers of risk perception, and risk perception itself was measured by health, money, time, lifestyle and taste losses in this study. These findings can help both the food industry and its regulators as they seek to formulate effective risk management and communication strategies. The model developed in this exploratory study can be extended to all commodities, as well as all services industry.