bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations of plasma pro‐inflammatory cytokines, fibrinogen, viscosity and C‐reactive protein with cardiovascular risk factors and social deprivation: the fourth Glasgow MONICA study
Authors: Welsh Paul , Woodward Mark , Rumley Ann , Lowe Gordon
Published: March 2008

Circulating inflammatory markers [plasma fibrinogen, viscosity and C‐reactive protein (CRP)] have been associated with cardiovascular risk factors. In part, these associations may reflect ‘upstream’ changes in pro‐inflammatory cytokines – interleukin (IL)‐6, IL‐18 and tumour necrosis factor (TNF)α. These variables were measured in 1666 men and women aged 25–64 years and their associations with risk factors were studied. All six markers increased significantly with age. IL‐18 and TNFα levels were higher, and fibrinogen levels lower, in males. Oral contraceptive use increased levels of CRP, whilst postmenopausal women had elevated IL‐18 levels. Inflammatory markers were also associated with components of the metabolic syndrome. Most inflammatory markers showed an increasing trend with alcohol consumption in men and a decreasing trend in women, and increasing trends with level of smoking. Inflammatory markers generally showed strong positive associations with social deprivation. After adjustment for classical risk factors, IL‐6, IL‐18 and TNFα retained significant associations with social deprivation only in men (P < 0·008). We conclude that pro‐inflammatory cytokines are associated with several cardiovascular risk factors including social deprivation, and may mediate some of their associations with ‘downstream’ inflammatory markers (fibrinogen, viscosity and CRP).
Vitamin D deficiency, cardiac iron and cardiac function in thalassaemia major
Authors: Wood John C. , Claster Susan , Carson Susan , Menteer J. D. , Hofstra Thomas , Khanna Rachna , Coates Thomas
Published: March 2008

Vitamin D25‐OH and D1‐25OH levels were compared with cardiac R2* (1/T2*), left ventricular ejection fraction (LVEF), age, ferritin and liver iron in 24 thalassaemia major patients. Vitamin D25‐OH levels were reduced in 13/24 patients while vitamin D1‐25OH levels were often elevated. Vitamin D25‐OH levels decreased with age (r2 = 0·48) and with liver iron (r2 = 0·20). Cardiac R2* was inversely related with the ratio of D25‐OH to D1‐25OH levels (r2 = 0·42). LVEF was also proportional to the D25‐OH/D1‐25OH ratio (r2 = 0·49). Vitamin D deficiency may be associated with cardiac iron uptake and ventricular dysfunction in thalassaemia major patients.
Process‐based model for direct and indirect effects of hydrographic conditions on Central Baltic cod (Gadus morhua) egg mortality
Authors: ANDERSEN K. H. , MÖLLMANN C. , KÖSTER F.W.
Published: March 2008

A process‐oriented model for the mortality of eggs of cod Gadus morhua in the Central Baltic Sea is developed, based on a synthesis of existing knowledge of the effects of salinity, oxygen and predation by sprat Sprattus sprattus. The models show the importance of the vertical and temporal overlap between eggs and predations. Effects related to the changing buoyancy of the eggs due to age and size of the mother fish, batch number and stock structure are not of major importance for the egg survival of this stock. It is demonstrated that under the present high sprat predation pressure, the observed delay in spawning time has increased egg survival.
Vertical distributions of Japanese sardine (Sardinops melanostictus) eggs: comparison of observations and a wind‐forced Lagrangian mixing model
Authors: TANAKA YUJI , FRANKS PETER J. S.
Published: March 2008

To understand how Japanese sardine eggs vertically disperse in water, we acquired a series of depth‐resolved samples of eggs while tracking a drogued buoy to follow the water mass in which the eggs were spawned. This survey was conducted in early March of 1991, when the sardine population was abundant and actively spawning in the Pacific off Kyushu. Buoyancy of the eggs was estimated by measuring the specific gravity, and was 1–4 × 10−3 less than that of the water in which they were spawned, giving a rising speed of 1–2 mm s−1. In an attempt to diagnose the dynamics underlying the observed vertical profiles of the eggs, a one‐dimensional egg distribution model incorporating the egg rising speed and wind‐ and depth‐dependent vertical diffusivity was formulated. Observed eggs were mainly in the surface mixed layer, and their vertical distribution changed with wind‐induced surface mixing: during strong winds, the eggs were distributed relatively evenly over the upper 60–75 m, whereas during weak winds and shallow pycnocline, the eggs formed a subsurface peak around 25 m depth. The model accurately reproduced these variations in the vertical distributions of eggs, suggesting that the gradients of egg concentration are sensitive to the strength of wind and the structure of underlying hydrography. Further tests with the model showed the importance of positive buoyancy: neutrally buoyant eggs formed subsurface maxima below the food‐rich euphotic zone. The balance of vertical mixing and floating, which allows the eggs to remain in the euphotic zone but away from the near‐surface waters, may be an adaptation to minimize surface‐enhanced predation, while allowing the eggs to hatch in the food‐rich euphotic zone.
Relationships between oceanic conditions and growth of Chinook salmon (Oncorhynchus tshawytscha) from California, Washington, and Alaska, USA
Authors: WELLS BRIAN K. , GRIMES CHURCHILL B. , SNEVA JOHN G. , McPHERSON SCOTT , WALDVOGEL JAMES B.
Published: March 2008

We model age‐specific growth rates of Chinook salmon (Oncorhynchus tshawytscha) with two life‐history behaviors from Alaska (i. Situk and ii.Taku Rivers), Puget Sound, Washington (iii., iv. Skagit River), and California (v. Smith River) relative to oceanic conditions in those regions. By analyzing over 20 yr of biological and physical data from the NE Pacific downwelling, upwelling, and transition zones, we are able to determine the factors affecting growth across much of the species’ range and between life‐history behaviors. With scale increment data from returning fish, we use path analysis and partial least squares regression to quantify the relationships between growth and regional‐ and large‐scale oceanic conditions (e.g., sea level height, sea surface temperature, upwelling). Alaskan fish with both ocean‐ and stream‐type behaviors were fit best by the environmental data from the winter in Alaska waters. Specifically, coastal and gyre factors such as sea surface temperature, river flow, and Ekman pumping positively correlated to growth, indicating a productive and strong Alaska Current promoted growth. Growth of fish from California was fit by local factors such as increased upwelling, lower coastal sea surface temperature, and wind stresses during summer and spring, indicating a productive and strong California Current promoted growth. For Puget Sound, Washington, growth of fish that migrate to sea in their first year was generally negatively correlated to a strong California Current. Puget Sound fish that spend a year in freshwater before migrating to sea were modeled well with environmental data from their source region for the first 2 yr at sea and by data from Alaska waters in their third year at sea. Results suggest that conditions in which the transition zone is dominated by neither the Alaska nor California Currents are best for increased growth of Puget Sound fish.
Effects of three stressors on vegetation in an oligohaline marsh
Authors: SLOCUM MATTHEW G. , MENDELSSOHN IRVING A.
Published: March 2008

1. When multiple stressors have interactive effects they can lead to important changes in ecosystem function. We examined how three stressors affected the plant community in an oligohaline marsh in southeastern Louisiana, U.S.A. These stressors included herbivory (mostly by the introduced rodent Myocastor coypus), disturbance (herbicide application) and nutrient enrichment (three levels of N–P–K fertilizer). Sampling was conducted six times over 4 years.

2. Recovery after disturbance was slow, such that after 26 months biomass in disturbed plots was 36% that of controls. Slow recovery appeared to be due to herbivory, as exclusion of herbivores for 14 months led to much more biomass compared to non‐excluded plots. Exclusion did not, however, aid recovery of species richness; this recovery required 51 months in total.

3. Nutrient enrichment increased biomass by 41% and decreased species richness by c. 20% in later sampling periods. Decreased species richness was due primarily to a reduced ability of dominant species to co‐exist (as determined with Hill’s diversity number N1). Nutrient enrichment did not interact with the other treatments.

4. Disturbance favoured two grasses (Echinochloa crus‐galli and Leptochloa fascicularis), while lack of disturbance favoured two herbs (Sagittaria lancifolia and Polygonum punctatum) and two vines (Ipomoea sagittata and Cuscuta pentagona). Nutrient enrichment positively affected abundance of two species (C. pentagona and L. fascicularis). Herbivory did not affect species composition.

5. The effect of one stressor (experimental disturbance) on plant biomass depended on the strength of another stressor (herbivory). Nutrient enrichment was also important in affecting the plant community, but only as a single stressor. All effects changed over time, and it was clear that to understand properly the effects of multiple stressors, long‐term, manipulative field experiments are necessary.
Carbon allocation in boreal black spruce forests across regions varying in soil temperature and precipitation
Authors: VOGEL JASON G. , BOND‐LAMBERTY BEN P. , SCHUUR EDWARD A. G. , GOWER STITH T. , MACK MICHELLE C. , O'CONNELL KARI E. B. , VALENTINE DAVID W. , RUESS ROGER W.
Published: March 2008

A common hypothesis for northern ecosystems is that low soil temperatures inhibit plant productivity. To address this hypothesis, we reviewed how separate components of ecosystem carbon (C) cycling varied along a soil temperature gradient for nine well‐drained, relatively productive boreal black spruce (Picea mariana Mill. [B.S.P.]) forests in Alaska, USA, and Saskatchewan and Manitoba, Canada. Annual soil temperature [expressed as soil summed degree days (SDD)] was positively correlated with aboveground net primary productivity (ANPP), while negatively correlated with total belowground carbon flux (TBCF). The partitioning of C to ANPP at the expense of root processes represented a nearly 1 : 1 tradeoff across the soil temperature gradient, which implied that the amount of C cycling through these black spruce ecosystems was relatively insensitive to variation in SDD. Moreover, the rate at which C accumulated in the ecosystem since the last stand replacing fire was unrelated to SDD, but SDD was positively correlated to the ratio of spruce‐biomass : forest‐floor‐mass. Thus, plant partitioning of C and the distribution of ecosystem C were apparently affected by soil temperature, although across regions, precipitation co‐varied with soil temperature. These two factors likely correlated with one another because of precipitation's influence on soil heat balance, suggesting that a soil temperature–precipitation interaction could be responsible for the shifts in C allocation. Nonetheless, our results highlight that for this boreal ecosystem, ANPP and TBCF can be negatively correlated. In tropical and temperate forests, TBCF and ANPP have been reported as positively correlated, and our results may reflect the unique interactions between soil temperature, forest floor accumulation, rooting depth, and nutrient availability that characterize the black spruce forest type.
Changes in grassland ecosystem function due to extreme rainfall events: implications for responses to climate change
Authors: FAY PHILIP A. , KAUFMAN DAWN M. , NIPPERT JESSE B. , CARLISLE JONATHAN D. , HARPER CHRISTOPHER W.
Published: March 2008

Climate change is causing measurable changes in rainfall patterns, and will likely cause increases in extreme rainfall events, with uncertain implications for key processes in ecosystem function and carbon cycling. We examined how variation in rainfall total quantity (Q), the interval between rainfall events (I), and individual event size (SE) affected soil water content (SWC) and three aspects of ecosystem function: leaf photosynthetic carbon gain (), aboveground net primary productivity (ANPP), and soil respiration (). We utilized rainout shelter‐covered mesocosms (2.6 m3) containing assemblages of tallgrass prairie grasses and forbs. These were hand watered with 16 I×Q treatment combinations, using event sizes from 4 to 53 mm. Increasing Q by 250% (400–1000 mm yr−1) increased mean soil moisture and all three processes as expected, but only by 20–55% (P≤0.004), suggesting diminishing returns in ecosystem function as Q increased. Increasing I (from 3 to 15 days between rainfall inputs) caused both positive () and negative () changes in ecosystem processes (20–70%, P≤0.01), within and across levels of Q, indicating that I strongly influenced the effects of Q, and shifted the system towards increased net carbon uptake. Variation in SE at shorter I produced greater response in soil moisture and ecosystem processes than did variation in SE at longer I, suggesting greater stability in ecosystem function at longer I and a priming effect at shorter I. Significant differences in ANPP and between treatments differing in I and Q but sharing the same SE showed that the prevailing pattern of rainfall influenced the responses to a given event size. Grassland ecosystem responses to extreme rainfall patterns expected with climate change are, therefore, likely to be variable, depending on how I, Q, and SE combine, but will likely result in changes in ecosystem carbon cycling.
Using quality report cards for reshaping dentist practice patterns: a pre‐play communication approach
Authors: Lin Chinho , Lin Chun‐Mei
Published: March 2008

Rationale, aims and objectives  Understanding how information disclosure influences dentists’ patterns of practice change is important in developing quality‐improvement policies and cost containment. Thus, using quality report cards is a promising strategy for investigating whether dentists will reshape their patterns of practice because of the influence of peer comparison.

Methods  Based on the coordination game, a data warehouse decision support system (DWDSS) was used as a pre‐play communication instrument, along with the disclosure of quality report cards, which allow dentists to search their own service rates of dental restoration and restoration replacement as well as compare those results with others.

Results and conclusions  The group using the DWDSS had a greater decrease in two indicators (i.e. service rates of dental restoration and restoration replacement) than the dentists who did not use it, which implies that the DWDSS is a useful facility for helping dentists filter and evaluate information for establishing the maximum utility in their practice management. The disclosure of information makes significant contributions to solving managerial problems associated with dentists’ deviation of practice patterns.
Multilevel factors affecting tuberculosis diagnosis and initial treatment
Authors: Thongraung Wilawan , Chongsuvivatwong Virasakdi , Pungrassamee Petchawan
Published: March 2008

Objectives  The study aims to assess provider adherence to national tuberculosis programme guidelines on diagnosis, initial regimens and dosages, and to examine independent effects of factors at patient, staff and hospital levels influencing adherence.

Methods  A review of 383 medical records of new tuberculosis (TB) patients and interviews with related staff were carried out. The study was conducted in 16 public hospitals of seven provinces of southern Thailand. The outcome variables were provider adherence to the guidelines on diagnostic procedure, initial regimen and dosage. Independent variables consisted of patient, staff and hospital factors. Multilevel logistic regression was used to identify factors associated with adherence.

Results  The proportions of adherence to the diagnostic procedure, initial regimen and initial dosage prescribed were 70.0%, 100.0% and 57.1%, respectively. Most of diagnosis non‐adherence was anti‐TB drugs being prescribed for smear‐negative patients without prior antibiotic trial (12.5%). The anti‐TB drug with the highest percentages of patients receiving non‐adhered dosage was ethambutol (33.6%). In contrast to single‐level analysis, which showed significant influence of up to five factors, multilevel analysis confirmed only strong effect of male patients receiving better adhered diagnosis and of non‐doctors and TB clinics providing better dosage adherence.

Conclusions  Adherence to TB diagnostic procedures was not good, and adherence to initial dosage, especially for ethambutol, was poor. TB clinics, the key factor of adherence, should be expanded. Female patients should be reviewed more carefully because they tend to receive poorer diagnosis adherence.
Interaction effects and subgroup analyses in clinical trials: more than meets the eye?
Authors: Sevdalis Nick , Jacklin Rosamond
Published: March 2008

In clinical trials, it is common practice to follow up significant interactions between the factors under investigation with subgroup analyses. Such analyses pose at least two analytical and interpretational challenges. The first challenge is that performing multiple subgroup analyses increases the likelihood of obtaining spuriously significant results. This has been acknowledged and relevant guidance exists in the medical literature. The second challenge is that the effects that are obtained at the level of subgroup are composite. This has yet to be fully acknowledged and discussed in the context of medical research. This paper aims to fill this lacuna. Using a simple additive model, we use recent findings from the CHARISMA trial on the efficacy of clopidogrel in addition to aspirin in the treatment of patients at risk for atherothrombotic events to demonstrate quantitatively the composition of effects at the level of subgroups. In the simplest case of a design involving an interaction (two crossed factors, with two levels each, i.e. a 2 × 2 design), effects at the level of subgroup consist of influences that stem (i) from the incidence of the measured outcome in the study population as a whole; (ii) from the factor of interest (e.g. treatment vs. placebo); (iii) from the second factor (e.g. patient group membership); (iv) from the interaction between the two factors; and (v) from random error in the measured outcome. The value of the approach illustrated here is that it is generalizable to any research design irrespective of its complexity and that it prompts clinicians to consider the multiple causality underlying medical research findings.
General practitioners’ assessment of risk of violence in their practice: results from a qualitative study
Authors: Magin Parker , Adams Jon , Joy Elyssa , Ireland Malcolm , Heaney Susan , Darab Sandra
Published: March 2008

Rationale, aims and objectives  Clinicians’ means of stratification of risk of violence has been previously studied in health settings, but not in general practice. This study aimed to investigate the means by which general practitioners (GPs) assess risk of violence in their clinical practice.

Method  A qualitative design using focus group interviews and written responses on a subsequent questionnaire. Focus group discussions were audiotaped and transcribed. Questionnaires were sent to all members of three Divisions of General Practice offering the opportunity for respondents to make qualitative comments. The focus group transcripts and qualitative questionnaire responses were coded independently by members of the research team and subjected to thematic analysis. The setting was three Urban Divisions of General Practice in New South Wales, Australia. Participants were one hundred and seventy‐two urban GPs – 18 participants in four focus groups and 154 GPs providing written responses.

Results  Assessment and stratification of risk by GPs conformed to a schema based on the physical environment of the consultation, individual characteristics of the patient, individual characteristics of the doctor, and characteristics of the doctor–patient relationship. Despite this, risk assessment and risk stratification were often on the basis of ad hoc, subjective decision making. An aspect of the ad hoc nature of risk assessment was the pre‐eminence afforded ‘instinct’ or ‘intuition’ in subjects’ responses.

Conclusion  A schema of factors involved in GPs’ assessment of risk of violence is presented. An appreciation of these will be of clinical and policy importance.
The impact of choice of maternity care on psychological health outcomes for women during pregnancy and the postnatal period
Authors: Jomeen Julie , Martin Colin R.
Published: March 2008

Rationale  Psychological factors are acknowledged to impact on pregnancy, birth, neonatal outcomes and maternal mental health. The importance of psychological well‐being is now recognized within maternity care and UK maternity policy advocates choice and control, equating this to increased quality of experience and improved psychological outcomes. There remains, however, lack of substantive and consistent evidence with regard to the psychological benefits of choice in maternity care. The aim of this study is to investigate the impact of choice of maternity care on psychological health outcomes.

Methods  165 antenatal women were recruited and sampled according to their choices for care. Women were assessed utilizing the Hospital Anxiety and Depression Scale (HADS), Edinburgh Postnatal Depression Scale (EPDS), Cambridge Worry Scale (CWS), Multidimensional Health Locus of Control (MHLC), SF‐36, Pittsburgh Sleep Quality Index (PSQI) and Culture Free Self‐esteem Inventory (CFSEI) at 12 and 32 weeks pregnant and 14 days and 6 months postnatal.

Results  No significant differences between groups were revealed on any of the scales or subscales measured. Significant and corresponding differences were identified within groups over time for CWS socio‐medical worries, MHLC ‘powerful others’, SF‐36 bodily pain, vitality personal health and change in health, PSQI global sleep. An interaction effect for CFSEI general and social self‐esteem was revealed between birth centre and midwifery‐led care/main unit women at 14 days postnatal.

Conclusions  These results demonstrate that pregnancy represents a psychological challenge regardless of care type chosen and choice of no one care option confers greater psychological benefit across the maternity experience as a whole. It is possible, however, that differences in experience or environment at critical times can affect psychological status.
Evaluating the impact of mobile telephone technology on type 2 diabetic patients’ self‐management: the NICHE pilot study
Authors: Faridi Zubaida , Liberti Lauren , Shuval Kerem , Northrup Veronika , Ali Ather , Katz David L.
Published: March 2008

Rationale, aims and objectives  Utilizing information technology, such as Internet and cellphones, holds great promise in enhancing diabetic care. Yet few studies have examined the impact of cellphone technology on type 2 diabetics’ self‐care. The primary aim of the study is to examine the feasibility of utilizing this technology to assist with diabetes self‐care in a clinic population as well as its impact on clinical outcomes.

Methods  Thirty patients with a diagnosis of type 2 diabetes at two Community Health Centers were randomized to intervention or control. Intervention patients participated in a brief intervention and received tailored daily messages via cellphone prompting them to enhance their diabetic self‐care behaviour. Patients at the control site continued with their standard diabetes self‐management.

Results  A mean improvement in HbA1c levels was apparent (−0.1, SD = 0.3%; P = 0.1534) in the intervention group, compared with a mean deterioration in the control (0.3, SD = 1.0%; P = 0.3813), yet without statistical significance. Self‐efficacy scores improved significantly in the intervention group (−0.5, SD = 0.6; P = 0.0080) compared with no improvement in the control (0.0, SD = 1.0; P = 0.9060). Participants encountered numerous technological barriers when attempting to adhere to the intervention protocol.

Conclusion  The results indicate the intervention had a positive impact on some clinical outcome and self‐efficacy. Although the technology appears feasible in a clinical setting technology must be made more user‐friendly before a larger phase II trial is conducted.
Comparisons of risk‐adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan
Authors: Ishizaki Tatsuro , Imanaka Yuichi , Sekimoto Miho , Fukuda Haruhisa , Mihara Hanako ,   Treatment of Subarachnoid Hemorrhage Expert Group
Published: March 2008

Objectives To assess predictive value of patient characteristics and severity of aneurysmal subarachnoid haemorrhage (SAH) patients for clinical outcomes, and thereby estimate risk‐adjusted clinical outcomes and compare the outcomes across hospitals.

Methods We selected 256 aneurysmal SAH patients from eight teaching hospitals in Japan. The clinical outcomes of patients at the time of discharge were assessed by the Glasgow Outcome Scale (GOS). A multiple logistic regression analysis was performed to identify predictors for the GOS status at the time of discharge. The risk‐adjusted proportion of patients with a favourable GOS outcome was then estimated for each facility and compared across hospitals.

Results The logistic regression analysis revealed that younger age (P < 0.001), patients with good World Federations of Neurological Surgeons grade at admission (P < 0.001) and absence of chronic renal failure or ischaemic heart disease as a comorbid condition (P < 0.001) were identified as significant predictors for favourable GOS outcome at the time of discharge among aneurysmal SAH patients (Cstatistic = 0.88). We found that one hospital had significantly better outcomes than the others.

Conclusion After comparison of risk‐adjusted values across hospitals, the clinical management methods of the hospital that showed the best performance were examined and shared among providers.
Who’s in charge? Challenges in evaluating quality of primary care treatment for low back pain
Authors: Wasiak Radoslaw , Pransky Glenn S. , Atlas Steven J.
Published: March 2008

Rationale and objectives  Low back pain (LBP) is a common condition with frequent health care visits and work disability. Quality improvement efforts in primary care focused on guidelines adherence, provider selection and education, and feedback on appropriateness of care. Such efforts can only succeed if a health care provider is in charge of care over a substantial period. This study was conducted to provide insights about actual patterns of provider involvement in LBP care and implications for quality evaluation.

Methods  Established primary care patients with occupational LBP and health care covered by a workers’ compensation insurer were selected. Primary care physician (PCP) involvement was examined relative to overall health care utilization. Four methods of classifying PCP involvement were used to assess the association between PCP involvement and health care and work disability outcomes over a 2‐year follow‐up period.

Results  Primary care physician was rarely the sole provider during episodes of occupational LBP. PCP was the initial non‐emergency room provider in 55% of cases, and was the most prevalent provider during at least one episode of care in 45% of cases. Different methods of classification led to different conclusions about the association between PCP involvement and work disability or number of health care visits. Multiple providers were involved throughout the clinical course of the small number of cases that accounted for most of the health care visits and work disability; in these cases, the role of PCP in care was difficult to determine.

Conclusions  Administrative data alone are adequate for provider comparisons only in relatively simple cases. Provider comparisons based on initial treating provider likely overstate the importance of early care, particularly in more complex cases. For LBP, quality improvement models based on PCP‐directed interventions or reinforcing guideline adherence may not impact outcomes. A patient‐centred model may be necessary to achieve outcome improvements.
Experiences of diagnosis and treatment among people with multiple sclerosis
Authors: Edwards Rhiannon G. , Barlow Julie H. , Turner Andrew P.
Published: March 2008

Rationale, aims and objectives  The aim of this qualitative study was to examine patients’ experiences of being diagnosed with multiple sclerosis (MS), the information that they were given at this time, subsequent treatment and its impact on their lives.

Method  Data were collected through semi‐structured interviews with 24 people with MS. The use of interviews allowed participants’ experiences to be explored in depth. Participants were recruited by the MS Society through membership details and through a press release in a local newspaper. Telephone interviews lasted between 30 and 60 minutes, were tape‐recorded and transcribed verbatim. Data were analysed using thematic content analysis.

Results  The majority of participants were female (n = 17), with ages ranging from 35 to 72 years. Disease duration ranged from 1 to 37 years. Many participants’ diagnosed before and after 2000 had experienced long delays in diagnosis. At the point of diagnosis, participants had to make sense of and understand their diagnosis often with insufficient support. Some participants expressed anger about the way they had been given their diagnosis. Many felt they had not received sufficient information about their illness at this time and had responded by conducting their own searches for information to satisfy this need.

Conclusion  Improving the way in which doctors communicate with patients experiencing diagnostic delay and at the point of diagnosis deserves further study, in order to avoid later adjustment problems.
Prolonged elevation of galanin and tachykinin expression in mucosal and myenteric enteric nerves in trinitrobenzene sulphonic acid colitis
Authors: Simpson J. , Sundler F. , Humes D. J. , Jenkins D. , Wakelin D. , Scholefield J. H. , Spiller R. C.
Published: March 2008

Abstract  Diverticulitis causes recurrent abdominal pain associated with increased mucosal expression of mucosal galanin and substance P (SP). We studied changes in mucosal and myenteric plexus neuropeptides in adult rats using a model of colonic inflammation, trinitrobenzenesulphonic acid colitis. We assessed the effects on the pan‐neuronal markers protein gene product 9.5 (PGP9.5) and neurofilament protein, as well as specific neuropeptides at 1, 2, 3, 4, 6, 8, 10 and 14 weeks. Following the acute injury there was macroscopic resolution of inflammation but minor microscopic abnormalities persisted. Percent area stained of mucosal PGP9.5 fell initially but average levels on days 21 and 28 levels were significantly elevated (P < 0.001), returning to normal by day 42. Percent area staining of PGP9.5 in the muscle rose immediately and remained significantly elevated at 70 days (P < 0.001). SP, neuropeptide K and galanin followed a similar overall pattern. SP to PGP9.5 ratio was significantly increased in the muscle both acutely (days 1–28) and in the long term (days 70 and 98), whereas the galanin to PGP9.5 ratio was significantly increased in the mucosa throughout the study. Low‐grade chronic inflammation after an acute initial insult causes a persistent increase in the expression of galanin in the mucosa and SP in muscle layer.
Distribution of interstitial cells of Cajal and nitrergic neurons in normal and diabetic human appendix
Authors: Miller S. M. , Narasimhan R. A. , Schmalz P. F. , Soffer E. E. , Walsh R. M. , Krishnamurthi V. , Pasricha P. J. , Szurszewski J. H. , Farrugia G.
Published: March 2008

Abstract  The objective of this study was to determine the distribution of enteric nerves and interstitial cells of Cajal (ICC) in the normal human appendix and in type 1 diabetes. Appendixes were collected from patients with type 1 diabetes and from non‐diabetic controls. Volumes of nerves and ICC were determined using 3‐D reconstruction and neuronal nitric oxide synthase (nNOS) expressing neurons were counted. Enteric ganglia were found in the myenteric plexus region and within the longitudinal muscle. ICC were found throughout the muscle layers. In diabetes, c‐Kit positive ICC volumes were significantly reduced as were nNOS expressing neurons. In conclusion, we describe the distribution of ICC and enteric nerves in health and in diabetes. The data also suggest that the human appendix, a readily available source of human tissue, may be useful model for the study of motility disorders.
Vagal dysfunction in irritable bowel syndrome assessed by rectal distension and baroreceptor sensitivity
Authors: Spaziani R. , Bayati A. , Redmond K. , Bajaj H. , Bienenstock J. , Collins S. M. , Kamath M. V.
Published: March 2008

Abstract  Autonomic nervous system dysfunction has been implicated in the pathophysiology of irritable bowel syndrome (IBS). This study characterized the autonomic response to rectal distension in IBS using baroreceptor sensitivity (BRS), a measure of autonomic function. Rectal bag pressure, discomfort, pain, ECG, blood pressure and BRS were continuously measured before, during and after rectal distension in 98 healthy volunteers (34 ± 12 years old, 52 females) and 39 IBS patients (39 ± 11 years old, 35 females). In comparison with the healthy volunteers, IBS patients experienced significantly more discomfort (69 ± 2.2% vs 56 ± 3.6%; P < 0.05), but not pain (9 ± 1.4% vs 6 ± 2.4%; ns) with rectal distension despite similar distension pressures (51 ± 1.4 vs 54 ± 2.4 mmHg; ns) and volumes (394 ± 10.9 vs 398 ± 21.5 mL; ns). With rectal distension, heart rate increased in both healthy volunteers (66 ± 1 to 71 ± 1 bpm; P < 0.05) and IBS patients (66 ± 2 to 74 ± 3 bpm; P < 0.05). Systolic blood pressure also increased in both healthy volunteers (121 ± 2 to 143 ± 2 mmHg; P < 0.05) and patients (126 ± 3 to 153 ± 4 mmHg (P < 0.05) as did diastolic blood pressure, 66 ± 2 to 80 ± 2 mmHg (P < 0.05), compared with 68 ± 3 to 84 ± 3 mmHg (P < 0.05) in IBS patients. The systolic blood pressure increase observed in IBS patients was greater than that seen in healthy volunteers and remained elevated in the post distension period (139 ± 3 mmHg vs 129 ± 2 mmHg; P < 0.05). IBS patients had lower BRS (7.85 ± 0.4 ms mmHg−1) compared with healthy volunteers (9.4 ± 0.3; P < 0.05) at rest and throughout rectal distension. Greater systolic blood pressure response to rectal distension and associated diminished BRS suggests a compromise of the autonomic nervous system in IBS patients.
The use of gastric electrical signals for algorithm for automatic eating detection in dogs
Authors: Aviv R. , Sanmiguel C. P. , Kliger A. , Policker S. , Haddad W. , Hagiike M. , Soffer E. E.
Published: March 2008

Abstract  Food ingestion increases fundic impedance (FI) and reduces antral slow wave rate (SWR).

Our aim was to determine if such changes can be integrated into an algorithm for automatic eating detection (AED). When incorporated in implantable medical devices, AED can time treatment to food intake without need for patient input.

Four dogs were implanted with fundic and antral electrodes, connected to an implantable recording device. Changes in FI and SWR induced by fixed meals of different weights were determined, and were used to build an AED algorithm. Its performance was then tested on the same animals given an ad libitum access to food. The effects of gastric balloon distension and nitroglycerin on SWR and FI were also tested.

Fixed meals reduced SWR in a weight‐dependant manner, R2 = 0.936, P < 0.05 baseline compared to 50, 100, 200 and 400 g. Meals increased FI above baseline in a weight‐dependant manner; R2 = 0.994, P < 0.05 baseline compared to 200 and 400 g. During ad libitum intake, the AED algorithm detected 86% of all meals ≥15 g. Gastric distension reduced SWR and increased FI. Nitroglycerin reduced SWR.

AED, using changes in FI and gastric SWR is feasible. Changes in FI and SWR are induced primarily by the presence of food in the stomach.
Cyclic vomiting syndrome in adults
Authors: Abell T. L. , Adams K. A. , Boles R. G. , Bousvaros A. , Chong S. K. F. , Fleisher D. R. , Hasler W. L. , Hyman P. E. , Issenman R. M. , Li B. U. K. , Linder S. L. , Mayer E. A. , Mccallum R. W. , Olden K. , Parkman H. P. , Rudolph C. D. , Taché Y. , Tarbell S. , Vakil N.
Published: March 2008

Abstract Cyclic vomiting syndrome (CVS) was initially described in children but can occur in all age groups. Cyclic vomiting syndrome is increasingly recognized in adults. However, the lack of awareness of CVS in adults has led to small numbers of diagnosed patients and a paucity of published data on the causes, diagnosis and management of CVS in adults. This article is a state‐of‐knowledge overview on CVS in adults and is intended to provide a framework for management and further investigations into CVS in adults.
Sweetened carbonated drinks do not alter upper digestive tract physiology in healthy subjects
Authors: Cuomo R. , Savarese M. F. , Sarnelli G. , Vollono G. , Rocco A. , Coccoli P. , Cirillo C. , Asciore L. , Nardone G. , Buyckx M.
Published: March 2008

Abstract  Sweetened carbonated beverages are widely consumed, which has fuelled several conflicting opinions about their effects on upper digestive tract functions. We aimed to evaluate the effect of sweetened carbonated drinks, consumed with a standard meal, on gastro‐oesophageal reflux, gastric emptying and gallbladder contraction and postmeal sensations in healthy subjects. Thirteen healthy volunteers (seven women, six males; median age 22 years) were tested following the intake of 300 mL sweetened water containing increasing concentrations of carbon dioxide (seven subjects), and of 300 mL sweetened commercial flavoured drink with and without carbon dioxide (six subjects). Gastro‐oesophageal reflux, gastric emptying and gallbladder contraction were studied by pH‐impedance, octanoic acid breath test and ultrasound respectively. Gastro‐oesophageal refluxes were significantly increased 1 h after meal with both water and commercial beverages; only sweetened water without carbon dioxide determined a persistently increasing number of refluxes 2 h postmeal. No differences were found for gastric emptying, gallbladder contraction or postmeal symptoms with any of the beverages tested. This study shows that 300 mL of sweetened carbonated beverage with different levels of carbonation or a commercial soft drink do not modify the physiology of the upper digestive tract.
Effects of bean rust (Uromyces appendiculatus) epidemics on host dynamics of common bean (Phaseolus vulgaris)
Authors: Mersha Z. , Hau B.
Published: March 2008

Epidemics of bean rust (Uromyces appendiculatus) and their effects on host dynamics of common bean (Phaseolus vulgaris) were studied in three controlled greenhouse experiments, with and without fungicide sprays, on two susceptible bean cultivars, Dufrix and Duplika. Bean plants were artificially inoculated with a suspension of 105 U. appendiculatus urediniospores mL−1 water and temporal disease progress, as well as host growth dynamics (leaf size and defoliation), were monitored on a leaflet basis in comparison with non‐inoculated plants, which were sprayed with deionized water. Progress curves of bean rust, expressed as the proportion of leaf area occupied by pustules (uredinia), or as the proportion occupied by total lesion area (= halo areas + pustule area), were well described by logistic functions with maximum disease levels clearly lower than 1. Bean rust epidemics substantially affected host growth by reducing the total leaf area formed by 17·4–35·6% and 35·3–46·2% compared with healthy plants for cvs Dufrix and Duplika, respectively. Fungicide sprays mitigated the negative effect of bean rust, leading to a gain in leaf area of 17–21% compared with unsprayed plants in both cultivars in two experiments, while in another experiment, disease control had no effect in Dufrix, but a clear effect in Duplika. In addition to the growth depression, bean rust also led to pronounced losses of leaf area as a result of reduced leaf size (leaf shrivelling) and accelerated defoliation.
Heritable variation and genetic correlation of quantitative traits within and between ecotypes ofAvena barbata
Authors: GARDNER K. M. , LATTA R. G.
Published: March 2008

We examined heritable variation for quantitative traits within and between naturally occurring mesic and xeric ecotypes of the slender wild oat (Avena barbata), and in 188 recombinant inbred lines derived from a cross between the ecotypes. We measured a suite of seedling and adult traits in the greenhouse, as well as performance‐related traits in field sites native to the two ecotypes. Although the ecotypes were genetically diverged for most traits, few traits showed significant heritable variation within either ecotype. In contrast, considerable heritable variation was released in the recombinant progeny of the cross, and transgressive segregation was apparent in all traits. Heritabilities were substantially greater in the greenhouse than in the field, and this was associated with an increase in environmental variance in the field, rather than a decrease in genetic variance. Strong genetic correlations were evident among the recombinants, such that 22 measured traits could be well represented by only seven underlying factors, which accounted for 80% of the total variation. The primary axis of variation in the greenhouse described a trade‐off between vegetative and reproductive allocation, mediated by the date of first flowering, and fitness was strongly correlated with this trade‐off. Other factors in the greenhouse described variation in size and in seedling traits. Lack of correlation among these factors represents the release of multivariate trait variation through recombination. In the field, a separate axis of variation in overall performance was found for each year/site combination. Performance was significantly correlated across field environments, but not significantly correlated between greenhouse and field.
Relationship between analytic values and canine obesity
Authors: Peña C. , Suárez L. , Bautista I. , Montoya J. A. , Juste M. C.
Published: March 2008

The objective of this study was to assess the relationship between canine body condition and metabolic parameters like serum lipids, blood glucose and alanine aminotransferase (ALT) concentrations. We selected 127 dogs (42 males and 85 females) that were taken to our veterinary medicine service during routine visits. The mean age was 6.67 ± 5.24 years. Body condition (BC) was measured by Laflamme scale and dogs were considered as obese when BC score was over 6. The following variables were collected: total cholesterol, high‐density lipoprotein cholesterol, triglycerides, basal glucose and ALT. 66.1% of the dog cohort were obese. Total cholesterol and triglycerides were found to be higher (p < 0.05) in obese dogs with respect to normal weight dogs. In conclusion, obesity in dogs is associated with higher serum lipid levels.
COLOUR IN THE DEVELOPMENT OF ISODOSE DOCUMENTATION AS A TRAINING PROCEDURE AND METHOD OF INTER‐DEPARTMENTAL COMMUNICATION
Authors: MOWATT KEITH S.
Published: March 2008

This paper was presented in the hope that our colleagues would give consideration to the adoption of some such method for interstate communication when patients are transferred from centre to centre. Subsequently a considerable amount of interest has been expressed by various departments, and it is felt that the most valuable contribution in terms of colour presentation would be to indicate some typical isodose diagrams that occur in our practice.

A colour code is suggested. In general practice we utilize green and blue for the colder levels of dosage, orange and red for the more adequate dosage and cross‐hatched areas for high level of dosage.
AN OXYGEN BAROTHERAPY APPARATUS FOR USE WITH THE 4MeV ACCELERATOR*
Authors: van den BRENK H. A. S.
Published: March 2008

A barotherapy apparatus manufactured by the Commonwealth Aircraft Corporation Pty. Ltd. for the Peter MacCallum Clinic, Melbourne has been described. It is designed to operate at pressures of 60 psi oxygen (or less) in conjunction with a 4MeV Linear Accelerator (Metropolitan Vickers). The apparatus provides the means of obtaining a uniformity in dosi‐metry of tumours to be treated comparable with conventional techniques. It provides simple and accurate planning and positioning of patients before treatment, also comparable to the conventional methods in use. Multifield treatments can be given without decompression and recompression of the patient. The occupation time in the accelerator room has been cut to a minimum and does not impose restrictions on the use of the accelerator for routine purposes.
Renal Medullary Necrosis
Authors: Ross Paul
Published: March 2008

Chronic medullary necrosis is a variant of chronic pyelonephritis. Many cases are associated with phenacetin abuse and some with diabetes. Obstruction is uncommon.

It is seen mainly in middle‐aged females.

The lesion is an ischaeniic infarct and as this distinctive, with formation of a ring shadow and later a cavity.

Most papillae of both kidneys ar usually involved. Concretions are frequent.

Most kidneys shrink and dye excretion 0n intravenous urography is diminished, both due to pyelonephritis.

The clinical features are mainly those of urinary tract infection and tend to parallel the urographic findings.

The disease tends to have a cyclic course with remissions but usually deterioration occurs.

Treatment is directed to any predisposing factors and to eliminating infection.
The Costeilo Memorial Lecture, 1966*
Authors: Begg A. C.
Published: March 2008

The life and work of Desmond Costello are surveyed briefly.

Attention is drawn to two valuable contributions to diagnostic radiology. One, the Valsalva experiment, is old; the other, neuroleptanalgesia, is new.

The history of the Valsalva, its radiological applications, and its particular importance in the examination of the arterial and venous systems are discussed. Some observations concerning the physiological and anatomical mechanisms of this phenomenon are illustrated.

The pharmacological basis of neuroleptanalgesia is discussed and a well‐tried and successful regime for its administration is presented. In use it has proved to be consistently safe and of great benefit to both the patient and the radiologist. Trying and painful procedures, such as encephalography, cause little upset and no unpleasant after‐effects. The patient remains conscious yet feels no pain, and can cooperate fully with the radiologist throughout the examination.
Neonatal Respiratory Difficulty*
Authors: Ryan James
Published: March 2008

The results of chest radiography in newborn children suffering from respiratory difficulty are given. Forty‐five of 150 examinations were positive for some abnormality, the most common of which was hyaline membrane disease.

The need for an adequate examination is stressed. Antero‐posterior and lateral films are essential.
The “Distorted Spoke” Sign of Malignant Gastric Ulceration
Authors: Kalokerinos James
Published: March 2008

A new term, “the distorted spoke sign”, is used to describe the mucosal folds of malignant gastric ulceration. The ends of the gastric folds near the edge of a malignant gastric ulcer may show one or more of the following appearances: sudden cut‐off, sudden tapering, swelling, erosion of one edge, or erosion of both edges.