bluuebunny/crossref_metadata_2025 huggingface dataset:
Population Structure of Potebniamyces pyri in the U.S. Pacific Northwest and Evidence of Outcrossing Inferred with Sequence-Characterized Amplified Region Markers
Authors: Liu Q. , Peever T. L. , Xiao C. L.
Published: April 2009

Potebniamyces pyri is the cause of Phacidiopycnis rot of d'Anjou pear, which is grown primarily in Washington and Oregon. To estimate the population structure of P. pyri, 146 single-spore isolates were sampled from five major pear-production areas and scored for variation at eight sequence-characterized amplified region (SCAR) loci. Significant genetic differentiation was detected among five subpopulations and a total of 54 multilocus genotypes were identified, with significant genotypic diversity in each subpopulation. No genotype was shared among more than three subpopulations. To estimate the relationship between phenotype and multilocus SCAR genotype, four to five representative isolates of each dominant SCAR genotype in each subpopulation were assayed for growth rate on oatmeal agar and virulence on d'Anjou pear fruit. Significant differences in daily growth rates and virulence were detected among genotypes; however, genotype was not predictive of virulence. To assess the mating system of the pathogen, 10 ascospores were sampled from each of 20 apothecia from a commercial orchard and scored for five SCAR markers. Segregation of alleles at one or more SCAR loci was detected among 18 of 20 ascospore progeny sets, indicating that P. pyri is likely a heterothallic fungus with a predominantly outcrossing mating system.
Cultural Methods and Environmental Conditions Affecting Gray Mold and Its Management in Lisianthus
Authors: Shpialter Lena , David Dalia Rav , Dori Irit , Yermiahu Uri , Pivonia Shimon , Levite Rahel , Elad Yigal
Published: April 2009

Gray mold, caused by Botrytis cinerea, severely affects the base of the stems of lisianthus (Eustoma grandiflorum) plants as well as the cut stems left after flowers are harvested. This study examined infection of lisianthus plants by B. cinerea under laboratory and commercial greenhouse production conditions typical for Israel and evaluated cultural methods for manipulating disease development in commercial greenhouses. Although the lower nodes of lisianthus stems are typically infected, in this study, the inherent susceptibility of these nodes was less than that of nodes midway up the stem. Greater light intensity (4,860 lux) was associated with significantly more severe stem wounds than lower light intensities of 140 to 1,020 lux. Lower light intensity (140 lux) was associated with significantly more severe leaf infection. The development of gray mold along leaves toward the stem was slower at 26°C than at 18 to 20°C and was fastest at relative humidity (RH) levels close to saturation (>99%). B. cinerea infection developed in all stem wounds exposed to 65 to 99% RH and at temperatures of 12 to 29°C. Infection severity in stem wounds (measured as lesion length) on whole plants was significantly less at 26°C than at 18 or 22°C, and was significantly higher at 99% RH compared with 70 to 85 and 85 to 95% RH. Severity of gray mold was the greatest at 15 to 22°C and 85 to 99% RH. Under commercial greenhouse conditions, supplemental calcium (Ca(NO3)2) applied in fertigation or as a spray led to moderate yet significant reduction in disease severity. In addition, polyethylene soil cover and the use of buried drip irrigation instead of surface drip irrigation suppressed gray mold significantly on cut stems following harvest. Covering the soil with polyethylene also suppressed gray mold significantly as compared with the common practice of growing lisianthus in bare soil.
Epiphytic Bacteria and Yeasts on Apple Blossoms and Their Potential as Antagonists of Erwinia amylovora
Authors: Pusey P. Lawrence , Stockwell Virginia O. , Mazzola Mark
Published: April 2009

Apple blossoms were sampled for indigenous epiphytic populations of culturable microorganisms during different stages of bloom at two locations in central Washington State and one site in Corvallis, OR. Frequencies and population sizes of bacteria on stigmas of apple were lower in Washington than at Corvallis, where average relative humidity was higher and possibly favored greater colonization; however, bacteria at Corvallis were mainly pseudomonads, whereas those in Washington were diverse, composed of several genera. In Washington, yeast as well as bacteria were isolated from both stigmatic and hypanthial surfaces. Sampled blossoms were processed immediately to assess microbial populations, or after a 24-h incubation at 28°C and high relative humidity, which broadened the range of detectable taxa evaluated as potential antagonists. Identifications were based on fatty acid methyl ester profiles and rDNA sequence analyses. Yeasts or yeastlike organisms were detected at frequencies similar to or greater than bacteria, particularly in hypanthia. When microbial isolates were tested for their capacity to suppress Erwinia amylovora on stigmas of detached crab apple flowers, many were ineffective. The best antagonists were the bacteria Pantoea agglomerans and Pseudomonas spp. and a few yeasts identified as Cryptococcus spp. Further evaluation of these taxa on flowers could lead to the discovery of additional biocontrol agents for fire blight.
Evidence that Prohexadione-Calcium Induces Structural Resistance to Fire Blight Infection
Authors: McGrath Molly J. , Koczan Jessica M. , Kennelly Megan M. , Sundin George W.
Published: April 2009

Mechanisms of fire blight control by the shoot-growth regulator prohexadione-calcium (ProCa) were investigated by comparing disease development in ProCa-treated potted apple trees (cv. Gala) to paclobutrazol (another shoot-growth regulator)-treated and nontreated trees and in ProCa-treated cv. McIntosh trees in the field. Twenty-eight days after inoculation with Erwinia amylovora Ea110, disease incidence on ProCa- and paclobutrazol-treated shoots was significantly reduced compared with that on nontreated shoots. Disease severity (percent shoot length infected) was also significantly lower on both ProCa- and paclobutrazol-treated shoots than on nontreated shoots. However, bacterial populations within inoculated shoots were high and bacterial growth occurred in all treatments. In addition, the mean cell wall width of the cortical parenchyma midvein tissue of the first and second youngest unfolded leaves of ProCa- and paclobutrazol-treated shoots was significantly wider both 0.5 and 2 cm from the leaf tips compared with the cell walls of the nontreated tissue. Taken together, these results suggest that reduction of fire blight symptoms by ProCa and paclobutrazol is not the result of reduced populations of E. amylovora in shoots. Moreover, because paclobutrazol also reduced disease severity and incidence, changes in flavonoid metabolism induced by ProCa but not paclobutrazol does not appear to be responsible for disease control as suggested in recent literature. Finally, although this study did not directly link disease control to the observed cell wall changes, the possibility that an increase in cell wall width impedes the spread of E. amylovora should be investigated in more depth.
Host Range and Genetic Relatedness of Colletotrichum acutatum Isolates from Fruit Crops and Leatherleaf Fern in Florida
Authors: MacKenzie S. J. , Peres N. A. , Barquero M. P. , Arauz L. F. , Timmer L. W.
Published: April 2009

Isolates of Colletotrichum acutatum were collected from anthracnose-affected strawberry, leatherleaf fern, and Key lime; ripe-rot-affected blueberry; and postbloom fruit drop (PFD)-affected sweet orange in Florida. Additional isolates from ripe-rot-affected blueberry were collected from Georgia and North Carolina and from anthracnose-affected leatherleaf fern in Costa Rica. Pathogenicity tests on blueberry and strawberry fruit; foliage of Key lime, leatherleaf fern, and strawberry; and citrus flowers showed that isolates were highly pathogenic to their host of origin. Isolates were not pathogenic on foliage of heterologous hosts; however, several nonhomologous isolates were mildly or moderately pathogenic to citrus flowers and blueberry isolates were pathogenic to strawberry fruit. Based on sequence data from the internal transcribed spacer (ITS)1-5.8S rRNA-ITS2 region of the rDNA repeat, the glutaraldehyde-3-phosphate dehydrogenase intron 2 (G3PD), and the glutamine synthase intron 2 (GS), isolates from the same host were identical or very similar to each other and distinct from those isolated from other hosts. Isolates from leatherleaf fern in Florida were the only exception. Among these isolates, there were two distinct G3PD and GS sequences that occurred in three of four possible combinations. Only one of these combinations occurred in Costa Rica. Although maximum parsimony trees constructed from genomic regions individually displayed little or no homoplasy, there was a lack of concordance among genealogies that was consistent with a history of recombination. This lack of concordance was particularly evident within a clade containing PFD, Key lime, and leatherleaf fern isolates. Overall, the data indicated that it is unlikely that a pathogenic strain from one of the hosts examined would move to another of these hosts and produce an epidemic.
Refining Surge Capacity: Conventional, Contingency, and Crisis Capacity
Authors: Hick John L. , Barbera Joseph A. , Kelen Gabor D.
Published: April 2009

Health care facility surge capacity has received significant planning attention recently, but there is no commonly accepted framework for detailed, phased surge capacity categorization and implementation. This article proposes a taxonomy within surge capacity of conventional capacity (implemented in major mass casualty incidents and representing care as usually provided at the institution), contingency capacity (using adaptations to medical care spaces, staffing constraints, and supply shortages without significant impact on delivered medical care), and crisis capacity (implemented in catastrophic situations with a significant impact on standard of care). Suggested measurements used to gauge a quantifiable component of surge capacity and adaptive strategies for staff and supply challenges are proposed. The use of refined definitions of surge capacity as it relates to space, staffing, and supply concerns during a mass casualty incident may aid phased implementation of surge capacity plans at health care facilities and enhance the consistency of terminology and data collection between facilities and regions. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S59–S67)
Creation of Surge Capacity by Early Discharge of Hospitalized Patients at Low Risk for Untoward Events
Authors: Kelen Gabor D. , McCarthy Melissa L. , Kraus Chadd K. , Ding Ru , Hsu Edbert B. , Li Guohua , Shahan Judy B. , Scheulen James J. , Green Gary B.
Published: April 2009

Objectives:US hospitals are expected to function without external aid for up to 96 hours during a disaster; however, concern exists that there is insufficient capacity in hospitals to absorb large numbers of acute casualties. The aim of the study was to determine the potential for creation of inpatient bed surge capacity from the early discharge (reverse triage) of hospital inpatients at low risk of untoward events for up to 96 hours.

Methods:In a health system with 3 capacity-constrained hospitals that are representative of US facilities (academic, teaching affiliate, community), a variety (N = 50) of inpatient units were prospectively canvassed in rotation using a blocked randomized design for 19 weeks ending in February 2006. Intensive care units (ICUs), nurseries, and pediatric units were excluded. Assuming a disaster occurred on the day of enrollment, patients who did not require any (previously defined) critical intervention for 4 days were deemed suitable for early discharge.

Results:Of 3491 patients, 44% did not require any critical intervention and were suitable for early discharge. Accounting for additional routine patient discharges, full use of staffed and unstaffed licensed beds, gross surge capacity was estimated at 77%, 95%, and 103% for the 3 hospitals. Factoring likely continuance of nonvictim emergency admissions, net surge capacity available for disaster victims was estimated at 66%, 71%, and 81%, respectively. Reverse triage made up the majority (50%, 55%, 59%) of surge beds. Most realized capacity was available within 24 to 48 hours.

Conclusions:Hospital surge capacity for standard inpatient beds may be greater than previously believed. Reverse triage, if appropriately harnessed, can be a major contributor to surge capacity. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S10–S16)
Correction for Moon, Robert Willis and Franz Reuleaux: pioneers in the theory of machines
Authors: Moon F. C.
Published: April 2009

Correction for ‘Robert Willis and Franz Reuleaux: pioneers in the theory of machines’ by F. C. Moon (Notes Rec. R. Soc. Lond.
57
, 209–230. (doi:
10.1098/rsnr.2003.0207
)).

p. 228. The legend to figure 11 should read as follows: Figure 11. Sketch by Willis of the front claw of a common crab. From R. Willis, Principles of mechanism, 2nd edn (London 1870).
Higher‐level phylogenetics of linyphiid spiders (Araneae, Linyphiidae) based on morphological and molecular evidence
Authors: Arnedo Miquel A. , Hormiga Gustavo , Scharff Nikolaj
Published: April 2009

This study infers the higher‐level cladistic relationships of linyphiid spiders from five genes (mitochondrial CO1, 16S; nuclear 28S, 18S, histone H3) and morphological data. In total, the character matrix includes 47 taxa: 35 linyphiids representing the currently used subfamilies of Linyphiidae (Stemonyphantinae, Mynogleninae, Erigoninae, and Linyphiinae (Micronetini plus Linyphiini)) and 12 outgroup species representing nine araneoid families (Pimoidae, Theridiidae, Nesticidae, Synotaxidae, Cyatholipidae, Mysmenidae, Theridiosomatidae, Tetragnathidae, and Araneidae). The morphological characters include those used in recent studies of linyphiid phylogenetics, covering both genitalic and somatic morphology. Different sequence alignments and analytical methods produce different cladistic hypotheses. Lack of congruence among different analyses is, in part, due to the shifting placement ofLabulla,Pityohyphantes,Notholepthyphantes, andPocobletus. Almost all combined analyses agree on the monophyly of linyphioids, Pimoidae, Linyphiidae, Erigoninae, Mynogleninae, as well asStemonyphantesas a basal lineage within Linyphiidae. Our results suggest independent origins of the desmitracheate tracheal system in micronetines and erigonines, and that erigonines were primitively haplotracheate. Cephalothoracic glandular specializations of erigonines and mynoglenines apparently evolved independently. Subocular sulci of mynoglenines and lateral sulci (e.g.Bathyphantes) evolved independently but glandular pores in the prosoma proliferated once. The contribution of different character partitions and their sensitivity to changes in traditional analytical parameters is explored and quantified.

 © The Willi Hennig Society 2009.
Interaction between superantigen and T‐cell receptor Vβ element determines levels of superantigen‐dependent cell‐mediated cytotoxicity of CD8+ T cells in induction and effector phases
Authors: Li Zhong‐Juan , Omoe Katsuhiko , Shinagawa Kunihiro , Yagi Junji , Imanishi Ken’ichi
Published: April 2009

Specific superantigens activate different T‐cell fractions with distinct TCR Vβ elements in association with MHC class II molecules and also induce SDCC against MHC class II+ target cells. In the present study, to determine whether the responsiveness of each CD8+ T‐cell fraction expressing a different TCR Vβ element is primarily determined by the TCR Vβ, we compared the levels of proliferation and SDCC in Vβ3+ and Vβ11+ T cells upon stimulation with SEA. Upon stimulation with SEAwt, the levels of proliferation were higher in Vβ3+ T cells than in Vβ11+ T cells. The levels of SDCC were also higher for the combination of Vβ3+ T cells and SEAwt than for the combination of Vβ11+ T cells and SEAwt during both the induction phase and the effector phase. In addition, upon stimulation with SEAm, the levels of proliferation were higher in Vβ11+ T cells than in Vβ3+ T cells. And then, the levels of SDCC were also higher for the combination of Vβ11+ T cells and SEAm than for the combination of Vβ3+ T cells and SEAm during both the induction phase and the effector phase. These results suggest that the SAG‐responsiveness of each CD8+ T‐cell fraction expressing a different TCR Vβ element is primarily determined by the interaction between the TCR Vβ element and the SAG.
Improved cellular immune response elicited by a ubiquitin‐fused ESAT‐6 DNA vaccine against Mycobacterium tuberculosis
Authors: Wang Qing‐min , Kang Lin , Wang Xiao‐hua
Published: April 2009

The present study evaluated the immune response elicited by a ubiquitin‐fused ESAT‐6 DNA vaccine against Mycobacterium tuberculosis. BALB/c mice were vaccinated with plasmid DNA encoding ESAT‐6 protein, ubiquitin‐fused ESAT‐6 DNA vaccine (UbGR‐ESAT‐6), pcDNA3‐ubiquitin and blank vector, respectively. ESAT‐6 DNA vaccine immunization induced a Thl‐polarized immune response. The production of Thl‐type cytokine (IFN‐γ) and proliferative T‐cell responses was enhanced significantly in mice immunized with UbGR‐ESAT‐6 fusion DNA vaccine, compared to non‐fusion DNA vaccine. This fusion DNA vaccine also resulted in an increased relative ratio of IgG2a to IgGl and the cytotoxicity of T cells. Thus, the present study demonstrated that the UbGR‐ESAT‐6 fusion DNA vaccine inoculation improved antigen‐specific cellular immune responses, which is helpful for protection against tuberculosis infection.
Ankylosing spondylitis: recent developments and anaesthetic implications
Authors: Woodward L. J. , Kam P. C. A.
Published: April 2009

Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway, cardiovascular and respiratory complications, and the medications used to reduce pain and control the disease. There is also an increased risk of neurological complications in the peri‐operative period. Awake fibreoptic intubation is the safest option in those patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a definitive airway. Neurophysiological monitoring (somatosensory and motor evoked potentials) should be considered in patients undergoing surgery for cervical spine deformity. The medical management of the disease has improved with the use of anti‐tumour necrosis factor‐α agents. There is potential for increased wound infection in patients taking these drugs. This article reviews the anaesthetic issues in patients with ankylosing spondylitis. The challenge to the anaesthetist is in the understanding of these issues so that appropriate management can be planned and undertaken.
Tracheal intubation and alternative airway management devices used by healthcare professionals with different level of pre‐existing skills: a manikin study*
Authors: Wahlen B. M. , Roewer N. , Lange M. , Kranke P.
Published: April 2009

The classic Laryngeal Mask Airway (cLMA™), ProSeal Laryngeal Mask Airway (PLMA™), Intubating Laryngeal Mask Airway™ (ILMA™), Combitube (CT™), Laryngeal Tube (LT™) and tracheal intubation (TI) were compared in a manikin study. Nurses, anaesthetic nurses, paramedics, physicians and anaesthetists inserted the devices three times in a randomised sequence. Time taken for successful insertion, success rates and ease of insertion were evaluated. Anaesthetists performed tracheal intubation significantly faster than other healthcare professionals (p < 0.05). Insertion times for the cLMA, PLMA, LT and CT were not significantly different between the groups. Insertion of the CT, ILMA and TI was associated with a significant learning effect in all groups. This was not observed with the cLMA, PLMA or LT. All non‐anaesthetists were able to insert the cLMA, PLMA and LT within two attempts with a > 90% success rate on the first attempt. The ILMA and TI were the only devices where more than one subject experienced some difficulty in insertion. The cLMA, PLMA and LT should be evaluated for use in situations where only limited airway training is possible.
Effect of nasal cannula oxygen administration on oxygen concentration at facial and adjacent landmarks
Authors: Orhan‐Sungur M. , Komatsu R. , Sherman A. , Jones L. , Walsh D. , Sessler D. I.
Published: April 2009

An oxygen‐enriched atmosphere enhances the potential for operating‐room fires. We thus determined oxygen concentrations at various facial landmarks during oxygen administration via nasal cannulae. Thirteen supine volunteers were draped similarly to patients undergoing a cervical‐node biopsy. Oxygen was delivered in random order through nasal cannulae at rates of 2, 4, and 6 l.min−1. Oxygen concentration was measured at pre‐determined facial landmarks and also distal to the drape at non‐facial sites. At a flow of 2 l.min−1, oxygen concentrations exceeded 23% only within a few centimetres of the nasal cannula. Concentration increased as a function of flow, but rarely exceeded 26%. At all flow rates, concentrations distal to the drape were < 24%. To reduce combustion risk, ignition sources should be kept at least 10 cm from the oxygen outlet when using nasal cannula at a flow rate ≥ 4 l.min−1.
Hypertension and intra‐operative incidents: a multicentre study of 125 000 surgical procedures in Swiss hospitals*
Authors: Beyer K. , Taffé P. , Halfon P. , Pittet V. , Pichard S. , Haller G. , Burnand B. ,   for the ADS study Group
Published: April 2009

It is debated whether chronic hypertension increases the risk of cardiovascular incidents during anaesthesia. We studied all elective surgical operations performed in adults under general or regional anaesthesia between 2000 and 2004, in 24 hospitals collecting computerised clinical data on all anaesthetics since 1996. The focus was on cardiovascular incidents, though other anaesthesia‐related incidents were also evaluated. Among 124 939 interventions, 27 881 (22%) were performed in hypertensive patients. At least one cardiovascular incident occurred in 7549 interventions (6% (95% CI 5.9–6.2%)). The average adjusted odds ratio of cardiovascular risk for chronic hypertension was 1.38 (95% CI 1.27–1.49). However, across hospitals, adjusted odd ratios varied from 0.41 up to 2.25. Hypertension did not increase the risk of other incidents. Hypertensive patients are still at risk of intra‐operative cardiovascular incidents, while risk heterogeneity across hospitals, despite taking account of casemix and hospital characteristics, suggests variations in anaesthetic practices.
Evaluation of the LMA Supreme™ in 100 non‐paralysed patients*
Authors: Cook T. M. , Gatward J. J. , Handel J. , Hardy R. , Thompson C. , Srivastava R , Clarke P. A.
Published: April 2009

We studied the LMA Supreme™ in 100 elective, anaesthetised, healthy patients assessing: ease of use, airway quality, anatomical and functional positioning, airway leak and complications. Insertion was successful on first, second or third attempt in 90, nine and one patient respectively. Thirty manipulations were required in 22 patients to achieve a clear airway. Median [interquartile (range)] insertion time was 18 [10–25 (5–120)] s. During ventilation, an expired tidal volume of 7 ml.kg−1 was achieved in all patients. Median [interquartile (range)] airway leak pressure was 24 [20–28 (13–40)] cmH2O. On fibreoptic examination via the device, vocal cords were visible in 83 patients (85%). During maintenance, five patients (5%) required 13 airway manipulations. There was one episode of minor regurgitation, without aspiration. Other complications and patient side‐effects were mild and few. The LMA Supreme is easily and rapidly inserted, providing a reliable airway and good airway seal. Further studies are indicated to assess safety and performance compared to other supraglottic airway devices.
Myocardial infarction associated with the administration of intravenous ephedrine and metaraminol for spinal‐induced hypotension
Authors: Khavandi A. , Gatward J. J. , Whitaker J. , Walker P.
Published: April 2009

A 31‐year‐old female with no risk factors for cardiac disease suffered a peri‐operative myocardial infarction during an elective gynaecological procedure under spinal anaesthesia. The timing and nature of cardiac symptoms suggest that the myocardial infarction was caused by coronary artery vasospasm secondary to ephedrine and/or metaraminol, which were administered to treat spinal‐induced hypotension. We review the recent literature and case reports on myocardial infarction attributed to sympathomimetic drugs, and recommend the use of sublingual or intravenous nitrates when signs or symptoms of coronary arterial vasospasm become evident during their use.
Risk index for peri‐operative atrial fibrillation in patients undergoing open intracranial neurosurgical procedures
Authors: Bilotta F. , Pizzichetta F. , Fiorani L. , Paoloni F. P. , Delfini R. , Rosa G.
Published: April 2009

The aim of this prospective study was to determine the prevalence of pre‐operative atrial fibrillation and the incidence of postoperative atrial fibrillation in patients undergoing elective or emergency intracranial neurosurgical procedures and the relation to survival and neurological outcome at 6‐months follow‐up compared to patients with sinus rhythm. A total of 2020 patients were enrolled; 1540 patients underwent elective procedures and 480 underwent emergency procedures. Prevalence of pre‐operative atrial fibrillation was 3.7% in elective and 7.2% in emergency procedures (p = 0.0012). In patients undergoing elective cerebral procedures with pre‐operative atrial fibrillation, compared to patients with sinus rhythm, 6‐month neurological outcome and survival rate are similar. In patients undergoing emergency neurosurgical cerebral procedures, the presence of pre‐operative atrial fibrillation is related to an increased risk of poor neurological outcome but with similar survival rate.
Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?
Authors: Morris C. , Perris A. , Klein J. , Mahoney P.
Published: April 2009

In rapid sequence induction of anaesthesia in the emergency setting in shocked or hypotensive patients (e.g. ruptured abdominal aortic aneurysm, polytrauma or septic shock), prior resuscitation is often suboptimal and comorbidities (particularly cardiovascular) may be extensive. The induction agents with the most favourable pharmacological properties conferring haemodynamic stability appear to be ketamine and etomidate. However, etomidate has been withdrawn from use in some countries and impairs steroidogenesis. Ketamine has been traditionally contra‐indicated in the presence of brain injury, but we argue in this review that any adverse effects of the drug on intracranial pressure or cerebral blood flow are in fact attenuated or reversed by controlled ventilation, subsequent anaesthesia and the greater general haemodynamic stability conferred by the drug. Ketamine represents a very rational choice for rapid sequence induction in haemodynamically compromised patients.
Causes for cancellation of elective surgical procedures in a Spanish general hospital
Authors: González‐Arévalo A. , Gómez‐Arnau J. I. , DelaCruz F. J. , Marzal J. M. , Ramírez S. , Corral E. M. , García‐del‐Valle S.
Published: April 2009

Cancellation of scheduled surgery is undesirable for patients and an inefficient use of resources. We prospectively collected data for 52 consecutive months in a public general hospital to estimate the prevalence and causes. The overall cancellation rate was 6.5% (2559 of 39 115 scheduled operations). Cancellation by broad category was for ‘medical reasons’ in 50%, ‘patient‐related factors’ in 23%, and due to ‘administrative/logistic problems’ in 25%. The commonest specific causes within these categories were respectively: infections/fever (18%), patient did not attend (20%) and lack of theatre time (23%). This data will help direct resources to target prevention of cancellations as a result of these main problems.
Acquired hypernatraemia is an independent predictor of mortality in critically ill patients
Authors: O’Donoghue S. D. , Dulhunty J. M. , Bandeshe H. K. , Senthuran S. , Gowardman J. R.
Published: April 2009

This study reports the incidence and associated mortality of acquired hypernatraemia (Na > 150 mmol.l−1) in a general medical/surgical intensive care unit. Patients admitted over a 5‐year period with normal sodium values were eligible for inclusion; exclusions were made for burn/neurosurgical diagnoses and for hypertonic saline therapy. From 3475 admissions (3317 patients), 266 (7.7%) episodes of hypernatraemia were observed. Hospital mortality was 33.5% in the hypernatraemic group and 7.7% in the normonatraemic group (p < 0.001). Acquired hypernatraemia was an independent risk factor for in‐hospital mortality (OR 1.97, 95% CI 1.37–2.82, p < 0.001). Intermediate sodium levels (145–150 mmol.l−1) were associated with increased mortality (OR 1.42, 95% CI 1.02–1.98). Uncorrected sodium at discharge (p = 0.001) and peak sodium (p = 0.001) were better predictors of mortality than time to onset (p = 0.71) and duration of hypernatraemia (p = 1.0). Hypernatraemia avoidance is justified, but determinants of hypernatraemia and benefits of targeted treatment strategies require further elucidation.
Shear-wave splitting around the Eifel hotspot: evidence for a mantle upwelling
Authors: Walker K. T. , Bokelmann G. H. R. , Klemperer S. L. , Bock G.
Published: April 2009

We present the results of a shear-wave splitting analysis across the Eifel hotspot in west-central Europe. Our data set includes 18 permanent European broadband stations and 102 temporary Eifel broadband and short-period stations. We observe variations in splitting at most permanent stations, but are not able to model them reliably with unique dipping-axis or two-layer anisotropy models. We prefer instead a single-layer model with a horizontal fast axis to approximate the first-order anisotropy, which varies smoothly between stations. We observe a first-order parabolic pattern in fast polarization azimuth around the hotspot, which suggests that a lattice preferred orientation (LPO) of olivine fast axes exists in the asthenosphere as a result of the interaction between the slowly WSW-moving Eurasian plate and a mantle upwelling beneath the Eifel volcanic fields. The minority of the variation not explained by this model correlates with rapid lateral changes in splitting, and is interpreted as a result of additional anisotropy and/or the effects of dynamic recrystallization associated with LPO development in the region of corner flow near the conduit. Our parabolic asthenospheric flow (PAF) interpretation is consistent with Eifel geological, tomographic, receiver function, global absolute plate motion, electrical conductivity anisotropy, and geochemical studies, as well as with splitting studies in the Great Basin and around Hawaii.We suggest that the Eifel upwelling is sporadic, and a result of a low excess upwelling temperature and/or varying crustal stresses that periodically shift and facilitate eruption. The PAF pattern we observe neither suggests nor rules out anisotropy in the conduit associated with a wet Eifel upwelling.We use our optimum PAF model parameters to calculate a Eurasian plate speed of 12 km Ma−1, which is consistent with the recent HS3-NUVEL1A speed of 19 ± 14 km Ma−1.
Seismic tomography of the Tongariro Volcanic Centre, New Zealand
Authors: Rowlands D. P. , White R. S. , Haines A. J.
Published: April 2009

Tomographic inversion of local earthquake P- and S-wave traveltime data is used to investigate 3-D P-wave velocity (Vp) and P-wave/S-wave velocity ratio (Vp/Vs) variations at the Tongariro Volcanic Centre (TgVC), New Zealand. P-wave model resolution is generally high throughout the TgVC at depths of around 3–9 km below sea level. Near-surface resolution is lower since rays at shallow depths are predominantly subparallel. Resolution decreases below 12 km depth due to clustering of seismicity at greater depths. The final 3-D Vp model shows low-velocity volumes from 3 to 7 and 8 km depth, respectively beneath the active volcanoes Ruapehu and Ngauruhoe. Smaller low-velocity volumes are observed beneath the active Tongariro volcano and the extinct Tama Lakes vents. Synthetic tests indicate that the resolution of the 3-D Vp/Vs model is insufficient to permit any reliable interpretation.

Accurate earthquake depths are determined for the first time within the TgVC. Seismicity is largely restricted to two clusters west of Ruapehu, possibly with origins on eastward striking branches of the normal Raurimu Fault, two lineations near Waiouru in the south-east of the study area and a fault belt between Tongariro and Lake Taupo in the north of the study area.

Earthquake depths indicate possible shallowing of the brittle-ductile transition beneath Ruapehu and Ngauruhoe.
Revisiting the cost‐effectiveness of primary prophylaxis with clotting factor for the treatment of severe haemophilia A
Authors: MINERS A.
Published: April 2009

Summary. Severe haemophilia A is a lifelong condition that requires treatment with exogenous clotting factor. While primary prophylaxis is the clinically preferred method of delivering treatment, its provision is costly. A 2002 evaluation of primary prophylaxis suggested an incremental cost‐effectiveness of approximately £50 000 per additional quality‐adjusted life‐year (QALY). However, since this time, preferable evaluative methods have been developed and means of assessing the value of future research also now exist. Thus, the primary aims of this study were to update a previously published cost‐effectiveness analysis of primary prophylaxis vs. treating on‐demand in terms of methods and to estimate the value of undertaking further primary research. The base case incremental cost‐effectiveness ratio was shown to be approximately £37 000, £10 000 lower than the value published in 2002. The main reason for this difference was the use of different structural assumptions and methods to fit the various model parameters. At a willingness to pay per additional QALY threshold of £30 000, the probability prophylaxis is cost‐effective was 13%. However, this increased to over 90% when alternative structural assumptions were employed, such as the rate at which future QALYs are discounted. The value of further research to increase the precision of this newly calculated cost‐effectiveness estimate was high at a threshold willingness to pay values of £30 000–£40 000 per QALY, particularly for the utilities associated with the health states. Thus, there is considerable value in conducting further primary research related to economic aspects of primary prophylaxis.
Treatment of ischaemic heart disease in haemophilia patients: an institutional guideline
Authors: SCHUTGENS R. E. G. , TUINENBURG A. , ROOSENDAAL G. , GUYOMI S. Hoseyni , MAUSER‐BUNSCHOTEN E. P.
Published: April 2009

Summary.  Since the introduction of clotting factor concentrates, life expectancy of haemophilia patients is increasing and now approaches that of the general male population. Increasingly, haemophilia patients are confronted with age‐related co‐morbidity, including ischaemic cardiovascular disease. Treatment of stable angina pectoris and the acute coronary syndrome with antithrombotic therapy and percutaneous coronary intervention in haemophilia patients is feasible, but requires a tight co‐operation between all specialists involved. As evidence‐based guidelines are lacking, we developed a protocol on how we will treat haemophilia patients with ischaemic heart disease.
Bleeding symptoms and laboratory correlation in patients with severe von Willebrand disease
Authors: METJIAN A. D. , WANG C. , SOOD S. L. , CUKER A. , PETERSON S. M. , SOUCIE J. M. , KONKLE B. A. ,   THE HTCN STUDY INVESTIGATORS
Published: April 2009

Summary.  Type 3 von Willebrand disease (VWD) is a rare bleeding disorder with markedly decreased or absent von Willebrand factor (VWF) protein, accompanied by a parallel decrease in VWF function and factor VIII (FVIII) activity. The goal of this study was to describe the population of patients enrolled in the USA Centers for Disease Control Universal Data Collection (UDC) study with type 3 VWD, defined as a VWF:Ag of <10%, and to correlate bleeding symptoms with VWF and FVIII levels. Data on 150 patients were analysed. Almost all patients experienced bleeding episodes (98%) and required blood and/or factor product treatment (92%). While oral mucosal bleeding (the site of first bleed in 54%) was most common, subsequent muscle and joint bleeds were also seen (28%, 45%, respectively), and intracranial haemorrhage occurred in 8% of individuals. Mean age of first bleed was lower in those with either a FVIII ≤5% or a VWF:Ag <1%. Univariate marginal model analysis showed lower levels of FVIII and VWF:Ag both predicted a higher risk of joint bleeding. Longitudinal multivariate analysis found a lower FVIII level (P = 0.03), increasing age (P < 0.0001), history of joint bleeding (P = 0.001), higher body mass index (BMI) (P < 0.0001), and use of home infusion (P = 0.02) were all negatively associated with joint mobility. Low levels of VWF:Ag (P = 0.003) and male sex (P = 0.007) were also negatively associated with joint function. This study documents the strong bleeding phenotype in severe VWD and provides data to help target therapy, including prophylaxis, for patients most at risk of bleeding complications.
Survival in a cohort of patients with haemophilia at the haemophilia care center in Vienna, Austria, from 1983 to 2006
Authors: REITTER S. , WALDHOER T. , VUTUC C. , LECHNER K. , PABINGER I.
Published: April 2009

Summary. Survival of patients with haemophilia is still a relevant issue of great interest. A survival analysis was conducted among 226 patients with haemophilia A and B (128 severe haemophiliacs), who were treated at the haemophilia care centre in Vienna. Information on mortality in our patient cohort was obtained from the Austrian Central Death Register. Overall, 96 of a total of 226 patients (42.5%) died between 1983 and 2006; 37 patients (38.5%) died due to HIV‐infection, 15 due to HCV infection, 15 due to bleeding (15.6%, respectively) and 29 (30.2%) due to various other causes. The mortality of HIV‐positive patients was 74.3% (n = 55) and that of HCV‐positive patients was 40.4% (n = 55) in the analysed period. The patient mortality rates were compared with those of the general Austrian male population following adjustment for age and calendar period. We found that the cumulative relative survival of all patients was 0.694 (95% CI 0.614–0.767). The cumulative relative survival of patients with severe haemophilia (FVIII or IX level ≤1%) was 0.489 (0.394–0.579), but was normal (0.986; 95% CI 0.858–1.082) for patients with mild or moderate haemophilia (FVIII or IX level 2–50%). The survival rate was lowest in HIV‐positive patients (0.287; 95% CI 0.186–0.398), but was also decreased to 0.874 (0.776–0.951) in HIV‐negative patients. It can, therefore, be concluded that the survival of patients with severe haemophilia is still decreased compared to those with non‐severe haemophilia and the general male population, regardless of HIV‐infection.
Clinical trials and haemophilia: does the Bayesian approach make the ideal and desirable good friends?
Authors: IORIO A. , MARCUCCI M.
Published: April 2009

Summary.  When the disease is rare and/or the outcome is uncommon the trial design does not warrant precise and unbiased estimates due to a lack of power or the expected length of recruitment and observation periods. Is there any reliable method to control for bias and consequently achieve an advantage from estimates generated by different study designs? An interesting statistical approach suitable to solve this problem has been theorized by Thomas Bayes. A Bayesian analysis is aimed at answering the question ‘How this trial will modify our belief about that treatment effect?’ In summary, the Bayesian approach can be defined as the explicit and quantitative use of any kind of external evidence in the design, analysis, and interpretation of an experimental trial. The results of a Bayesian analysis is the 95% credible interval in which we believe the estimate to lie with a probability of 95%, or the estimate of the probability that the quantity of interest is less than a specific value. The principal advantages of the Bayesian approach are that it allows to directly make probability statements about quantities of interest; it allows to easily make predictive statements, conditional on the current state of knowledge; it enables evidence from a variety of sources to be taken into account within a coherent modelling framework; it requires the investigator to explicit prior beliefs and demands. Exemplifications of the advantages of the Bayesian approach will be given discussing some papers published in Haemophilia.
Space maintenance
Authors: LAING EMMA , ASHLEY PAUL , NAINI FARHAD B. , GILL DALJIT S.
Published: April 2009

Objective.  The use of a space maintainer appliance, or restoration of a carious primary tooth that can then act as a natural space maintainer, may potentially obviate the consequences of loss of arch length and the need for complex orthodontic treatment at a later stage. Nevertheless, all space maintainer appliances are plaque retentive and may predispose to dental caries and gingival inflammation. Space maintainer appliances may also impinge on the soft tissues, interfere with eruption of adjacent teeth, fracture, and become dislodged or lost. This review article provides a summary of the available evidence, and considers the indications for space maintenance.

Methods.  Medline and Ovid Medline were scanned, and additionally a hand‐search of non‐listed peer‐reviewed papers written in English was performed. A total of 16 pertinent papers published between 1987 and 2007 that satisfied the inclusion criteria were selected for discussion.

Conclusions.  There is limited evidence to recommend either for or against the use of space maintainers to prevent or reduce the severity of malocclusion in the permanent dentition. Decisions regarding the use of space maintainers should be guided by balancing the occlusal disturbance that may result if one is not used against the potential plaque accumulation and caries that the appliance may cause.
Has urbanization become a risk factor for dental caries in Kerala, India: a cross‐sectional study of children aged 6 and 12 years
Authors: CHRISTIAN BRADLEY , EVANS R. WENDELL
Published: April 2009

Objectives.  The objectives of this study were to: (i) test the hypothesis that urbanization is a risk factor for dental caries in children aged 6 and 12 years in Kollam, Kerala; and (ii) identify other possible risk factors for dental caries.

Methods.  A cross‐sectional study design was followed. The subjects were stratified by socio‐demographic status into urban middle class, urban poor, and rural poor. Caries experience was measured by visual examination of teeth according to the World Health Organization criteria. Data on potential risk factors were collected using a close‐ended, structured, and interviewer‐administered questionnaire. Data modelling was conducted using logistic regression analyses.

Results.  Eight hundred seventy‐six children were examined; 53% of 6‐year‐olds and 90% of 12‐year‐olds examined were caries free. The caries experience rates were 1.40 decayed, missing, or filled primary teeth and 0.15 Decayed, Missing, and Filled Teeth (DMFT) for the 6‐ and 12‐year‐olds, respectively. Urban children did not have a higher caries experience compared with rural children. The only risk factor associated with a significant difference in DMFT scores was the dental visiting pattern. Children who visited the dentist had a significantly higher mean DMFT score (P = 0.009).

Conclusion.  There was no evidence that urbanization is a risk factor for dental caries in Kerala. Dental caries experience was low, against any standard, in Kollam. Risk factors for caries were not identified.
Evidence‐based practice‐focused interactive teaching strategy: a controlled study
Authors: Kim Son C. , Brown Caroline E. , Fields Willa , Stichler Jaynelle F.
Published: April 2009

Title.  Evidence‐based practice‐focused interactive teaching strategy: a controlled study.

Aim.  This paper is a report of a study to evaluate the effectiveness of the evidence‐based practice (EBP)‐focused interactive teaching (E‐FIT) strategy.

Background.  Although EBP is a mandatory competency for all healthcare professionals, little is known about the effectiveness of E‐FIT in nursing.

Methods.  A quasi‐experimental, controlled, pre‐ and post‐test study involving senior, 4th‐year nursing students (N = 208) at two nursing schools in the USA was carried out from August 2007 to May 2008. The experimental group (n = 88) received the E‐FIT strategy intervention and the control group (n = 120) received standard teaching. A Knowledge, Attitudes and Behaviors Questionnaire for Evidence‐Based Practice was used to assess the effectiveness of the E‐FIT strategy.

Results.  Independent t‐tests showed that the experimental group had statistically significant higher post‐test Evidence‐Based Practice Knowledge (mean difference = 0·25; P = 0·001) and Evidence‐Based Practice Use (mean difference = 0·26; P = 0·015) subscale scores compared to the control group, but showed no statistically significant differences in Attitudes toward Evidence‐Based Practice and Future Use of Evidence‐Based Practice (mean difference = −0·12; P = 0·398 and mean difference = 0·13; P = 0·255 respectively). Hierarchical multiple regression analyses of the post‐test data indicated that the intervention explained 7·6% and 5·1% of variance in Evidence‐Based Practice Knowledge and Evidence‐Based Practice Use respectively.

Conclusion.  The EBP‐focused interactive teaching strategy was effective in improving the knowledge and use of EBP among nursing students but not attitudes toward or future use of EBP.
Smoking‐cessation therapy using varenicline: the cost‐utility of an additional 12‐week course of varenicline for the maintenance of smoking abstinence
Authors: Bolin Kristian , Mörk Ann‐Christin , Wilson Koo
Published: April 2009

Study objectives  To evaluate the cost‐effectiveness of an additional 12‐week treatment with varenicline for abstainers who had successfully completed an initial 12‐week treatment.

Design  The Benefits of Smoking Cessation on Outcomes simulation model was used to simulate both direct and indirect effects of smoking cessation. All calculations were performed in 2003 Swedish prices.

Setting  Sweden in 2003.

Patients or participants  The modelled cohort consisted of 25% of adult smokers motivated to quit smoking (168 844 males and 208 737 females). The age and sex distributions of the cohort reflect that of the Swedish population in 2003.

Interventions  Smokers who had achieved abstinence for at least 7 days following 12‐week open‐label treatment with varenicline were randomized to receive an additional 12‐week treatment with either varenicline or placebo.

Measurements and results  The incremental costs per quality‐adjusted life‐year (QALY) gained, for abstainers who received an additional 12‐week varenicline treatment compared with only 12 weeks, were €7066 for men and €7108 for women, over a 50‐year time horizon. (1€ ≈ SEK 9.12). These estimates excluded indirect effects on production and consumption of increased survival. The corresponding incremental costs per QALY including indirect effects were €24 149 and €24 436, respectively. Sensitivity analysis indicated that the estimated cost‐utility ratios are robust, but relatively sensitive to treatment efficiency and intervention costs.

Conclusions  An additional 12‐week course of varenicline treatment, provided to abstainers after an initial 12‐week treatment, produces relatively low incremental cost‐utility ratios in the spectrum of life‐saving medical treatments.