bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and clinical relevance of specific immunoglobulin E to pollen caused by sting‐ induced specific immunoglobulin E to cross‐reacting carbohydrate determinants in Hymenoptera venoms
Authors: Kochuyt A.‐M. , Van Hoeyveld E. M. , Stevens E. A. M.
Published: April 2005

Background
Hymenoptera stings can induce specific IgE (sIgE) to carbohydrate determinants (CD) on venom glycoproteins that cross‐react with CD in pollen. sIgE to such cross‐reacting CD (CCD) are believed to have little or no biological activity and thus may cause misdiagnosis of pollen sensitization after a sting.

Objective
To determine the prevalence of multiple false positive CAP results to pollen because of sting induced anti‐CCD sIgE in Hymenoptera venom (HV) allergic patients and to investigate the association of such anti‐CCD sIgE with features of ‘atopy’.

Methods
Skin prick tests (SPT) and CAP tests with grass, tree and weed pollen and with house dust mite (HDM) were carried out prospectively in 259 HV allergic patients and CAP tests with honeybee (HBV) and yellow jacket (YJV) venom were performed. Patients with negative pollen SPT associated with positive CAP tests to all three pollen groups were operationally defined as ‘CCD positive’. We investigated in selected ‘CCD positive’ patients the presence of anti‐CCD sIgE by CAP tests with bromelain and studied the identity of CD in HVs and pollen by mutual sIgE inhibition tests with CD from proteinase treated HBV (HBV‐CD) and Lolium perenne (Lol‐CD) extracts.

Results
sIgE to all three pollen groups without positive SPT or history was found in 16% of 259 patients. The presence of anti‐CCD sIgE was substantiated by positive CAP tests with bromelain in 14/14 and by inhibition of all pollen CAP tests with HBV‐CD in 8/9 and with Lol‐CD in 2/2 patients. Double venom (DV) positive CAP tests were present in 93% of ‘CCD positive’ patients and were in some associated with DV skin test positivity and allergy. The prevalence of ‘CCD positivity’ was significantly higher among HBV (23%) than among YJV (11%) allergic patients, but was also unexpectedly high among those with DV allergy (47%). ‘CCD positive’ patients were younger, had a higher total IgE and more sIgE to HDM than ‘CCD negative’ patients.

Conclusion
We have shown that the risk in HV allergic patients for misdiagnosis of multivalent pollen sensitization is 16%, and we have confirmed that sting induced anti‐pollen sIgE are directed to similar CD in venoms and pollen. We found evidence that the recognition of CCD might be related to the ‘atopic’ trait. Importantly, a positive bromelain CAP test does not exclude clinical reactivity to both venoms in ‘CCD positive’ HV allergic patients.
Comparing Norwegian nurses’ and physicians’ perceptions of the needs of significant others in Intensive Care Units
Authors: Takman Christina , Severinsson Elisabeth
Published: April 2005

Aim and objectives.  To illuminate and compare the perceptions of registered nurses (n = 243) and physicians (n = 29) in medical and surgical ICUs for adults on the needs of significant others.

Background.  Previous studies have established the necessity for healthcare professionals in Intensive Care Units (ICUs) to identify and meet the needs of critically ill adult patients’ significant others.

Design.  A survey was conducted and data from the Critical Care Family Needs Inventory were analysed using descriptive and inferential statistics.

Results.  The findings revealed four factors: ‘attentiveness and assurance’, ‘taking care of themselves’, ‘involvement’, and ‘information and predictability’. Nurses scored higher than physicians on ‘attentiveness and assurance’. Nurses with experience of being a patient or a significant other in an ICU placed a higher value on ‘involvement’ compared with nurses without such experience, while physicians with such experience scored higher on ‘information and predictability’ compared with those without such experience. Older physicians and those with extensive professional and ICU experience had a low score on ‘involvement’, but scored higher on ‘information and predictability’ compared with physicians with less experience. Nurses with extensive ICU and professional experience also scored higher on ‘information and predictability’ than nurses with less experience. Women placed a higher value on each of the four factors than men.

Conclusion.  The study revealed variations in ICU professionals’ perceptions of significant others’ needs.

Relevance to clinical practice.  There is a need for nurses and physicians to acknowledge that varying perceptions on significant others needs could lead to different ways of conducting themselves in encounters with significant others in ICUs. There is also a risk that the patients’ significant others could be forced to adapt themselves to professionals’ different and perhaps contradictory perceptions of their needs in ICUs.
Breast self‐examination and breast awareness: a literature review
Authors: McCready Tracey , Littlewood Dot , Jenkinson Jane
Published: April 2005

Aim.  To explore the literature on breast self‐examination and breast awareness.

Objectives.  To clarify the confusion surrounding breast awareness and breast self‐examination. To critique the evidence for breast awareness as a health promotion tool.

Background.  Over 41 000 women are diagnosed with breast cancer each year in the United Kingdom. Compared with other European countries, women in England have poor survival prospects, for breast cancer, due in part to advanced disease at first presentation. In the United Kingdom, women are encouraged to be breast aware from the age of 18. However, the evidence suggests that women do not engage in breast awareness and are frightened and confused about their role in breast health promotion.

Methodology.  Four databases were used: Medline, Ebsco including CINAHL and Sociological Abstracts and the Cochrane Database of Systematic Reviews. The search terms ‘breast awareness’ and ‘breast self‐examination’ were used and combined with ‘breast cancer’, ‘breast screening’ and ‘health promotion’.

Conclusion.  The evidence on breast self‐examination is clear, there is no benefit to breast cancer mortality and results suggest that breast self‐examination may do more harm than good. Breast awareness provides women with some acknowledgement of the part they can play in being empowered to fight breast disease, not in terms of statistics used for mortality but on the qualitative effects of reductions in morbidity.

Relevance to clinical practice.  The Royal College of Nursing of The United Kingdom is actively encouraging all nurses to promote breast awareness along with clear guidelines for doing so. The United Kingdom National Health Service Cancer Plan: a plan for investment, a plan for reform, encourages preventive care, information giving, good communication as well as evidence‐based practice. In breast care this can reduce confusion for women and encourage empowerment in breast health promotion.
Working in long‐term care settings for older people with dementia: nurses’ aides
Authors: Sung Huei‐chuan , Chang Shu‐min , Tsai Chuan‐shoiu
Published: April 2005

Aim.  This paper reports a study exploring the reasons for continuing to work among nurse aides who cared for older people with dementia in long‐term care settings in Taiwan.

Background.  High nurse aide turnover has been a major problem for many managers of long‐tem care facilities in Taiwan. Most studies on nurse aide turnover have focused on the factors on why they left, but little is known about their reasons for continuing to work in long‐term care settings in Taiwan.

Methods.  A qualitative research design was used. Sixteen nurse aides were interviewed individually using a semi‐structured interview guide and content analysis was used to identify the major themes in the data.

Results.  Five major themes emerged from interview data: monetary needs, relationships with residents, working environment, training opportunities and gratification (listed in order of frequency of occurrence).

Conclusion.  Nurse aides face challenges in caring for the increased number of older people with cognitive impairment and it is important to assess their perspectives towards their work in the changing environment. The findings suggest that it is essential for nursing managers to assess nurse aides’ needs to increase job retention and to improve the quality of resident care in long‐term care settings.

Relevance to clinical practice.  Careful appraisal of prospective nurse aides’ attitudes, regular training programmes in dementia care, adequate staffing and equipment, performance‐based pay rises and subsidized training are practical retention strategies for these nurse aides.
Association of a novel high molecular weight, serine‐rich protein (SrpA) with fibril‐mediated adhesion of the oral biofilm bacterium Streptococcus cristatus
Authors: Handley P. S. , Correia F. F. , Russell K. , Rosan B. , DiRienzo J. M.
Published: April 2005

The surface of the oral plaque bacterium Streptococcus cristatus is decorated with a lateral tuft of fibrils. The fibrillar tuft functions in the adhesion of S. cristatus to heterologous bacterial species in the plaque biofilm. The tuft typically consists of a densely packed fringe of shorter fibrils 238 ± 19 nm long with longer, less abundant fibrils 403 ± 66 nm long projecting through the fringe of short fibrils. The two types of fibrils in the tufts of S. cristatus have been refractory to biochemical separation, complicating their characterization. A hexadecane partition assay was used to enrich for subpopulations of S. cristatus CR311 (type strain NCTC 12479) having distinct fibrillar morphotypes. Negative staining in the TEM revealed that cells of a hydrophobic subpopulation of S. cristatus (CR311var1) carried only the long fibrils (395 ± 32 nm). A hydrophilic subpopulation of S. cristatus (CR311var3) consisted of mixed morphotypes having no fibrils or remnant short fibrils (223 ± 49 nm). No long fibrils were observed on any cells in the CR311var3 subpopulation. The CR311var3 morphotype, unlike the wild‐type strain and CR311var1, was not able to form corncobs with either Corynebacterium matruchotii or Fusobacterium nucleatum. Variant CR311var3 did not express the novel gene srpA, which encodes a high molecular weight (321,882 Da) serine‐rich protein, SrpA. The SrpA protein contains two extensive repeat motifs of 17 and 71 amino acids and a gram‐positive cell wall anchor consensus sequence (LPNTG). The unusual properties of SrpA most closely resemble those of Fap1, the fimbrial‐associated adhesin protein of Streptococcus parasanguis. The association of long fibrils, high surface hydrophobicity, ability to form corncob formations, and expression of the srpA gene suggest that SrpA is a long fibril protein in S. cristatus.
Effect of khat chewing on 14 selected periodontal bacteria in sub‐ and supragingival plaque of a young male population
Authors: Al‐Hebshi N. N. , Skaug N.
Published: April 2005

Background/aims:  The habit of chewing khat (Catha edulis) for its amphetamine‐like effects is highly prevalent in Yemen and east Africa, and has expanded to Western countries. The purpose of this study was to estimate and compare the prevalence and levels of 14 periodontal bacteria in gingival plaque of khat chewers and khat nonchewers, as well as of khat chewing sides and khat nonchewing sides.

Methods:  A total of 408 sub‐ and supragingival plaque samples were collected from 51 young males (29 khat chewers and 22 khat nonchewers; age range 19–28 years) and analyzed using whole genomic DNA probes and checkerboard DNA–DNA hybridization. Clinical parameters were recorded for all teeth at six sites per tooth.

Results:  Streptococcus intermedius and Veillonella parvula were significantly more prevalent in the subgingival plaque of chewers, which also showed significantly higher levels of V. parvula and Eikenella corrodens. Similar results were found for the subgingival plaque of the chewing sides compared to the nonchewing sides. However, there was a significantly higher prevalence and higher levels of Tannerella forsythia in the subgingival plaque of the nonchewing sides. No significant differences were observed for the supragingival plaque between the two study groups. There was a significantly lower prevalence of Capnocytophaga gingivalis and Fusobacterium nucleatum in the khat chewing sides, and higher levels of V. parvula and Actinomyces israelii.

Conclusion:  The data suggest that khat chewing induces a microbial profile that is not incompatible with gingival health.
Stress and the periodontal diseases: growth responses of periodontal bacteria to Escherichia coli stress‐associated autoinducer and exogenous Fe
Authors: Roberts A. , Matthews J. B. , Socransky S. S. , Freestone P. P. E. , Williams P. H. , Chapple I. L. C.
Published: April 2005

Psychological stress is known to increase the circulating levels of the catecholamine hormones noradrenaline and adrenaline, which have been shown to influence the growth of a large number of bacterial species by acting in a siderophore‐like manner or by inducing the production of novel autoinducers of growth. As we have previously demonstrated that periodontal organisms display differing growth responses to noradrenaline and adrenaline, the aim of this study was to determine whether these growth effects were based upon either siderophore‐like or autoinducer mechanisms. Initial inocula of 43 microbial organisms normally found within the subgingival biofilm were established under anaerobic conditions (35°C). Each strain was re‐inoculated into a serum‐based minimal medium and growth was assessed by optical density (OD600nm) with test and control cultures performed in triplicate. Test cultures were supplemented with either 50 μm ferric nitrate or a previously described Escherichia coli autoinducer of growth. Significant growth effects for supplementation with ferric nitrate (13 species responding positively) and E. coli autoinducer (24 species responding positively) were observed, with differences in growth response within bacterial species and within microbial complexes. When data for all organisms were compared with published responses to catecholamines there were only weak correlations with Fe (r = 0.28) and E. coli autoinducer (r = 0.34) responses. However, large positive responses (> 25% increase) to free Fe and/or E. coli autoinducer were significantly more prevalent in the group of organisms (n = 12) known to exhibit similar responses to catecholamine hormones (P < 0.01; χ2 = 4.56). The results support the view that catecholamines may exert their effects on subgingival organisms by initiating autoinducer production, or simply by acting in a siderophore‐like manner, scavenging bound iron from the local environment. It is possible that autoinducer mechanisms may play an important role in the response of oral microorganisms to stress hormones, thereby contributing to the clinical course of stress‐associated periodontal diseases.
Effects of insect growth regulators on the hairy rose beetle, Tropinota squalida (Col., Scarabeidae)
Authors: Hussein H. M. , Dimetry N. , Zidan Z. , Iss‐hak R. R. , Sehnal F.
Published: April 2005

Abstract:  Saponin extract from alfalfa roots, azadirachtin from the neem seed oil, synthetic ecdysteroid agonist RH‐2485, and the juvenoid hydroprene disturb the development and reproduction of Tropinota squalida. Feeding beetles on diets containing 750 p.p.m. saponins, 7.5 p.p.m. RH‐2485, and 1.13 p.p.m. azadirachtin reduces their progeny from 51 second instar larvae per female to 24, 15, and 15 larvae, respectively. When the larvae of untreated adults are fed for 1 week on dung with 75 p.p.m. saponins, 50 p.p.m. RH‐2485, and 0.45 p.p.m. azadirachtin, the rate of adult emergence drops from 80% (controls) to 20, 0 and 13%, respectively. No adults emerge when the treatment is continued through the second and third larval instars. Two topical treatments of larvae with 0.2 μg hydroprene decrease the rate of adult emergence from 90 to 11%, and treatments with 2 μg prevent adult development in all insects. The observed effects warrant testing of azadirachtin, RH‐2485, and hydroprene in the field. Several types of their application for the control of T. squalida are suggested.
Gregarious development of the solitary endo‐parasitoid, Microplitis rufiventris in its habitual host, Spodoptera littoralis
Authors: Hegazi E. M. , Khafagi W. E.
Published: April 2005

Abstract:  Earlier research has shown that the koinobiont parasitoid, Microplitis rufiventris, attacks and can develop on early instars of Spodoptera littoralis larvae with preference to third instars. However, the present study was carried out using the newly moulted sixth instar larvae at two different temperatures (20 ± 1 and 27 ± 1°C) to study the developmental interaction between the parasitoid and the last instar host larvae. Parasitoid eggs laid in singly parasitized host larvae invariably died. As the number of parasitoid eggs/host larvae increased, the proportion of eggs that hatched and number of viable parasitoid larvae successfully reached to their final instar increased. The effect of superparasitization seems to be dose (no. of eggs + parasitoid factors)‐temperature‐dependent. The results demonstrate a kind of ‘Allee effect’ suggesting that superparasitized last instar S. littoralis larvae provide a better host environment than singly parasitized hosts for the parasitoid, M. rufiventris. This may be due to host's hormone and/or low dose of factors injected with parasitoid eggs. The supernumerary individuals of wasp larvae developed normally to the point of emergence but most did not successfully emerge from the host. The improvement of both hatchability and post‐embryonic development of parasitoid wasp was significantly (P < 0.01) greater at 20°C than at 27°C. The results of the present study are useful in understanding the evolution of life‐history strategies and host range in parasitic hymenoptera.
Analysis of genetic diversity among different geographical populations and determination of biotypes of Bemisia tabaci in China
Authors: Zhang L. P. , Zhang Y. J. , Zhang W. J. , Wu Q. J. , Xu B. Y. , Chu D.
Published: April 2005

Abstract:  Analysis of the genetic diversity among 27 different geographical populations of Bemisia tabaci and determination of biotypes of B. tabaci in China based on amplified fragment‐length polymorphism (AFLP) and the mitochondrial cytochrome oxidase I (mtDNA COI) gene sequences were conducted. In AFLP assay, the use of five primer combinations selected from 64 primer combinations allowed the identification of 229 polymorphic bands (97.03%) from 60 to 500 bp, suggesting abundant genetic diversity among different geographical populations of B. tabaci. To further identify biotypes of B. tabaci in China, the mtDNA COI gene sequences of nine representative populations from China, Israel and Spain were obtained. Molecular phylogenetic tree based on AFLP and mtDNA COI gene analyses revealed the presence, in China, of at least four different genetic groups of B. tabaci. B biotype, Q biotype and two non‐B/Q biotype. B biotype was distributed nationwide. Q biotype was present only in the local region of China including the YunNan province and BeiJing city. This was also the first report about the invasion of Q biotype into China. Of the other two non‐B/Q biotype groups, one was found in ShanDong and HeBei provinces, and another in ZheJiang province. The non‐B/Q biotype ZheJiang population showed very high similarity with another Asian population India‐IW (AF110704) in mtDNA COI sequences and was possibly a Chinese indigenous population. The close monitoring of the Q biotype in locales of China where commercial plants were exported or imported, is now essential to avoid the further accidental distribution of the Q biotype.
Influences of fertilization on Aphis gossypii and insecticide usage
Authors: Chau A. , Heinz K. M. , Davies F. T.
Published: April 2005

Abstract:  Fertilization levels for ornamental crops may influence pest population dynamics, crop quality, and pest management strategy. We examined the effect of fertilization on population growth and within‐plant distribution of melon or cotton aphid, Aphis gossypii Glover, on potted chrysanthemum, Dendranthema grandiflora (Tzvelev). In terms of pest management implications, we also investigated the effect of fertilization on the number of insecticide applications needed to control A. gossypii on potted chrysanthemum. Population growth rate of A. gossypii increased with fertilization levels from 0 to 38 ppm N and reached a plateau from 38 to 488 ppm N. Increased fertilization beyond 38 ppm N, 10% of the commercial standard, did not result in higher aphid number. Aphids responded to nutrient availability of plants by distributing themselves in areas with higher level of nitrogen. More aphids were found in the apical and middle strata of the plants than the basal stratum, which had the lowest nitrogen content. Leaf nitrogen content increased with increased fertilization level and was consistently higher in the apical and middle strata than the basal stratum. Increased fertilization from 0 to 375 ppm N did not result in higher number of insecticide applications. All three insecticides (bifenthrin, kinoprene or pymetrozine) were effective in keeping the aphid infestation below a pre‐determined level, five aphids per plant, but pymetrozine required the least number of applications. For chrysanthemum, a fast‐growing crop and heavy utilizer of nitrogen, increased fertilization shortened the time to flowering, which would allow growers to harvest their crop sooner and reduce the time for aphid population growth. Reduction in time to harvest could result in significant reduction of insecticide usage by reducing the time for aphid population growth. As a result, high fertilization together with minimal runoff may be a useful tactic to an integrated pest management (IPM) programme for managing A. gossypii on potted chrysanthemums.
Retinoic acid induces CDK inhibitors and growth arrest specific (Gas) genes in neural crest cells
Authors: Wang Linping , Mear John P. , Kuan Chia‐Yi , Colbert Melissa C.
Published: April 2005

Retinoic acid (RA), the active metabolite of vitamin A, regulates cellular growth and differentiation during embryonic development. In excess, this vitamin is also highly teratogenic to animals and humans. The neural crest is particularly sensitive to RA, and high levels adversely affect migration, proliferation and cell death. We investigated potential gene targets of RA associated with neural crest proliferation by determining RA‐mediated changes in gene expression over time, using microarrays. Statistical analysis of the top ranked RA‐regulated genes identified modest changes in multiple genes previously associated with cell cycle control and proliferation including the cyclin‐dependent kinase inhibitors Cdkn1a (p21), Cdkn2b (p15INK4b), and Gas3/PMP22. The expression of p21 and p15INK4b contribute to decreased proliferation by blocking cell cycle progression at G1‐S. This checkpoint is pivotal to decisions regulating proliferation, apoptosis, or differentiation. We have also confirmed the overexpression of Gas3/PMP22 in RA‐treated neural crests, which is associated with cytoskeletal changes and increased apoptosis. Our results suggest that increases in multiple components of diverse regulatory pathways have an overall cumulative effect on cellular decisions. This heterogeneity contributes to the pleiotropic effects of RA, specifically those affecting proliferation and cell death.
TGF‐β3 induces ectopic mineralization in fetal mouse dental pulp during tooth germ development
Authors: Huojia Muhetaer , Muraoka Noriko , Yoshizaki Keigo , Fukumoto Satoshi , Nakashima Misako , Akamine Akifumi , Nonaka Kazuaki , Ohishi Masamichi
Published: April 2005

Several members of the transforming growth factor (TGF)‐β superfamily are expressed in developing teeth from the initiation stage through adulthood. Of those, TGF‐β1 regulates odontoblast differentiation and dentin extracellular matrix synthesis. However, the molecular mechanism of TGF‐β3 in dental pulp cells is not clearly understood. In the present study, beads soaked with human recombinant TGF‐β3 induced ectopic mineralization in dental pulp from fetal mouse tooth germ samples, which increased in a dose‐dependent manner. Further, TGF‐β3 promoted mRNA expression, and increased protein levels of osteocalcin (OCN) and type I collagen (COL I) in dental pulp cells. We also observed that the expression of dentin sialophosphoprotein and dentin matrix protein 1 was induced by TGF‐β3 in primary cultured dental pulp cells, however, not in calvaria osteoblasts, whereas OCN, osteopontin and osteonectin expression was increased after treatment with TGF‐β3 in both dental pulp cells and calvaria osteoblasts. Dentin sialoprotein was also partially detected in the vicinity of TGF‐β3 soaked beads in vivo. These results indicate for the first time that TGF‐β3 induces ectopic mineralization through upregulation of OCN and COL I expression in dental pulp cells, and may regulate the differentiation of dental pulp stem cells to odontoblasts.
Characterization of an exchangeable gene trap using pU‐17 carrying a stop codon‐βgeo cassette
Authors: Taniwaki Takuya , Haruna Kyoko , Nakamura Hiroshi , Sekimoto Tomohisa , Oike Yuichi , Imaizumi Takashi , Saito Fumiyo , Muta Mayumi , Soejima Yumi , Utoh Ayako , Nakagata Naomi , Araki Masatake , Yamamura Ken‐ichi , Araki Kimi
Published: April 2005

We have developed a new exchangeable gene trap vector, pU‐17, carrying the intron‐lox71‐splicing acceptor (SA)‐βgeo‐loxP‐pA‐lox2272‐pSP73‐lox511. The SA contains three stop codons in‐frame with the ATG of βgalactosidase/neomycin‐resistance fusion gene (βgeo) that can function in promoter trapping. We found that the trap vector was highly selective for integrations in the introns adjacent to the exon containing the start codon. Furthermore, by using the Cre‐mutant lox system, we successfully replaced the βgeo gene with the enhanced green fluorescent protein (EGFP) gene, established mouse lines with the replaced clones, removed the selection marker gene by mating with Flp‐deleter mice, and confirmed that the replaced EGFP gene was expressed in the same pattern as the βgeo gene. Thus, using this pU‐17 trap vector, we can initially carry out random mutagenesis, and then convert it to a gain‐of‐function mutation by replacing the βgeo gene with any gene of interest to be expressed under the control of the trapped promoter through Cre‐mediated recombination.
Both the functional specificity and autoregulative activity of two ascidian T‐box genes HrBra and HrTbx6 are likely to be mediated by the DNA‐binding domain
Authors: Takahashi Hiroki , Mitani Yasuo , Satoh Nori
Published: April 2005

T‐box genes encode a family of transcription factors having conserved DNA‐binding domains and diverged transcription regulatory domains, and each family member shows a specific expression pattern and plays a specific and crucial role in animal development. Two fundamental questions to be answered are whether the T‐box gene functional specificity is located in the DNA‐binding domain or in the transcription regulatory domain and how the specific expression of T‐box genes is controlled. In the ascidian Halocynthia roretzi, Brachyury (HrBra) is expressed only in notochord cells while Tbx6 (HrTbx6) is expressed in muscle cells. In the present study, we made chimeric constructs of the two genes to determine the above mentioned questions. Our results suggest that the functional specificity of these two ascidian T‐box genes is associated with the DNA‐binding domain but not with the transcription regulatory domain. The 5′ flanking region of both HrBra and HrTbx6 contains T‐protein binding motifs near their minimal promoters that are associated with the autoregulative activation of these genes. Using the chimeric constructs, we also determined whether the autoregulative activity is mediated by the DNA‐binding domain or by the transcription activation domain of the gene products. Our results suggest that the autoregulative activity of these two ascidian T‐box genes is also mediated by the DNA‐binding domain, not by the transcription activation domain of the encoded proteins.
SEVERE TRAUMA CAUSED BY STABBING AND FIREARMS IN METROPOLITAN SYDNEY, NEW SOUTH WALES, AUSTRALIA
Authors: Wong Kenneth , Petchell Jeffrey
Published: April 2005

Background:  Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre.

Methods:  Data from a prospectively generated trauma registry regarding all patients presenting to Royal Prince Alfred Hospital (RPAH), Sydney, Australia with penetrating trauma causing severe injuries from July 1991 to June 2001 was retrospectively analysed.

Results:  Of all patients presenting to RPAH with stabbing and firearms wounds over the 11 year study period, 28% received an ISS >15. One hundred and forty patients were identified. 94% were male. The mean age was 34 years (15−82 years). The number of cases/year has not shown an increasing trend. Thirty per cent of patients sustained firearm related injuries, with the remainder mainly caused by knives or machetes. Fifteen per cent of injuries were self inflicted. The most common location of injury was on a public street. Fifty‐two per cent of patients were injured in more than one anatomical region, with the abdomen being the most common site of injury (53%). On hundred and seventy‐four operations were performed − laparotomies (43%), thoracotomies (26%), craniotomies (5%) and orthopaedic, vascular, wound explorations and other procedures (26%). Twenty‐eight per cent of patients suffered at least one complication during their admission, with coagulopathy being the most common complication (20%). Mean length of stay was 10.4 days (1−107 days). The total mortality rate for the severely injured patients was 21%, with gun‐related injuries having a higher mortality rate than stabbing injury (36%vs 15%). Sixty per cent of deaths were related to exsanguination.

Conclusions:  Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma.
TUBERCULOUS PERITONITIS IN NO RISK PATIENTS: DIAGNOSTIC APPROACH
Authors: Tazzioli Giovanni , Farinetti Alberto , Gelmini Roberta , Longo Giuseppe , Barbolini Giuseppe , Saviano Massimo
Published: April 2005

Background:  Incidence of tubercoulosis is increasing in Western countries particularly in immigrants from endemic areas and in patients with HIV or immunocompromised. The disease is unusual in patients without risk factors. In these conditions the diagnosis of tuberculous peritonitis is often delayed, resulting in high morbidity and mortality.

Methods:  We describe a case of tuberculous peritonitis in a man suffering from ascites referred for presumed peritoneal carcinosis. The finding of no malignancies in the peritoneal fluid must rise the suspect of tuberculosis that, if misdiagnosed, is fatal. The patient was submitted to diagnostic videolaparoscopy and multiple biopsies were done. The definitive histological diagnosis was chronic granulomatous flogosis with giant cells, focally necrotizing, caused by peritoneal tubercolosis.

Results:  The patient was submitted to chemotherapy with isoniazide, rifampicine, piazafoline, ethambutol and streptomycine which determined the resolution of the clinical picture.

Conclusions:  We believe the diagnostic procedure of choice is videolaparoscopy when tubercolous peritonitis is suspected. This technique allows to obtain selective biopsies of peritoneal nodules and to collect samples for specific cultural and cytohistological exams. The operation is safe, reliable with few complications and permits a prompt diagnosis necessary to cure the patient.
ILEOSTOMY CLOSURE WITHOUT CONTRAST STUDY IS SAFE IN SELECTED PATIENTS
Authors: Cowan Timothy , Hill Andrew G.
Published: April 2005

Background:  Following anterior resection of the rectum it is common to defunction the anastomosis with an ileostomy. Prior to closure of this, a contrast study is usually performed to check for healing. Several patients at our institution have not undergone a contrast study prior to closure. The present study aimed to compare outcome in this group with patients who had undergone contrast radiology.

Methods:  A retrospective review of patients undergoing anterior resection with an ileostomy was performed. We only included those patients who had a straight colorectal/coloanal anastomosis that could be examined clinically and had a smooth postoperative course with no evidence of pelvic sepsis.

Results:  Fifty‐nine patients fulfilled the criteria for the study. Thirty‐five patients had a contrast study. These showed two leaks and five strictures. The anastomosis was 0−7 cm from the anal verge in 31 patients (16 contrast studies). It was above 7 cm in 28 patients (19 contrast studies). No patient had pelvic sepsis after ileostomy reversal.

Conclusions:  In patients with an ileostomy following anterior resection, with a clinically examinable anastomosis and a smooth postoperative course, a radiological examination of the anastomosis prior to ileostomy closure appears unnecessary.
STAPHYLOCOCCAL POST‐STERNOTOMY MEDIASTINITIS: FIVE YEAR AUDIT
Authors: Upton Arlo , Roberts Sally A. , Milsom Paget , Morris Arthur J.
Published: April 2005

Background:  The reported rate of post‐sternotomy mediastinitis is between 0.8 and 2.3%, with up to 79% of cases caused by staphylococci. Mediastinitis is associated with significant morbidity and mortality. Obesity and diabetes are the only risk factors consistently identified. The aims of the present study were to determine the incidence and risk factors for staphylococci post‐sternotomy mediastinitis and to audit its management.

Methods:  The clinical records of patients with staphylococcal post‐sternotomy mediastinitis between 1 January 1998 and 31 May 2003 were retrospectively reviewed. Information collected included patient demographics, comorbidities, operation type, microbiology findings, surgical and medical management, and outcome. Data collected on cases were compared with data collected in a prospective database of all patients undergoing cardiac surgery.

Results:  The incidence of staphylococcal post‐sternotomy mediastinitis was 1.2% (60 cases in 5176 median sternotomies). Staphylococcus aureus was isolated in 49 (82%) cases and coagulase‐negative staphylococci in 11 (18%) cases. Eight (16%) S. aureus isolates were methicillin‐resistant. Risk factors associated with mediastinitis were ethnicity, diabetes mellitus, emergency surgery, ejection fraction and length of preoperative hospital stay. In‐hospital mortality was 15%. Eighteen per cent of cases were not cured by initial therapy.

Conclusion:  Staphylococcal mediastinitis is a serious complication with significant rates of relapse and mortality. This audit has lead to an evaluation of our clinical pathways to ensure that prevention and management of surgical site infection is optimized.
Anesthesia in a child with homozygous porphobilinogen deaminase deficiency: a severe form of acute intermittent porphyria
Authors: SHEPPARD LORCAN , DORMAN TERESA
Published: April 2005

We report a case history of the anesthetic management of a child with a severe form of acute intermittent porphyria (AIP). AIP is an autosomal dominant condition with incomplete penetrance, caused by deficiency of porphobilinogen deaminase, an enzyme found in the synthetic pathway for heme. Anesthesia and surgery may present many precipitants for a potentially fatal acute porphyric attack. These include fasting, dehydration, stress, infection and drugs. Here, we describe the safe use of sevoflurane in the maintenance of anesthesia. Its relative insolubility and low metabolism suggest that sevoflurane may be a reasonable agent for anesthesia in the porphyric patient.
Ventilation with the laryngeal tube in pediatric patients undergoing elective ambulatory surgery
Authors: GENZWUERKER HARALD V. , HOHL EVA Ch. , RAPP HANS‐JUERGEN
Published: April 2005

Background : The laryngeal tube is a new supraglottic alternative for securing the airway. Few data on the use of this airway device in pediatric patients are so far available. Experiences of the study are reported.

Methods : Use of the laryngeal tube for ventilation during intermittent positive‐pressure ventilation was studied in an open, noncomparative observational study in 80 pediatric patients (age: 2–12 years) undergoing elective ambulatory surgery. Insertion success, time to achieve a patent airway, and occurrence of adverse events were documented.

Results : Mean (sd) patient age was 5.8 (2.3) years. The laryngeal tube was placed at the first attempt in 90% of patients, a second attempt was necessary in 6%. Ventilation was not possible after two attempts in three patients. Mean (sd) tidal volume was 10.1 (2.0) ml·kg−1 with a mean (sd) peak airway pressure of 15.6 (2.1) cmH2O. Chin lift was applied to improve ventilation in 15 patients (18.8%). Laryngospasm occurred in one patient, but ventilation was possible after adapting depth of anesthesia. Mean (sd) time for airway maintenance was 11.2 (3.7) s. No gastric insufflation of air occurred, no traces of blood could be detected after removal of the device. One patient complained of mild problems (swallowing, VAS 1). Mean (sd) anesthesia time was 44 (9) min.

Conclusions : In the age group studied, the laryngeal tube provides a rapid, patent airway in the majority of patients with a low complication rate.
Combined propofol and remifentanil intravenous anesthesia for pediatric patients undergoing magnetic resonance imaging
Authors: TSUI BAN C.H. , WAGNER ALESE , USHER ANDREW G. , CAVE DOMINIC A. , TANG CATHY
Published: April 2005

Background : A prospective observational case series of children receiving light general anesthesia for magnetic resonance imaging (MRI) was performed. Our purpose was to examine the merit of anesthesia and recovery/discharge times of combined remifentanil and propofol total intravenous anesthesia (TIVA) in spontaneously breathing children.

Methods : After IRB approval and informed consent, 56 patients receiving Remi/Propofol TIVA (Remifentanil 10 μg·ml−1 Propofol 10 mg·ml−1) were observed. Blood pressure, respiratory rate, endtidal CO2 (PECO2), oxygen saturation and temperature were recorded at the start and finish of anesthesia. In addition, induction and recovery times were noted. Recovery time was from scan completion until discharge from the initial recovery area. Discharge time was from scan completion to discharge home.

Results : Fifty‐six patients received Remi/Propofol TIVA. The mean Remi/Propofol recovery and discharge times were 8.9 and 28.2 min, respectively. There was a statistically significant decrease in respiratory rate and increase in CO2 from the start to the end of the procedure. During the scan, seven patients moved. One patient experienced postprocedure nausea and or vomiting.

Conclusions : The combination of remifentanil and propofol for TIVA may be an effective method of light general anesthesia in pediatric patients undergoing MRI.
Anatomical considerations of the pediatric ilioinguinal/iliohypogastric nerve block
Authors: VAN SCHOOR A.N. , BOON J.M. , BOSENBERG A.T. , ABRAHAMS P.H. , MEIRING J.H.
Published: April 2005

Background : The ilioinguinal/iliohypogastric nerve block is safe, effective and easy to perform in order to provide analgesia for a variety of inguinal surgical procedures in pediatric patients. A relatively high failure rate of 10–25% has been reported, even in experienced hands. The aim of this study was to determine the exact anatomical position of the ilioinguinal and iliohypogastric nerves in relation to an easily identifiable constant bony landmark, the anterior superior iliac spine (ASIS) in neonates and infants. The current ilioinguinal/iliohypogastric nerve block techniques were also evaluated from an anatomical perspective.

Method : Dissections were performed on a sample of 25 infant and neonatal cadavers (mean weight = 2.2 kg; mean height = 45.6 cm). The distance from the ASIS to both the ilioinguinal and iliohypogastric nerves, on a line connecting the ASIS to the umbilicus was carefully measured using a digital caliper. Three techniques, commonly used in clinical practice, were simulated on the anatomical specimens.

Result : The left and right ilioinguinal nerves were closer to the ASIS than previously described, i.e. 1.9 ± 0.9 mm (mean ± sd) and 2.0 ± 0.7 mm, respectively. The mean distance from the left and right iliohypogastric nerves to the ASIS are 3.3 ± 0.8 mm and 3.9 ± 1.0 mm, respectively.

Conclusions : We suggest that the high failure rate of the ilioinguinal/iliohypogastric nerve block in this age group could be due to lack of specific spatial knowledge of the anatomy of these nerves in infants and neonates. This cadaver‐based study suggests an insertion point closer to the ASIS, approximately 2.5 mm (range: 1.0–4.9) from the ASIS on a line drawn between the ipsilateral ASIS and the umbilicus.
Welfare Losses Due to Livestock Grazing on Public Lands: A Count Data Systemwide Treatment
Authors: Shonkwiler J. Scott , Englin Jeffrey
Published: April 2005

Backcountry hikers' willingness‐to‐pay for removing grazing from trails in the Hoover Wilderness is analyzed using a multinomial Dirichlet negative binomial distribution. This multivariate discrete distribution allows the direct calculation of seasonal welfare measures that are derived from an incomplete demand specification. The welfare maximizing choice of activities is examined on a trail‐by‐trail basis using the results of the analysis. Our findings suggest that a mix of hiking and grazing activities provide the greatest social welfare.
The Amenity and Disamenity Impacts of Agriculture: Estimates from a Hedonic Pricing Model
Authors: Ready Richard C. , Abdalla Charles W.
Published: April 2005

The positive and negative externalities from farmland are increasingly a focus of public policy discussion about agriculture and land use. A GIS‐based hedonic pricing model shows that agricultural open space increases nearby residential property values, but larger‐scale animal operations and mushroom production have negative impacts. Animal production facilities with as few as 200 animal equivalent units reduce nearby property values, but larger facilities do not necessarily generate larger impacts. Because they tend to occur together, the negative impacts of animal agriculture and the positive impacts of open space must be simultaneously modeled to avoid omitted variable bias.
When Two Wrongs Make a Right: Second‐Best Point‐Nonpoint Trading Ratios
Authors: Horan Richard D. , Shortle James S.
Published: April 2005

Most research on point‐nonpoint trading focuses on the choice of trading ratio (the rate point source controls trade for nonpoint controls), although the first‐best ratio is jointly determined with the optimal number of permits. In practice, program managers often do not have control over the number of permits—only the trading ratio. The trading ratio in this case can only be second‐best. We derive the second‐best trading ratio and, using a numerical example of trading in the Susquehanna River Basin, we find the values are in line with current ratios, but for different reasons than those that are normally provided.
Computational Methods for Measuring the Difference of Empirical Distributions
Authors: Poe Gregory L. , Giraud Kelly L. , Loomis John B.
Published: April 2005

This paper presents a simple computational method for measuring the difference of independent empirical distributions estimated by bootstrapping or other resampling approaches. Using data from a field test of external scope in contingent valuation, this complete combinatorial method is compared with other methods (empirical convolutions, repeated sampling, normality, nonoverlapping confidence intervals) that have been suggested in the literature. Tradeoffs between methods are discussed in terms of programming complexity, time and computer resources required, bias, and the precision of the estimate.
The Crowding Effects of Basic and Applied Research: A Theoretical and Empirical Analysis of an Agricultural Biotech Industry
Authors: Malla Stavroula , Gray Richard
Published: April 2005

Game theory is used to examine the incentives for private firms to fund applied research to improve differentiated crop varieties sold to compete with a public generic variety. We distinguish between applied research, modeled as a stochastic search process, and basic research, which improves applied research productivity. Propositions derived from the theoretical model are tested using empirical evidence from the canola crop research industry. The results show consistency between the analytical findings and the econometric results, supporting the validity of the framework and underlining the need to disaggregate the crowding effects of basic and applied public research.
Politics, Economics, and the Regulation of Direct Interstate Shipping in the Wine Industry
Authors: Riekhof Gina M. , Sykuta Michael E.
Published: April 2005

In 1986, California passed legislation restricting the direct importation of wine from another state by California residents unless the originating state allowed direct shipment from California wineries to residents in that state. The result has been a patchwork of direct shipment regulations across states. We examine how various economic and public interest factors affect the likelihood that a state adopts a change in its direct shipment regulation and the nature of that change. Our results suggest that private and public sector economic considerations lie at the root of direct shipment regulations in the wine industry.
How Do Journal Quality, Co‐Authorship, and Author Order Affect Agricultural Economists' Salaries?
Authors: Hilmer Christiana E. , Hilmer Michael J.
Published: April 2005

Utilizing an original data set containing annual salaries and peer‐reviewed publication histories for 326 faculty members from top‐ranked Ph.D.‐granting programs, we examine the labor market for academic agricultural economists. The results suggest that higher quality publications have a greater impact on annual earnings, that sole authored articles have a higher return than multi‐authored articles, and that no wage premium exists for being the lead author of a non‐alphabetic article.
Childhood Fears and Phobias: Assessment and Treatment
Authors: King Neville J. , Muris Peter , Ollendick Thomas H.
Published: April 2005

The specific phobias in children, such as night‐time fears and animal phobias, should not be underestimated since they cause personal distress to the child and also much interference with daily activities. Intervention plans should be informed by multi‐method assessment, using tools that are empirically sound and developmentally sensitive. We selectively review a number of assessment tools, including structured diagnostic interview schedules, standardised instruments such as anxiety or fear self‐report questionnaires, and behavioural tasks. We provide an overview of the main intervention approaches, from a behavioural perspective, including traditional behavioural intervention procedures such systematic desensitisation and its variants, cognitive‐behavioural therapy, and behavioural family therapy. We also present recent developments in psychodynamic treatment for phobic and anxious children. Medications are also discussed because of their possible use with psychosocial interventions. Finally, we present our conclusions on the empirical standing of the various treatment approaches and also examine the important issue of treatment outcome prediction.