bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Impact of Immune Microenvironment in Stage I Lung Adenocarcinoma: Tumor Interleukin-12 Receptor β2 (IL-12Rβ2), IL-7R, and Stromal FoxP3/CD3 Ratio Are Independent Predictors of Recurrence
Authors: Suzuki Kei , Kadota Kyuichi , Sima Camelia S. , Nitadori Jun-ichi , Rusch Valerie W. , Travis William D. , Sadelain Michel , Adusumilli Prasad S.
Published: December 2012

Purpose

Mounting evidence suggests that tumor-infiltrating immune cells have prognostic value for patients with solid organ malignancies. Our aim was to investigate the prognostic significance of the immune microenvironment in patients with stage I lung adenocarcinoma (ADC).

Patients and Methods

Using tissue microarray and immunohistochemistry, we investigated eight types of tumor-infiltrating immune cells in the tumor nest and tumor-associated stroma as well as tumor expression of five cytokines in a uniform cohort of 956 patients with stage I lung ADC (478 each in training and validation cohorts).

Results

Although a high density of stromal forkhead box P3 (FoxP3) –positive cells was associated with shorter recurrence-free probability (RFP; P = .043), the relative proportion of stromal FoxP3 to CD3 was a stronger predictor of recurrence (5-year RFP, 85% for high v 77% for low ratio; P = .004). High expression of tumor interleukin-12 receptor β2 (IL-12Rβ2) was associated with better outcome (5-year RFP, 90% for high v 80% for low expression; P = .026), whereas high expression of tumor IL-7R was associated with worse outcome (5-year RFP, 76% for high v 86% for low expression; P = .001). In multivariate analysis, these immune markers were independently associated with recurrence. Although IL-7R remained significant for poor overall survival, all the markers remained prognostic for recurrence in patients with stages IA and IB disease as well as for patients with tumors ≤ 2 cm.

Conclusion

Our investigation confirms the biologic and prognostic significance of the tumor immune microenvironment for patients with stage I lung ADC and provides support for its use to stratify clinical outcome and immunotherapeutic interventions.
Safety for home care: the use of Internet video calls to double-check interventions
Authors: Bradford Natalie , Armfield Nigel R , Young Jeanine , Ehmer Marissa , Smith Anthony C
Published: December 2012

We investigated the feasibility of using Internet video calls for a double check on medication or other complex interventions being administered in the home. Seven nurses were recruited to the study and received training on using laptop and tablet computers with mobile Internet connections. The devices were taken on scheduled home visits to patient homes and video calls with a second clinician were conducted to double-check various items associated with the clinical care of the patient. Over a 14-month period, 88 video calls were conducted during which a total of 600 checks were completed. The items checked included medication names, doses, segmentations on syringes and details of ventilator settings. The quality of the video call was acceptable on 97% of occasions. On three occasions (3%) it was not possible to establish a connection and the double check was not achieved. On every occasion that the video call was successful ( n = 85), nurses were 100% confident that they were able to carry out the full requirements of a double check. The use of Internet video calls is feasible for double-checking and has the potential to improve patient safety and reduce costs.
A pilot study of the effectiveness of home teleconsultations in paediatric palliative care
Authors: Bradford Natalie , Young Jeanine , Armfield Nigel R , Bensink Mark E , Pedersen Lee-Anne , Herbert Anthony , Smith Anthony C
Published: December 2012

We conducted a pilot study to investigate the effectiveness of a home telehealth service for paediatric palliative care consultations. Over a 10 week period, 14 of the 17 caregivers approached to be part of the study agreed to participate. Families were allocated, non-randomly, to a control group (usual care) or an intervention group (usual care with the addition of home telehealth consultations). The primary outcome measure was quality-of-life score. Caregivers were surveyed for up to 99 days following recruitment. A descriptive analysis of the quality-of-life data showed no differences between caregivers in the two groups. However, important lessons were learnt regarding factors which influence the success of studies in this population group, and the domains of caregiver quality-of-life that warrant intervention. Palliative care is complex, and multiple interventions and supports are required if care is to be managed at home. Home telehealth consultations are a feasible and acceptable means of facilitating a palliative care consultation which can reduce the burden on families at a distressing time.
Effects of type 2 diabetes behavioural telehealth interventions on glycaemic control and adherence: a systematic review
Authors: Cassimatis Mandy , Kavanagh David J
Published: December 2012

We reviewed the effect of behavioural telehealth interventions on glycaemic control and diabetes self-management in patients with type 2 diabetes. The databases CINAHL, Medline and psychlNFO were searched in August 2012. Journal articles were selected that had been published in English with a randomized controlled trial design using a usual care comparison group, and in which the primary intervention component was delivered by telehealth. Relevant outcome measures were glycaemic control and one or more of the following diabetes self-care areas: diet, physical activity, blood glucose self-monitoring (BGSM) or medication adherence. Interventions were excluded if they were primarily based on telemonitoring. The search retrieved 1027 articles, from which 49 were selected based on their title and abstract. Fourteen articles (reporting 1 3 studies) met the eligibility criteria for inclusion. Four studies reported significant improvements in glycaemic control. Five of eight studies on dietary adherence reported significant treatment effects, as did five of eight on physical activity, four of nine on blood glucose self-monitoring, and three of eight on medication adherence. Overall, behavioural telehealth interventions show promise in improving the diabetes self-care and glycaemic control of people with type 2 diabetes.
Telehealth opportunities in regional Queensland: a scoping study
Authors: Croll Jasmine , Norton Chrissie J , Gray Leonard C , Bryett Andrew , Smith Anthony C
Published: December 2012

We carried out a six month scoping study to ascertain current health service needs in the Queensland towns of Dalby, Chinchilla and Miles. The towns have a high proportion of their populations in the dependent age groups of over 65 years of age and less than 14 years of age. This implies a need for ready access to paediatric and geriatric specialist services. The hospitals in the three towns provided a range of health services, but patients still had to be referred to Toowoomba and Brisbane for specialist consultations. All three hospitals had videoconference facilities, but videoconferencing was mainly used for education, administration and training. General practitioners in the three towns did not use telehealth in their practice. The study reinforced the potential for telehealth services in three key domains: regional hospitals, residential aged-care facilities and general practice.
A qualitative study of the careers and professional practices of graduates from an e-health postgraduate programme
Authors: Edirippulige Sisira , Armfield Nigel R , Smith Anthony C
Published: December 2012

We studied the careers and professional practices of graduates from an e-health postgraduate programme at the University of Queensland (UQ). The information was collected using an online questionnaire distributed to those who graduated from 2005 to 2010. A total of 35 surveys were completed, a response rate of 89%. The majority of respondents ( n = 20, 57%) were male, and most of them ( n = 27, 77%) were aged 30-49 years. Most of the respondents ( n = 19, 54%) had graduated from the Graduate Certificate in E-healthcare programme; 12 had graduated from the Master of E-healthcare and 4 had graduated from the Graduate Diploma programme. The majority of respondents ( n = 29, 83%) perceived that e-health study at UQ helped in their career development. The current occupation of the majority of respondents ( n = 24, 69%) was related to health or medicine, and most ( n = 27, 77%) had worked in an e-health related job since graduating. Overall, the level of satisfaction regarding the learning experience doing e-health study at UQ was high.
Practical experience of telehealth between an Antarctic station and Japan
Authors: Ohno Giichiro , Watanabe Kentaro , Okada Yutaka , Higuchi Kazuo
Published: December 2012

The Japanese Antarctic Research Expedition (JARE) has had a presence in Antarctica since 1956. The Syowa station is 15,000 km from Japan and evacuation of patients is impossible during the winter months. From 1956 to 2003, a total of 4932 telemedical consultations were undertaken, i.e. every member of the station needed an average of 4 medical consultations each winter. Forty five percent of the consultations were surgical or orthopaedic cases, 23% were for internal medicine and 12% were for dental problems. In the early 1980s, satellite radio-telephony was found to be useful for consultations, but did not have the ability to transmit medical pictures. Email was transmitted by the International Mobile Satellite Organization (INMARSAT) but the connection was only available every 2 hours and the maximum message size was 100 kByte. In 2004, the International Telecommunications Satellite (INTELSAT) system made a connection constantly available, and increased the maximum message size to 10 MByte. Transmission of still and moving pictures became possible. Scheduled consultations are performed monthly. A doctor in Japan can ask the patient questions and perform a proxy examination with the assistance of the Antarctic doctor. Real-time telemedicine is very effective in orthopaedic and surgical cases, skin, eye and dental troubles. Still pictures are more effective for understanding in detail skin and eye problems. Emergency consultations are effective if adequate consulting staff are available.
The role of the champion in telehealth service development: a qualitative analysis
Authors: Wade Victoria , Eliott Jaklin
Published: December 2012

Telehealth ‘champions’ are enthusiastic individuals who initiate and promote the uptake of telehealth services. Their role and impact was investigated as part of a qualitative study into the uptake and sustainability of telehealth services in Australia. Semi-structured interviews were conducted with 39 individuals who had been involved in the establishment and operations of 37 diverse telehealth services throughout Australia. A grounded theory analysis was carried out. The results indicated that most services were initiated by champions (25 of the 37). The champions appeared to have three main roles: enthusiastic promotion of telehealth, acting as legitimators, and relationship building. Champions were capable of keeping small scale services operating, but the services were vulnerable to cessation when they lost interest or moved on. As long as participation in telehealth remains optional, the role of the champion will be an important factor in continued operations.
Sernbo score predicts survival after intracapsular hip fracture in the elderly
Authors: Dawe EJC , Lindisfarne E , Singh T , McFadyen I , Stott P
Published: December 2012

Introduction

The Sernbo score uses four factors (age, social situation, mobility and mental state) to divide patients into a high-risk and a low-risk group. This study sought to assess the use of the Sernbo score in predicting mortality after an intracapsular hip fracture.

Methods

A total of 259 patients with displaced intracapsular hip fractures were included in the study. Data from prospectively generated databases provided 22 descriptive variables for each patient. These included operative management, blood tests and co-mobidities. Multivariate analysis was used to identify significant predictors of mortality.

Results

The mean patient age was 85 years and the mean follow-up duration was 1.5 years. The one-year survival rate was 92% (±0.03) in the low-risk group and 65% (±0.046) in the high-risk group. Four variables predicted mortality: Sernbo score >15 (p=0.0023), blood creatinine (p=0.0026), ASA (American Society of Anaesthesiologists) grade >3 (p=0.0038) and non-operative treatment (p=0.0377). Receiver operating characteristic curve analysis showed the Sernbo score as the only predictor of 30-day mortality (area under curve 0.71 [0.65–0.76]). The score had a sensitivity of 92% and a specificity of 51% for prediction of death at 30 days.

Conclusions

The Sernbo score identifies patients at high risk of death in the 30 days following injury. This very simple score could be used to direct extra early multidisciplinary input to high-risk patients on admission with an intracapsular hip fracture.
Should prophylactic antibiotics be used routinely in epistaxis patients with nasal packs?
Authors: Biggs TC , Nightingale K , Patel NN , Salib RJ
Published: December 2012

Introduction

The current mainstream practice in otolaryngology departments relating to the use of prophylactic antibiotics in epistaxis patients requiring nasal packing is highly variable. This is due primarily to the lack of any validated guidelines. As such, we introduced a new treatment algorithm resulting in significant reduction of use in the systemic antibiotics, with emphasis instead on the use of topical antibiotics. The results were validated through a complete audit cycle.

Methods

A total of 57 patients undergoing nasal packing for spontaneous epistaxis were studied. Reaudit occurred after the implementation of new guidelines. Telephone surveys were conducted six weeks after hospital discharge, assessing infective nasal symptoms as well as rebleeding and readmission rates.

Results

Systemic antibiotic prescribing in anterior nasal packing fell by 58.2% between audit cycles with no statistically significant associated increase in infective nasal symptoms, rebleeding or readmission rates six weeks following hospital discharge.

Conclusions

Systemic prophylactic antibiotics are unnecessary in the majority of epistaxis patients with nasal packs. The use of topical antibiotics such as Naseptin® may be more appropriate, cheaper and as effective. Implementation of this treatment algorithm will help standardise systemic antibiotic usage in epistaxis patients with nasal packing and should reduce costs associated with unnecessary use of such medication.
The Waterlow score for risk assessment in surgical patients
Authors: Thorn CC , Smith M , Aziz O , Holme TC
Published: December 2012

Introduction

Perioperative scoring systems aim to predict outcome following surgery and are used in preoperative counselling to guide management and to facilitate internal or external audit. The Waterlow score is used prospectively in many UK hospitals to stratify the risk of decubitus ulcer development. The primary aim of this study was to assess the potential value of this existing scoring system in the prediction of mortality and morbidity in a general surgical and vascular cohort.

Methods

A total of 101 consecutive moderate to high risk emergency and elective surgical patients were identified through a single institution database. The preoperative Waterlow score and outcome data pertaining to that admission were collected. The discriminatory power of the Waterlow score was compared against that of the American Society of Anesthesiologists (ASA) grade and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM).

Results

The inpatient mortality rate was 17% and the 30-day morbidity rate was 29%. A statistically significant association was demonstrated between the preoperative Waterlow score and inpatient mortality (p<0.0001) and 30-day morbidity (p=0.0002). Using a threshold Waterlow score of 20 to dichotomise risk, accuracies of 0.84 and 0.76 for prediction of mortality and morbidity were demonstrated. In comparison with P-POSSUM, the preoperative Waterlow score performed well on receiver operating characteristic analysis. With respect to mortality, the area under the curve was 0.81 (0.80–0.85) and for morbidity it was 0.72 (0.69–0.76). The ASA grade achieved a similar level of discrimination.

Conclusions

The Waterlow score is collected routinely by nursing staff in many hospitals and might therefore be an attractive means of predicting postoperative morbidity and mortality. It might also function to stratify perioperative risk for comparison of surgical outcome data. A prospective study comparing these risk prediction scores is required to support these findings.
Role of the faecolith in modern-day appendicitis
Authors: Singh JP , Mariadason JG
Published: December 2012

Introduction

The prevailing view on appendicitis is that the main aetiology is obstruction owing to faecoliths in adults and lymphoid hyperplasia in children. Faecoliths on imaging studies are believed to correlate well with appendicitis.

Methods

A retrospective chart review was conducted of 1,014 emergency appendicectomy patients between 2001 and 2011. Faecolith prevalence in adult and paediatric appendicectomy specimens with and without perforation was studied. The sensitivity and positive predictive value (PPV) of computed tomography (CT) for identifying faecoliths in the pathology specimen were examined.

Results

Overall, faecoliths were found in 18.1% (178/986) of appendicitis specimens and 28.6% (8/28) of negative appendicectomies. Faecolith prevalence for positive cases was 29.9% (79/264) in paediatric patients and 13.7% (99/722) in adults (p<0.05). Faecolith prevalence was 39.4% in perforated appendicitis but only 14.6% in non-perforated appendicitis (p<0.05). In adults, faecolith prevalence was 27.5% in perforated appendicitis and 12.0% in non-perforated appendicitis (p<0.05) while in paediatric patients, it was 56.1% in perforated appendicitis and 22.7% in non-perforated appendicitis (p=0.00). Sensitivity and PPV of preoperative CT in identifying faecoliths on pathology were 53.1% (86/162) and 44.8% (86/192) respectively.

Conclusions

Faecolith prevalence is too low to consider the faecolith the most common cause of non-perforated appendicitis. Faecoliths are more prevalent in paediatric appendicitis than in adult appendicitis. Preoperative CT is an unreliable predictor of faecoliths in pathology specimens.
Reaction or infection: topical chloramphenicol treatment
Authors: Livingston RJ , Butterworth JW , Belt P
Published: December 2012

Chloramphenicol is a topical treatment that is used widely, especially in wounds around the eyes. In our practice there have been a number of cases of delayed hypersensitivity to chloramphenicol that has been mismanaged initially as an infective cellulitis. We hope to share some of our experience of this uncommon reaction to highlight the delayed reaction that can occur with topical application of this drug.
An unusual cause for a painful Birmingham hip resurfacing
Authors: Islam KA , Blake SM
Published: December 2012

The painful total hip arthroplasty requires careful evaluation and investigation. This is usually focused on the prosthesis and adjacent anatomical structures. We present a case report of a 64-year-old man who had a Birmingham hip resurfacing procedure for primary osteoarthritis. His hip pain worsened following the procedure and was under systematic investigation for this. Subsequent investigation for vascular disease revealed a total infrarenal aortic occlusion. An aortobifemoral bypass improved the hip pain and function dramatically, and the patient now has an excellent quality of life.
Audiovisual distraction reduces pain perception during aural microsuction
Authors: Choudhury N , Amer I , Daniels M , Wareing MJ
Published: December 2012

Introduction

Aural microsuction is a common ear, nose and throat procedure used in the outpatient setting. Some patients, however, find it difficult to tolerate owing to discomfort, pain or noise. This study evaluated the effect of audiovisual distraction on patients’ pain perception and overall satisfaction.

Methods

A prospective study was conducted for patients attending our aural care clinic requiring aural toileting of bilateral mastoid cavities over a three-month period. All microsuction was performed by a single clinical nurse specialist. Any patients with active infection were excluded. For each patient, during microsuction of one ear, they watched the procedure on a television screen while for the other ear they did not view the procedure. All patients received the same real time explanations during microsuction of both ears. After the procedure, each patient completed a visual analogue scale (VAS) to rate the pain they experienced for each ear, with and without access to the television screen. They also documented their preference and reasons why.

Results

A total of 37 patients were included in the study. The mean pain score for patients viewing the procedure was 2.43 compared with a mean of 3.48 for patients with no television view. This difference in patients’ pain perception was statistically lower in the group who observed the procedure on the television (p=0.003), consistent with the majority of patients reporting a preference to viewing their procedure (65%).

Conclusions

Audiovisual distraction significantly lowered patients’ VAS pain scores during aural microsuction. This simple intervention can therefore reduce patients’ perceived pain and help improve acceptance of this procedure.
Spontaneous pancreatic pseudocyst–portal vein fistula: a rare and potentially life threatening complication of pancreatitis
Authors: Raza SS , Hakeem A , Sheridan M , Ahmad N
Published: December 2012

Pseudocyst formation following acute and chronic pancreatitis is a well known complication. A pancreatic pseudocyst fistulating into the portal vein is a rare and potentially fatal complication. We report a case of pancreatic pseudocyst – portal vein fistula, which was managed with a conservative approach.
Aetiology of femoral hernias revisited: bilateral femoral hernia in a young male (two cases)
Authors: Kouchupapy RT , Ranganathan G , Dias S , Shanahan D
Published: December 2012

Bilateral femoral hernias are less common in men than in women and rare in young adults. Only one case of a bilateral femoral hernia in a young man has been reported in the literature before. Three main theories have been postulated for femoral hernias. The theory that they are an acquired disease is the most accepted due to the common occurrence of such hernias in multiparous women but the theory lacks enough evidence. We report two cases in young men. Anatomical variations in the femoral canal could be the primary aetiological factor in these patients. A unilateral femoral hernia in young men with acquired aetiological factors requires a clinical examination of the opposite side.
Laminar flow reduces cases of surgical site infections in vascular patients
Authors: Bosanquet DC , Jones CN , Gill N , Jarvis P , Lewis MH
Published: December 2012

Introduction

Numerous strategies are employed routinely in an effort to lower rates of surgical site infections (SSIs). A laminar flow theatre environment is generally used during orthopaedic surgery to reduce rates of SSIs. Its role in vascular surgery, especially when arterial bypass grafts are used, is unknown.

Methods

A retrospective review of a prospectively maintained database was undertaken for all vascular procedures performed by a single consultant over a one-year period. Cases were performed, via random allocation, in either a laminar or non-laminar flow theatre environment. Demographic data, operative data and evidence of postoperative SSIs were noted. A separate subgroup analysis was undertaken for patients requiring an arterial bypass graft. Univariate and multivariate logistical regression was undertaken to identify significant factors associated with SSIs.

Results

Overall, 170 procedures were analysed. Presence of a groin incision, insertion of an arterial graft and a non-laminar flow theatre were shown to be predictive of SSIs in this cohort. In the subgroup receiving arterial grafts, only a non-laminar flow theatre environment was shown to be predictive of an SSI.

Conclusions

This study suggests that laminar flow may reduce incidences of SSI, especially in the subgroup of patients receiving arterial grafts.
A five-year review of necrotising fasciitis in a tertiary referral unit
Authors: Swain RA , Hatcher JC , Azadian BS , Soni N , De Souza B
Published: December 2012

Introduction

Necrotising fasciitis is a life-threatening illness that is often difficult to diagnose. Immediate debridement and intravenous antibiotic therapy are required to limit the spread of infection. This five-year audit aimed to review the number and outcomes of all cases of necrotising fasciitis admitted to a tertiary referral unit and to assess the validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system.

Methods

A retrospective analysis of patient notes over the five-year period from October 2006 to October 2011 was undertaken. The LRINEC score was calculated for each patient to evaluate its usefulness.

Results

Overall, 15 patients were diagnosed with necrotising fasciitis. Three patients died. The median age of patients was 51.0 years (range: 34–76 years). There were no obvious predisposing factors in 8 cases but patients had a median of 2.0 co-morbidities. The most common infective agent, present in five patients, was Group A Streptococcus. Other monomicrobial agents included Group G Streptococcus and Klebsiella pneumoniae. Polymicrobial infections were less common than monomicrobial infections and two patients had a polymicrobial infection including methicillin-resistant Staphylococcus aureus. Although the LRINEC scoring system identified 12 of the 15 patients as having a high or intermediate likelihood of necrotising fasciitis, 3 were classified as low likelihood.

Conclusions

This limited case series strongly suggests that the LRINEC system is too insensitive for diagnosis.
Hospital Episode Statistics data analysis of postoperative venous thromboembolus in patients undergoing urological surgery: a review of 126,891 cases
Authors: Dyer J , Wyke S , Lynch C
Published: December 2012

Introduction

Current guidelines on venous thromboembolism (VTE) prevention do not reflect the potential varying risk for patients undergoing different urological procedures. Our study aimed to establish the procedure specific rate of postoperative VTE in patients undergoing urological surgery.

Methods

Hospital Episode Statistics were obtained for all patients undergoing common urological procedures between April 2009 and April 2010. This cohort was followed up to identify all patients reattending with either deep vein thrombosis (DVT) or pulmonary embolism (PE) within 12 months.

Results

A total of 126,891 individuals underwent urological surgery during the study period. This included 89,628 men (70.6%) and 37,236 women (29.3%) with a mean age of 65.2 years. At the 12-month follow-up, 839 patients (0.66%) were readmitted with VTE. Of these, 373 (0.29%) were admitted with DVT and 466 (0.37%) with PE. The procedure-specific rate of VTE varied significantly between 2.86% following cystectomy and 0.23% following urethral dilatation. Procedures performed in the lithotomy position carried a significantly lower risk of VTE than those performed in the supine position (0.60% vs 1.28%, p<0.0001). Furthermore, of all procedures performed in the lithotomy position, those performed on benign conditions carried a significantly lower risk than those performed on malignant disease (0.52% vs 0.79%, p<0.0001).

Conclusions

Procedure specific rates of postoperative VTE vary widely among patients undergoing urological procedures. These findings suggest the potential benefit of prolonging the use of thromboprophylaxis in high-risk patients but also exploring the apparent lack of need for routine thromboprophylaxis in patients undergoing low-risk procedures.
A quick guide to survey research
Authors: Jones TL , Baxter MAJ , Khanduja V
Published: December 2012

Questionnaires are a very useful survey tool that allow large populations to be assessed with relative ease. Despite a widespread perception that surveys are easy to conduct, in order to yield meaningful results, a survey needs extensive planning, time and effort. In this article, we aim to cover the main aspects of designing, implementing and analysing a survey as well as focusing on techniques that would improve response rates.
Caliper measurement to improve assessment of neck lumps: comment 1
Authors: Brennan P
Published: December 2012

Although this comment was published originally in the September 2012 issue of the Annals, we omitted to publish the author’s response alongside it. We include Mr Wasson’s response below and apologise for any inconvenience caused.
Mapping multiple source effects on the strontium isotopic signatures of ecosystems from the circum‐Caribbean region
Authors: Bataille Clement P. , Laffoon Jason , Bowen Gabriel J.
Published: December 2012

A method for mapping strontium isotope ratio (87Sr/86Sr) variations in bedrock and water has been recently developed for use in the interpretation of 87Sr/86Sr datasets for provenance studies. The mapping process adopted the simplifying assumption that strontium (Sr) comes exclusively from weathering of the underlying bedrock. The scope of this bedrock‐only mapping method is thus limited to systems where the contributions of other sources of Sr are minimal. In this paper, we build on this 87Sr/86Sr mapping method by developing a mixing model of Sr fluxes from multiple sources to the bioavailable Sr pool. The new multiple source model includes: (1) quantitative calculations of Sr fluxes from bedrock weathering using an empirical rock weathering model; and (2) addition of sub‐models calculating the contribution of Sr fluxes from atmospheric aerosols based on outputs from global climate model simulations. We compared the performance of the new multiple source model and the bedrock‐only mapping method in predicting observed values from two datasets of bioavailable 87Sr/86Sr from the circum‐Caribbean region (Antilles and Mesoamerica). Although the bedrock‐only method performs relatively well in Mesoamerica (n = 99, MAE = 0.00011, RMSE = 0.00073), its prediction accuracy is lower for the Antillean dataset (n = 287, MAE = 0.0021, RMSE = 0.0027). In comparison, the new multiple source model, which accounts for the deposition of sea salt and mineral dust aerosols, performs comparably well in predicting the observed 87Sr/86Sr values in both datasets (MAE = 0.00040, RMSE = 0.00087 and MAE = 0.00014, RMSE = 0.0010). This study underscores the potential of using process‐oriented spatial modeling to improve the predictive power of Sr isoscapes over large spatial scales and to refine sampling strategies and bioavailable Sr dataset interpretations for provenance studies.
Geographical and taxonomic biases in research on biodiversity in human‐modified landscapes
Authors: Trimble Morgan J. , van Aarde Rudi J.
Published: December 2012

Biodiversity persistence in human‐modified landscapes is crucial for conservation and maintaining ecosystem services. Studies of biodiversity in landscapes where humans live, work, and extract resources could support defensible policy‐making to manage land‐use. Yet, research should cover relevant regions, and biases in study topics should not lead to gaps in the evidence base. We systematically reviewed the literature of biogeography in human‐modified landscapes published in eight eminent biogeography, conservation, and ecology journals to assess geographical bias among biomes and geopolitical regions and taxonomic bias among species groups. We compared research output per biome to area, biome type, species richness, proportion of transformed land, and the ratio of transformed to protected land. We also compared research output per geopolitical region to area, proportion of transformed land, the ratio of transformed to protected land, and human population density. Research output was distributed unequally among biomes, geopolitical regions, and species groups. Biome type was a clear factor in research bias, and forest biomes were the subject of 87% of papers, while species richness was not generally associated with bias. Conservation in human‐modified landscapes is most important in regions with low protected area coverage, high land conversion, and high pressure from human populations, yet the distribution of published papers did not generally reflect these threats. Seventy‐five percent of studies focused on the Americas and Europe, while Africa and Asia were critically understudied. Taxonomically, plants and invertebrates were the most studied groups; however, research output was not correlated with species richness per group. Protected areas alone will not conserve biodiversity in the long term. Thus, a strong biogeographical evidence base is required to support policies for biodiversity maintenance on human‐modified land. Under‐studied regions and species groups deserve further research to elucidate what, where, and how biodiversity persists in human‐modified landscapes to inform conservation policy and enhance efficacy.
The effect of processing parameters on energy consumption of ball mill refiner for chocolate
Authors: Fistes Aleksandar , Rakic Dusan , Pajin Biljana , Dokic Ljubica , Nikolic Ivana
Published: December 2012

A laboratory ball mill consisting of vertical cylinder, equipped with a
rotating shaft with arms, and filled with steel balls as a grinding medium
has been used in the experiments. The aim of the study was to examine the
effect of agitator shaft speed and amount of grinding media (steel balls) on
power requirements and energy consumption of a ball mill. With constant mass
of the steel balls (20 kg, 30 kg and 40 kg), the agitator shaft speed was
increased from 10% to 100% of the maximum speed which corresponds to a speed
of 50 rpm. The power consumption (W) was recorded upon which milling energy
consumption (J/kg) has been calculated. The results were statistically
analyzed using ANOVA. The increase of the agitator shaft speed, in steps of
10% to the maximum speed of 50 rpm, led to a statistically significant
increase in milling energy consumption. At low agitator shaft speed (10%),
increase in the mass of the steel balls had no influence on the power
requirements. Power requirements for the grinding runs using 30 kg and 40 kg
are similar and higher compared to power requirement in trial with 20 kg, as
agitator shaft speed increases from 20% to 70%. At high agitator shaft speeds
(?80%), increase in steel balls mass led to the significant increase in power
requirements of the ball mill.
Long-term therapeutic efficacy of oral appliances in treatment of obstructive sleep apnea-hypopnea syndrome
Authors: Gong Xu , Zhang Jingjing , Zhao Ying , Gao Xuemei
Published: December 2012

Objective:

To investigate the long-term efficacy and safety of oral appliances (OAs) in treating obstructive sleep apnea-hypopnea syndrome (OSAHS) by length of treatment.

Materials and Methods:

This is a retrospective study to review the usage of OAs in Chinese OSAHS patients in recent decades. Ninety-four valid questionnaires were returned by 412 patients with OSAHS receiving OA treatment. Among the wearers, 22 agreed to follow-up polysomnography, and 25 agreed to follow-up cephalograms. Tolerance and side effects of OAs were assessed by a survey. Comparisons of efficacy were carried out between the initial and follow-up polysomnography measurements. Cephalometric analysis was used to investigate skeletal and occlusal changes to determine safety of the OAs.

Results:

The longest treatment extended to 147 months, with a median of 74 months (first and third quartiles, 30 and 99 months, respectively). Among the participants, 14.9% had been treated for more than 120 months. Side effects were temporary and relatively minimal and included tooth soreness (37.2%), dry mouth (33.0%), odd bite feeling (31.9%), and excess salivation (30.8%). Polysomnography proved that OAs remained effective for the treatment of OSAHS in the long term; initial Apnea-Hypopnea Index values were reduced from a median of 24.50 (quartiles, 14.65, 54.05) without the OA to 7.40 with the OA (2.12, 10.00), and follow-up median values were 25.55 without the OA (11.71, 43.65) and 4.25 with the OA (1.38, 7.70). Cephalometric analysis indicated mild and slow changes in the skeleton and occlusion after average treatment duration of 5 years.

Conclusion:

OAs provided effective and safe long-term therapy for patients with OSAHS. Follow-up supervision is recommended since long-term alterations take place, although these appear to be minimal.
Association of perinatal exposure to airborne Rhodococcus equi with risk of pneumonia caused by R equi in foals
Authors: Cohen Noah D. , Chaffin M. Keith , Kuskie Kyle R. , Syndergaard Melissa K. , Blodgett Glenn P. , Takai Shinji
Published: December 2012

Objective—To determine whether the concentrations of airborne virulent Rhodococcus equi in stalls housing foals during the first 2 weeks after birth are associated with subsequent development of R equi pneumonia in those foals.

Sample—Air samples collected from foaling stalls and holding pens in which foals were housed during the first 2 weeks after birth.

Procedures—At a breeding farm in Texas, air samples (500 L each) were collected (January through May 2011) from stalls and pens in which 121 foals were housed on day 1 and on days 4, 7, and 14 after birth. For each sample, the concentration of airborne virulent R equi was determined with an immunoblot technique. The association between development of pneumonia and airborne R equi concentration was evaluated via random-effects Poisson regression analysis.

Results—Some air samples were not available for analysis. Of the 471 air samples collected from stalls that housed 121 foals, 90 (19%) contained virulent R equi. Twenty-four of 121 (20%) foals developed R equi pneumonia. Concentrations of virulent R equi in air samples from stalls housing foals that developed R equi pneumonia were significantly higher than those in samples from stalls housing foals that did not develop pneumonia. Accounting for disease effects, air sample concentrations of virulent R equi did not differ significantly by day after birth or by month of birth.

Conclusions and Clinical Relevance—Exposure of foals to airborne virulent R equi during the first 2 weeks after birth was significantly (and likely causally) associated with development of R equi pneumonia.
Gene biomarkers in peripheral white blood cells of horses with experimentally induced osteoarthritis
Authors: Kamm J. Lacy , Frisbie David D. , McIlwraith C. Wayne , Orr Kindra E.
Published: December 2012

Objective—To use microarray analysis to identify genes that are differentially expressed in horses with experimentally induced osteoarthritis.

Animals—24 horses.

Procedures—During arthroscopic surgery, a fragment was created in the distal aspect of the radiocarpal bone in 1 forelimb of each horse to induce osteoarthritis. At day 14 after osteoarthritis induction, horses began exercise on a treadmill. Blood and synovial fluid samples were collected before and after surgery. At day 70, horses were euthanized and tissues were harvested for RNA analysis. An equine-specific microarray was used to measure RNA expression in peripheral WBCs. These data were compared with mRNA expression (determined via PCR assay) in WBCs, cartilage, and synovium as well as 2 protein biomarkers of cartilage matrix turnover in serum and synovial fluid.

Results—A metalloproteinase domain-like protein decysin-1 (ADAMDEC1), glucose-regulated protein (GRP) 94, hematopoietic cell signal transducer (HCST), Unc-93 homolog A (hUNC-93A), and ribonucleotide reductase M2 polypeptide (RRM2) were significantly differentially regulated in WBCs of horses with osteoarthritis, compared with values prior to induction of osteoarthritis. There was correlation between the gene expression profile in WBCs, cartilage, and synovium and the cartilage turnover proteins. Gene expression of ADAMDEC1, hUNC-93A, and RRM2 in WBCs were correlated when measured via microarray analysis and PCR assay.

Conclusions and Clinical Relevance—Expression of ADAMDEC1, GRP94, HCST, hUNC-93A, and RRM2 was differentially regulated in peripheral WBCs obtained from horses with experimentally induced osteoarthritis. Gene expression of ADAMDEC1, hUNC-93A, and RRM2 in peripheral WBCs has the potential for use as a diagnostic aid for osteoarthritis in horses.
Experimental determination of a subantimicrobial dosage of doxycycline hyclate for treatment of periodontitis in Beagles
Authors: Kim Se Eun , Kim Soohee , Jeong Manbok , Lee Yesran , Ahn Jeong Taek , Park Young Woo , Ahn Jae Sang , Lee Euiri , Ryu Doug-Young , Seo Kangmoon
Published: December 2012

Objective—To identify a subantimicrobial dose of doxycycline hyclate (SDD) and for the treatment of periodontitis in dogs.

Animals—20 healthy Beagles for measurement of serum doxycycline concentration and 15 Beagles with periodontitis for evaluation of the efficacy of the SDD.

Procedures—5 dogs each received doxycycline hyclate PO at a dose of 1, 2, 3, or 5 mg/kg. Blood samples were collected before and after administration, and serum concentrations of doxycycline were measured via high-performance liquid chromatography. Mean serum doxycycline concentrations were calculated, and SDDs were identified. In a separate trial, the identified SDDs (1 or 2 mg/kg) were administered PO once a day for 1 month to dogs with periodontitis (n = 5/group) and a control group (5) was fed vehicle only during the same period. Degree of gingival attachment and bleeding on probing (present or absent) were recorded. Gingival samples were collected before and after the 1-month period from the same anatomic sites. Degree of matrix metalloproteinase inhibition in gingival samples was determined via gelatin zymography and compared among treatment groups.

Results—Mean serum doxycycline concentrations in healthy dogs that received 1 or 2 mg of doxycycline/kg were consistently significantly lower than the minimal inhibitory doxycycline concentration for treatment of periodontitis throughout the 24-hour posttreatment period. Zymographic intensities were lower in dogs given 1 and 2 mg/kg than in the control dogs, and the degree of gingival attachment and bleeding significantly improved in dogs given 2 mg/kg, compared with in the control dogs and dogs given 1 mg of doxycycline/kg.

Conclusions and Clinical Relevance—A doxycycline dosage of 2 mg/kg daily appeared to be an appropriate subantimicrobial regimen for dogs with periodontitis. Furthermore, this dosage may be suitable for long-term treatment of gelatinolytic inflammatory diseases such as periodontitis in this species.
Evaluation of the effects of dorsal versus lateral recumbency on the cardiopulmonary system during anesthesia with isoflurane in red-tailed hawks (Buteo jamaicensis)
Authors: Hawkins Michelle G. , Malka Shachar , Pascoe Peter J. , Solano Adrian M. , Kass Philip H. , Ohmura Hajime , Jones James H.
Published: December 2012

Objective—To evaluate the effects of dorsal versus lateral recumbency on the cardiopulmonary system during isoflurane anesthesia in red-tailed hawks (Buteo jamaicensis).

Animals—6 adult 1.1- to 1.6-kg red-tailed hawks.

Procedures—A randomized, crossover study was used to evaluate changes in respiratory rate, tidal volume, minute ventilation, heart rate, mean arterial and indirect blood pressures, and end-tidal Pco2 measured every 5 minutes plus Paco2 and Pao2 and arterial pH measured every 15 minutes throughout a 75-minute study period.

Results—Respiratory rate was higher, tidal volume lower, and minute ventilation not different in lateral versus dorsal recumbency. Position did not affect heart rate, mean arterial blood pressure, or indirect blood pressure, although heart rate decreased during the anesthetic period. Birds hypoventilated in both positions and Paco2 differed with time and position × time interaction. The Petco2 position × time interaction was significant and Petco2 was a mean of 7 Torr higher than Paco2. The Paco2 in dorsal recumbency was a mean of 32 Torr higher than in lateral recumbency. Birds in both positions developed respiratory acidosis.

Conclusions and Clinical Relevance—Differences in tidal volume with similar minute ventilation suggested red-tailed hawks in dorsal recumbency might have lower dead space ventilation. Despite similar minute ventilation in both positions, birds in dorsal recumbency hypoventilated more yet maintained higher Pao2, suggesting parabronchial ventilatory or pulmonary blood flow distribution changes with position. The results refute the hypothesis that dorsal recumbency compromises ventilation and O2 transport more than lateral recumbency in red-tailed hawks.
Development of a broad-range quantitative polymerase chain reaction assay to detect and identify fungal DNA in equine endometrial samples
Authors: Ferris Ryan A. , Dern Katy , Veir Julia K. , Hawley Jennifer R. , Lappin Michael R. , McCue Patrick M.
Published: December 2012

Objective—To develop a broad-range 28S ribosomal DNA quantitative PCR (qPCR) assay for detection of fungal DNA in equine endometrial samples.

Sample—12 fungal samples from a clinical diagnostic laboratory and 29 samples obtained from 17 mares.

Procedures—The qPCR assay was optimized with commercially acquired fungal organisms and validated with samples obtained from the clinical diagnostic laboratory. Subsequently, 29 samples from 17 mares suspected of having fungal endometritis were evaluated via the qPCR assay and via traditional fungal culture and endometrial cytology. Amplicons from the qPCR assay were subjected to genetic sequencing to identify the organisms.

Results—The qPCR assay theoretically had a detection threshold of 2 organisms of Candida albicans. Fungal DNA was amplified from all 12 fungal samples from the commercial diagnostic laboratory. Fungal identification by use of genetic sequencing was successful for 34 of 36 amplicons from the 12 samples assayed. A fungal agent was identified via qPCR assay and genetic sequencing in all 12 samples; in contrast, a fungal agent was identified in only 8 of 12 samples via standard fungal culture and biochemical analysis. The qPCR assay detected fungal DNA in samples from 12 of 17 mares suspected of having fungal endometritis.

Conclusions and Clinical Relevance—A rapid, sensitive, and repeatable qPCR assay was developed for detection of fungal DNA from equine endometrial samples. The qPCR may prove to be clinically useful as an adjunct to microbial culture and cytologic examination to provide identification of fungal organisms in a timely manner.