bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and implementation of a bereavement follow‐up intervention for grieving fathers: an action research
Authors: Aho Anna L , Åstedt‐Kurki Päivi , Tarkka Marja‐Terttu , Kaunonen Marja
Published: October 2010

Aims and objectives.  The aim is to present the development and implementation of a bereavement follow‐up intervention for grieving fathers. The development and implementation process and components of the intervention are presented.

Background.  There is a lack of research into fathers’ grief and bereavement support for them after the death of a child. Promotion of evidence‐based nursing requires transparent development and implementation of nursing interventions and models to be able to repeat, evaluate their effectiveness and redevelop them.

Design.  Phases of action research were used when developing and implementing the intervention.

Methods.  Results of the baseline study of father’s grief and social support, the study of current bereavement support and the literature review were combined using triangulation.

Results.  In this action research, the development of a bereavement follow‐up intervention for grieving fathers began with the planning phase that included a baseline study about fathers’ grief and social support, a study of current bereavement support systems in Finnish university hospitals and a systematic review of literature on the topic area and collaboration with a panel of experts. The developed bereavement follow‐up intervention included three complementary components: support package, peer supporters’ contact and health care personnel’s contact. Implementation of the intervention included the development of a programme to be used in nursing practice, intervention training for programme implementers and intervention implementation.

Conclusions.  Developing and implementing an intervention is a complex, demanding and long‐term process. The planning required theoretical knowledge as well as understanding the experiences of fathers, nursing practice and collaboration with those who implemented the intervention.

Relevance to clinical practice.  New information about the fathers’ grief and bereavement follow‐up support is described. The model developed is evidence‐based and can be applied in nursing care where grieving fathers and families are met.
A qualitative study of the perceptions of coronary heart disease among Hong Kong Chinese people
Authors: Chan Choi Wan , Lopez Violeta , Chung Joanne WY
Published: October 2010

Aims and objectives.  The aim of this study was to investigate the perceptions of coronary heart disease among a sample of Hong Kong Chinese people.

Background.  Coronary heart disease is increasing among Chinese populations. Reducing coronary heart disease risk is highly dependant on a person’s evaluation of the risks and lifestyle behaviour. However, Chinese perceptions of coronary heart disease and the risks have been underexplored.

Design.  A qualitative study was conducted using focus group interviews.

Method.  Focus group interviews were tape recorded and transcribed. The data were analysed using content analysis.

Results.  The results show that the Hong Kong Chinese participants underestimated the severity of coronary heart disease. Perceptions of risk of coronary heart disease were influenced by the risk factors, symptoms, age, optimism, levels of suffering from coronary heart disease and reliance on medical professionals. Most of the participants perceived that this is because of inadequate understanding of coronary heart disease and lack of resources for coronary heart disease health education.

Conclusion.  Societal readiness is paramount in imparting accurate coronary heart disease knowledge to mediate the perception of coronary heart disease as a major health problem that affects the Chinese population.

Relevance to clinical practice.  Understanding the Chinese participants’ perceptions of coronary heart disease is vital in developing illness prevention and health promotion strategies to increase their levels of knowledge of coronary heart disease risk factors reduction.
From continuing education to personal digital assistants: what do physical therapists need to support evidence‐based practice in stroke management?
Authors: Salbach Nancy M. , Veinot Paula , Jaglal Susan B. , Bayley Mark , Rolfe Danielle
Published: October 2010

Rationale, aims and objectives  Understanding how to structure educational interventions and resources to facilitate physical therapists' application of the research literature is required. The objective of this study was to explore physical therapists' preferences for strategies to facilitate their access to, evaluation and implementation of the stroke research literature in clinical practice.

Methods  In‐depth, qualitative telephone interviews were conducted with 23 physical therapists who treat people with stroke in Ontario, Canada and who had participated in a previous survey on evidence‐based practice. Data were analysed using a constant comparative approach to identify emergent themes.

Results  Participants preferred online access to research summaries or systematic reviews to save time to filter and critique research articles. To enable access in the workplace, an acceptable computer‐to‐staff ratio, permission to access web sites and protected work time were suggested. Participants considered personal digital assistants as excellent tools for quick access to online resources but were unsure of their advantage over a desktop computer. Therapists favoured use of non‐technical language, glossaries of research terms and quality ratings of studies to ease understanding and appraisal. Teleconferencing or videoconferencing overcame geographical but not scheduling barriers to accessing education. To achieve behaviour change in clinical practice, therapists preferred multiple interactive, face‐to‐face education sessions in a group format, with opportunities for case‐based learning and practice of new skills.

Conclusion  Physical therapists prefer technology‐assisted access to resources and education and favour attending multiple interactive, expert‐facilitated education sessions incorporating opportunities for case‐based learning and practice of new skills to change behaviour related to evidence‐based practice.
The impacts of pre‐surgery wait for total knee replacement on pain, function and health‐related quality of life six months after surgery
Authors: Desmeules François , Dionne Clermont E. , Belzile Étienne L. , Bourbonnais Renée , Frémont Pierre
Published: October 2010

Objective  The purpose of the current study was to assess, in patients scheduled for primary total knee replacement (TKR), the effects of pre‐surgery waiting time on pain and functional limitations related to the knee joint undergoing surgery, on health‐related quality of life (HRQoL) and on contralateral knee pain 6 months after surgery.

Method  A total of 141 patients scheduled for TKR were recruited from three hospitals in Quebec City, Canada, and followed up until 6 months after surgery. Pre‐surgery wait, defined as the time between enrolment on the pre‐surgery waiting list and surgery, was considered in four categories (≤3, >3–6, >6–9, >9 months). Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC). HRQoL was measured with the SF‐36.

Results  Mean pre‐surgery waiting time was 184 (SD: 120.8) days. Six months after TKR, a significant difference was seen between the four groups of pre‐surgery wait in terms of HRQoL SF‐36 role physical [F(3, 136) = 2.74, P = 0.046] and contralateral knee WOMAC pain [F(3, 136) = 5.78, P = 0.0009] scores. Participants with the longest pre‐surgery wait (>9 months) showed the worst scores 6 months after TKR.

Conclusions  Longer pre‐surgery waiting time had a negative clinically important impact on HRQoL and contralateral knee pain 6 months after surgery.
Ketoprofen in piglets: enantioselective pharmacokinetics, pharmacodynamics and PK/PD modelling
Authors: FOSSE T. K. , TOUTAIN P. L. , SPADAVECCHIA C. , HAGA H. A. , HORSBERG T. E. , RANHEIM B.
Published: October 2010

Fosse, T. K., Toutain, P. L., Spadavecchia, C., Haga, H. A., Horsberg, T. E., Ranheim, B. Ketoprofen in piglets: enantioselective pharmacokinetics, pharmacodynamics and PK/PD modelling.J. vet. Pharmacol. Therap.34, 338–349.

The chiral pharmacokinetics and pharmacodynamics of ketoprofen were investigated in a placebo‐controlled study in piglets after intramuscular administration of 6 mg/kg racemic ketoprofen. The absorption half‐lives of both enantiomers were short, and S‐ketoprofen predominated over R‐ketoprofen in plasma. A kaolin‐induced inflammation model was used to evaluate the anti‐inflammatory, antipyretic and analgesic effects of ketoprofen. Skin temperatures increased after the kaolin injection, but the effect of ketoprofen was small. No significant antipyretic effects could be detected, but body temperatures tended to be lower in the ketoprofen‐treated piglets. Mechanical nociceptive threshold testing was used to evaluate the analgesic effects. The piglets in the ketoprofen‐treated group had significantly higher mechanical nociceptive thresholds compared to the piglets in the placebo group for 12–24 h following the treatment. Pharmacokinetic/pharmacodynamic modelling of the results from the mechanical nociceptive threshold testing gave a median IC50for S‐ketoprofen of 26.7 μg/mL and an IC50for R‐ketoprofen of 1.6 μg/mL. This indicates that R‐ketoprofen is a more potent analgesic than S‐ketoprofen in piglets. Estimated ED50for racemic ketoprofen was 2.5 mg/kg.
Sourcing Eurasian beaver Castor fiber stock for reintroductions in Great Britain and Western Europe
Authors: HALLEY Duncan J.
Published: October 2010

Eurasian beavers Castor fiber, formerly threatened with extinction, have been widely reintroduced since the 1920s. Reintroductions and studies of possible reintroductions are continuing.

The International Union for Conservation of Nature (IUCN) guidelines for reintroductions state that ‘the source population should ideally be closely related genetically to the original native stock’.

Palaeoecological studies suggest that the species survived the last Ice Age in two refugia: in the west in Iberia and Southern France and in the east in the Black Sea region. The post‐Ice Age population of Western Europe, including Great Britain, recolonized from the western refugium. Recent mitochondrial deoxyribonucleic acid studies strongly support this view, and extant beaver populations are clearly divided into eastern and western evolutionarily significant units (ESUs).

The western ESU is composed of three stocks which survived the 19th and early 20th century as very small, isolated populations. They are very closely related to each other. Each is genetically depauperate, apparently as a result of genetic drift at low population levels.

There is evidence of inbreeding depression and of phenotypic abnormalities in beaver populations descended from unmixed stocks.

The evidence suggests three coherent management options for sourcing reintroduction stock for Great Britain and for unoccupied areas of western continental Europe. These are (i) use animals from a single western ESU stock; (ii) intentionally mix animals from two or all three of the surviving western ESU stocks; (iii) make an informed exception to the IUCN guidelines and reintroduce animals of mixed eastern and western ESU provenance.

These options are discussed with regard to IUCN guidelines, conservation biology and animal welfare considerations. It would be advantageous if a common policy on the origin of reintroduction stock were agreed by the national agencies responsible.
A global meta‐analysis of Tuber ITS rDNA sequences: species diversity, host associations and long‐distance dispersal
Authors: BONITO GREGORY M. , GRYGANSKYI ANDRII P. , TRAPPE JAMES M. , VILGALYS RYTAS
Published: October 2010

Truffles (Tuber) are ectomycorrhizal fungi characterized by hypogeous fruitbodies. Their biodiversity, host associations and geographical distributions are not well documented. ITS rDNA sequences of Tuber are commonly recovered from molecular surveys of fungal communities, but most remain insufficiently identified making it difficult to determine whether these sequences represent conspecific or novel taxa. In this meta‐analysis, over 2000 insufficiently identified Tuber sequences from 76 independent studies were analysed within a phylogenetic framework. Species ranges, host associates, geographical distributions and intra‐ and interspecific ITS variability were assessed. Over 99% of the insufficiently identified Tuber sequences grouped within clades composed of species with little culinary value (Maculatum, Puberulum and Rufum). Sixty‐four novel phylotypes were distinguished including 36 known only from ectomycorrhizae or soil. Most species of Tuber showed 1‐3% intraspecific ITS variability and >4% interspecific ITS sequence variation. We found 123 distinct phylotypes based on 96% ITS sequence similarity and estimated that Tuber contains a minimum of 180 species. Based on this meta‐analysis, species in Excavatum, Maculatum and Rufum clades exhibit preference for angiosperm hosts, whereas those in the Gibbosum clade are preferential towards gymnosperms. Sixteen Tuber species (>13% of the known diversity) have putatively been introduced to continents or islands outside their native range.
The Shigella T3SS needle transmits a signal for MxiC release, which controls secretion of effectors
Authors: Martinez‐Argudo Isabel , Blocker Ariel J.
Published: October 2010

Type III secretion systems (T3SSs) are key determinants of virulence in many Gram‐negative bacteria, including animal and plant pathogens. They inject ‘effector’ proteins through a ‘needle’ protruding from the bacterial surface directly into eukaryotic cells after assembly of a ‘translocator’ pore in the host plasma membrane. Secretion is a tightly regulated process, which is blocked until physical contact with a host cell takes place. Host cell sensing occurs through a distal needle ‘tip complex’ and translocators are secreted before effectors. MxiC, a Shigella T3SS substrate, prevents premature effector secretion. Here, we examine how the different parts of T3SSs work together to allow orderly secretion. We show that T3SS assembly and needle tip composition are not altered in an mxiC mutant. We find that MxiC not only represses effector secretion but that it is also required for translocator release. We provide genetic evidence that MxiC acts downstream of the tip complex and then the needle during secretion activation. Finally, we show that the needle controls MxiC release. Therefore, for the first time, our data allow us to propose a model of secretion activation that goes from the tip complex to cytoplasmic MxiC via the needle.
Modulating cellular recombination potential through alterations in RecA structure and regulation
Authors: Bakhlanova Irina V. , Dudkina Alexandra V. , Baitin Dima M. , Knight Kendall L. , Cox Michael M. , Lanzov Vladislav A.
Published: October 2010

The wild‐type Escherichia coli RecA protein is a recombinase platform with unrealized recombination potential. We have explored the factors affecting recombination during conjugation with a quantitative assay. Regulatory proteins that affect RecA function have the capacity to increase or decrease recombination frequencies by factors up to sixfold. Autoinhibition by the RecA C‐terminus can affect recombination frequency by factors up to fourfold. The greatest changes in recombination frequency measured here are brought about by point mutations in the recA gene. RecA variants can increase recombination frequencies by more than 50‐fold. The RecA protein thus possesses an inherently broad functional range. The RecA protein of E. coli (EcRecA) is not optimized for recombination function. Instead, much of the recombination potential of EcRecA is structurally suppressed, probably reflecting cellular requirements. One point mutation in EcRecA with a particularly dramatic effect on recombination frequency, D112R, exhibits an enhanced capacity to load onto SSB‐coated ssDNA, overcome the effects of regulatory proteins such as PsiB and RecX, and to pair homologous DNAs. Comparisons of key RecA protein mutants reveal two components to RecA recombination function – filament formation and the inherent DNA pairing activity of the formed filaments.
Ecological differentiation in xylem cavitation resistance is associated with stem and leaf structural traits
Authors: MARKESTEIJN LARS , POORTER LOURENS , PAZ HORACIO , SACK LAWREN , BONGERS FRANS
Published: October 2010

Cavitation resistance is a critical determinant of drought tolerance in tropical tree species, but little is known of its association with life history strategies, particularly for seasonal dry forests, a system critically driven by variation in water availability. We analysed vulnerability curves for saplings of 13 tropical dry forest tree species differing in life history and leaf phenology. We examined how vulnerability to cavitation (P50) related to dry season leaf water potentials and stem and leaf traits. P50‐values ranged from −0.8 to −6.2 MPa, with pioneers on average 38% more vulnerable to cavitation than shade‐tolerants. Vulnerability to cavitation was related to structural traits conferring tissue stress vulnerability, being negatively correlated with wood density, and surprisingly maximum vessel length. Vulnerability to cavitation was negatively related to the Huber‐value and leaf dry matter content, and positively with leaf size. It was not related to SLA. We found a strong trade‐off between cavitation resistance and hydraulic efficiency. Most species in the field were operating at leaf water potentials well above their P50, but pioneers and deciduous species had smaller hydraulic safety margins than shade‐tolerants and evergreens. A trade‐off between hydraulic safety and efficiency underlies ecological differentiation across these tropical dry forest tree species.
Effects of temperature, inoculum concentration, leaf age, and continuous and interrupted wetness on infection of olive plants by Spilocaea oleagina
Authors: Obanor F. O. , Walter M. , Jones E. E. , Jaspers M. V.
Published: October 2010

Experiments were conducted on olive plants in controlled environments to determine the effect of conidial concentration, leaf age, temperature, continuous and interrupted leaf wetness periods, and relative humidity (RH) during the drier periods that interrupted wet periods, on olive leaf spot (OLS) severity. As inoculum concentration increased from 1·0 × 102 to 2·5 × 105 conidia mL−1, the severity of OLS increased at all five temperatures (5, 10, 15, 20 and 25°C). A simple polynomial model satisfactorily described the relationship between the inoculum concentration at the upper asymptote (maximum number of lesions) and temperature. The results showed that for the three leaf age groups tested (2–4, 6–8 and 10–12 weeks old) OLS severity decreased significantly (P < 0·001) with increasing leaf age at the time of inoculation. Overall, temperature also affected (P < 0·001) OLS severity, with the lesion numbers increasing gradually from 5°C to a maximum at 15°C, and then declining to a minimum at 25°C. When nine leaf wetness periods (0, 6, 12, 18, 24, 36, 48, 72 and 96 h) were tested at the same temperatures, the numbers of lesions increased with increasing leaf wetness period at all temperatures tested. The minimum leaf wetness periods for infection at 5, 10, 15, 20 and 25°C were 18, 12, 12, 12 and 24 h, respectively. The wet periods during early infection processes were interrupted with drying periods (0, 3, 6, 12, 18 and 24 h) at two levels of RH (70 and 100%). The length of drying period had a significant (P < 0·001) effect on disease severity, the effect depending on the RH during the interruption. High RH (100%) resulted in greater disease severity than low RH (70%). A polynomial equation with linear and quadratic terms of temperature, wetness and leaf age was developed to describe the effects of temperature, wetness and leaf age on OLS infection, which could be incorporated as a forecasting component of an integrated system for the control of OLS.
CD4+/CD25+ Cells in Systemic Inflammation in COPD
Authors: Domagała‐Kulawik J. , Hoser G. , Dąbrowska M. , Safianowska A. , Chazan R.
Published: October 2010

The autoimmune reaction is recently suspected to play a role in the pathogenesis of chronic obstructive lung disease (COPD). As COPD is a systemic disease, the elements of an autoimmune response in circulatory system is of interest. It has been shown that regulatory T cells are important in the control of autoimmunity. There are some data on a role of adiponectin in the regulation of immune reactions. The objective of this study was to assess the elements of autoimmune reaction in the peripheral blood (PB) of patients with COPD. Twenty‐eight patients with mild/moderate COPD and 20 healthy volunteers were investigated. Flow cytometry method with mixtures of monoclonal antibodies anti: CD14/CD45, CD3/CD19, CD4/CD25/CTLA4 and CD8/CD25 were used. Concentration of adiponectin was measured using ELISA method. We observed significantly lower proportion of CD4+/CD25+ as well as CD4+/CD25+ high cells in COPD patients than in healthy controls (15.3 versus 17.8% and 0.79 versus 1.54%, respectively, P < 0.05). The proportion of CTLA4+ cells in CD25+ cells and the mean fluorescence of CTLA4 on CD4+ cells were higher in patients than in healthy controls (10.4 versus 4.7%, P < 0.05, 189% versus 149%, non significant, respectively). We found significantly elevated concentration of adiponectin in patients when compared to healthy subjects (15.4 versus 8.5 μl/ml, P < 0.05). We found that the adiponectin/BMI ratio correlated with the decrease of FEV1%. The results of this study support the possible role of CD4/CD25/CTLA4 cells and adiponectin in the systemic inflammation in COPD.
Phenotypic Diversity of Peripheral Blood Plasma Cells in Primary Sjögren’s Syndrome
Authors: Szyszko E. A. , Brun J. G. , Skarstein K. , Peck A. B. , Jonsson R. , Brokstad K. A.
Published: October 2010

Production of autoantibodies is one of the main features of primary Sjögren’s syndrome (pSS). Long‐lived plasma cells (PC) can produce autoantibodies for prolonged period of times without being affected by immunosuppressive therapies. As of today, little is known about the long‐lived PC subset and their contribution to autoimmunity. We have characterized the phenotypic and migratory properties of peripheral blood PC isolated from pSS patients (grouped by focus score, FS) and compared them to PC from rheumatoid arthritis (RA) patients and normal non‐autoimmune subjects. We observed two populations of PC in all study groups, CD19+ PC and CD19− PC. Interestingly, the CD19− PC subset was most prominent in autoimmune patients (pSS and RA) compared to normal controls. Further investigation of the PC phenotype revealed that a high percentage of both CD19+ and CD19− PC isolated from pSS and RA patients did not express the CD27 marker, which is normally highly expressed on all types of PC. Differences in the expression of markers such as IgM, IgG, CD95 and CXCR3 in the group with high FS compared to FS = 1, underscore the heterogeneity of pSS patient group and demonstrate that phenotypic pattern of circulating PC associates with the severity of inflammation in the salivary glands of these patients. Our migration experiments show that addition of CXCL12 to PC in vitro, do not alter the migration potential of PC in any group tested. However, we observed an overall higher spontaneous migration of PC from pSS compared to both RA and normal controls.
In vitro susceptibility testing of meticillin‐resistant and meticillin‐susceptible staphylococci to mupirocin and novobiocin
Authors: Fulham Kristen S. , Lemarie Stephen L. , Hosgood Giselle , Dick Hani L. N.
Published: October 2010

Antimicrobials effective against meticillin‐resistant staphylococci are limited. Mupirocin is a topical antimicrobial used to treat bacterial skin infections. Novobiocin is an oral antimicrobial approved for treatment of staphylococcal upper respiratory infections in dogs. This study reports the in vitro activity of mupirocin and novobiocin on meticillin‐susceptible (MSS) and resistant staphylococci (MRS) from healthy dogs and dogs with superficial pyoderma. Staphylococci were isolated from skin swabs at four sites on healthy dogs and from lesions on dogs with superficial pyoderma. Staphylococci were identified by morphology and by catalase and coagulase testing. Speciation and susceptibility testing were performed by the Dade Microscan (W. Sacramento, CA, USA). Meticillin resistance was confirmed by an oxacillin screen plate. Novobiocin and mupirocin susceptibilities were tested by disc diffusion. Staphylococci were cultured from 61 healthy dogs (17 MRS and 44 MSS) and 30 dogs with pyoderma (15 MRS and 15 MSS), with higher proportions of MRS isolates in dogs with pyoderma (P = 0.038; χ2 test). For mupirocin, 79.5% (35 of 44) MSS and 82.3% (14 of 17) MRS isolates from healthy dogs, and 100% (15 of 15) MSS and 86.6% (13 of 15) MRS isolates from dogs with pyoderma were susceptible (MSS, P = 0.094; MRS, P = 1.0; Fisher’s exact test). For novobiocin, 95.4% (42 of 44) MSS and 52.9% (nine of 17) MRS isolates from healthy dogs and 93.3% (14 of 15) MSS and 80% (12 of 15) MRS isolates from dogs with pyoderma were susceptible (MSS, P = 1.0; MRS, P = 0.148; Fisher’s exact test).
Kidney transplantation in the morbidly obese: complicated but still better than dialysis
Authors: Bennett William M. , McEvoy Kevin M. , Henell Karen R. , Pidikiti Sudha , Douzdjian Viken , Batiuk Thomas
Published: October 2010

Bennett WM, McEvoy KM, Henell KR, Pidikiti S, Douzdjian V, Batiuk T. Kidney transplantation in the morbidly obese: complicated but still better than dialysis. Clin Transplant 2011: 25: 401–405. © 2010 John Wiley & Sons A/S.

Abstract:  Obese patients are denied renal transplantation in many centers. We report results regarding obesity from a new transplant program (1999 through 2007). Six hundred and forty‐two patients were transplanted: 439 patients with BMI < 30 (Group 1), 109 patients with BMI 30.1‐34.9 (Group 2), and 89 patients with BMI > 35 (Group 3). Follow‐up was at least one yr. Medical and surgical management was performed by the same team throughout the study period. There were no demographic differences between groups except for increased diabetes in Groups 2 and 3. Actuarial graft and patient survivals were not statistically different between groups. Group 3 patients had numerical trends toward more delayed graft function and lower graft survivals but these did not reach statistical significance. Biopsy‐proven rejections did not differ between groups. Wound infections were statistically significant in Groups 2 and 3 compared to Group 1 (p < 0.01). Despite increased wound infection rates with increased BMI, transplanting patients with morbid obesity results in better survival for individual patients than dialysis. Thus, there is no a priori ethical reason for treating obese ESRD patients differently from those with other comorbidities.
The use of sirolimus as a rescue therapy in pediatric intestinal transplant recipients
Authors: Andres Ane M. , Lopez Santamaría Manuel , Ramos Esther , Hernandez Francisco , Prieto Gerardo , Encinas Jose , Leal Nuria , Molina Manuel , Sarría Jesús , Tovar Juan
Published: October 2010

Andres AM, Lopez Santamaría M, Ramos E, Hernandez F, Prieto G, Encinas J, Leal N, Molina M, Sarría J, Tovar JA. The use of sirolimus as a rescue therapy in pediatric intestinal transplant recipients. Pediatr Transplantation 2010: 14: 931–935. © 2010 John Wiley & Sons A/S.

Abstract:  To review our experience with SRL as a second‐line therapy in our series of 45 SBTx recipients (1997–2009). Retrospective review of five children converted to SRL: 3 M/2 F; median of three yr old (range 20 months–18 yr); rescue indications, adverse events with SRL, resolution of tacrolimus‐related side effects, incidence of rejection, PTLD, or GVHD were summarized. Tacrolimus was discontinued (average 13 months after transplant) because of refractory hemolytic anemia in four patients with decreased renal function and because of advanced renal failure and unclear neutropenia in one. PTLD and GVHD had been previously diagnosed in two. Tacrolimus‐related side effects disappeared in all five although other immunosuppressants and splenectomy were used simultaneously or later in most of them. Adverse events reported after the conversion were infections (tuberculosis and Pneumocystis carinii in two) and mild hypertriglyceridemia. No rejection, GVHD, or PTLD episode was observed. Four patients are alive with excellent quality of life (median follow‐up 18 months). Sirolimus is a safe rescue therapy in SBTx children when tacrolimus is not well tolerated. Renal function and hematologic disorders seem to improve, although other simultaneous strategies could be also involved. Further studies could demonstrate its efficacy as a first‐line treatment.
Uncoupling ecological innovation and speciation in sea snakes (Elapidae, Hydrophiinae, Hydrophiini)
Authors: SANDERS K. L. , MUMPUNI  , LEE M. S. Y.
Published: October 2010

The viviparous sea snakes (Hydrophiini) are by far the most successful living marine reptiles, with ∼60 species that comprise a prominent component of shallow‐water marine ecosystems throughout the Indo‐West Pacific. Phylogenetically nested within the ∼100 species of terrestrial Australo‐Melanesian elapids (Hydrophiinae), molecular timescales suggest that the Hydrophiini are also very young, perhaps only ∼8–13 Myr old. Here, we use likelihood‐based analyses of combined phylogenetic and taxonomic data for Hydrophiinae to show that the initial invasion of marine habitats was not accompanied by elevated diversification rates. Rather, a dramatic three to six‐fold increase in diversification rates occurred at least 3–5 Myr after this transition, in a single nested clade: the Hydrophis group accounts for ∼80% of species richness in Hydrophiini and ∼35% of species richness in (terrestrial and marine) Hydrophiinae. Furthermore, other co‐distributed lineages of viviparous sea snakes (and marine Laticauda, Acrochordus and homalopsid snakes) are not especially species rich. Invasion of the oceans has not (by itself) accelerated diversification in Hydrophiini; novelties characterizing the Hydrophis group alone must have contributed to its evolutionary and ecological success.
Epidemiology of high‐level parvovirus B19 viraemia among Dutch blood donors, 2003–2009
Authors: Kooistra K. , Mesman H. J. , de Waal M. , Koppelman M. H. G. M. , Zaaijer H. L.
Published: October 2010

Background and Objectives  Plasma derivatives and blood components with low levels of parvovirus B19 (B19) seem not infectious, but recently infected, highly viraemic donors may transmit B19. We studied the incidence of high‐level B19 viraemia (B19 DNA > 106 IU/ml) in 6·5 million Dutch blood donations.

Materials and Methods  Between 2003 and 2009, all Dutch blood and plasma donations were screened for the presence of B19 DNA, via pools of 480. Reactive pools were resolved and demographic parameters were obtained for all donors with B19 viraemia > 106 IU/ml. In a subset, IgG and IgM antibodies to B19 were determined.

Results  Four hundred and eleven donations (1/15815) were identified with B19 DNA levels above 106 IU/ml, predominantly (83%) occurring in donors aged 18–47 years. Each year infection rates were elevated between December and July, with April accounting for 16% of infections. The years 2004 and 2009 were epidemic, with up to 1/4880 highly viraemic donations in May 2004. In a subset of 67 viraemic donations, 47/67 (70%) tested negative for IgG and IgM antibodies to B19; 16/67 (24%) showed isolated IgM and 4/67 (6%) contained IgG and IgM antibodies. The seasonal pattern of asymptomatic B19 infection in blood donors followed the notification rate of clinical cases. Geographically, B19 infection was randomly spread over the Netherlands.

Conclusions  In epidemic seasons, blood donations with high levels of parvovirus, without concurrent antibodies, are common. They may infect immunocompromised and parvovirus‐naïve recipients. The feasibility of preventive measures should be studied.
Marine artificial micro‐reserves: a possibility for the conservation of endangered species living on artificial substrata
Authors: García‐Gómez José C. , López‐Fé Carlos M. , Espinosa Free , Guerra‐García José M. , Rivera‐Ingraham Georgina A.
Published: October 2010

The installation of urban and commercial infrastructures on the coast has a severe impact on the marine environment. This impact is mostly negative but, simultaneously, some of the species that colonize artificial substrata (sometimes rare or threatened) find refuge in man‐made structures. The protection of endangered species is usually provided by marine protected areas or by laws that punish their damage or collection, but effective enclosure and custody must be achieved in the case of easily accessible intertidal species. We used the ferruginous limpet,Patella ferruginea,as a case study because it is the most endangered invertebrate in the Mediterranean. This species, which lives in the intertidal zone and is very accessible to people, is a free‐spawning, protandric hermaphrodite, highly dependent on population density and individual size for its reproductive success. Previous work by the authors found the species is especially abundant on artificial substrates on both shores of the Strait of Gibraltar, where people collect fewer of them. Spanish laws of coastal management do not allow the enclosure of the natural coastline, but artificial installations like harbour breakwaters may be closed or guarded, and visits for educational purposes may be carried out under control. The possibility of declaring some kind of environmental protection for these artificial areas would be a very helpful tool for conservation and management purposes. Protected individuals would grow larger and eventually produce exponentially more offspring, which could be transported by currents to adjacent habitats. Here we propose a protection concept for artificial sites termed Artificial Marine Micro‐Reserve (AMMR), where some endangered species experience a refuge from human disturbance. This concept is a modification of the land micro‐reserves that have been recently declared in small natural sites that keep rare plant species. A network of AMMRs would be the final objective, allowing the creation of a great metapopulation ofP. ferrugineaand also giving refuge to other endangered species that have been found to grow in this type of substratum. Critically, the declaration of a micro‐reserve cannot be used as a reason in favour of new construction because of the negative influence of such structures on the marine environment, together with the fact that there is no certainty that valuable species will settle on them.
Isolation of recombinant cysteine dioxygenase protein from Trichophyton mentagrophytes
Authors: Kasperova Alena , Kunert Jiri , Horynova Milada , Weigl Evzen , Sebela Marek , Lenobel Rene , Raska Milan
Published: October 2010

Cysteine dioxygenase (CDO, EC 1.13.11.20) catalyses the oxygenation of cysteine to cysteine sulphinic acid leading to the production of sulphite, sulphate and taurine as the final metabolites of cysteine catabolism. Keratinolytic fungi secrete sulphite and sulphate to reduce disulphide bridges in host tissue keratin proteins as the first step of keratinolysis. In the present study, we describe the identification of cDNA, as well as expression and characterisation of recombinant CDO protein from Trichophyton mentagrophytes. The cDNA was amplified using primers designed on the basis of high conservancy CDO regions identified in other fungi. PCR product was cloned and sequenced. Recombinant CDO was expressed in Escherichia coli, and affinity purified and identified by matrix‐assisted laser desorption/ionization – time‐of‐flight mass spectrometry (MALDI‐TOF MS). Enzyme activity was assayed by monitoring the production of cysteine sulphinate using mass spectrometry. The Cdo cDNA encodes for a protein consisting of 219 amino acids. Recombinant CDO protein C‐terminally fused with a His tag was purified by affinity chromatography. The CDO purified under native condition was proved to be enzymatically active. Protein identity was confirmed by MALDI‐TOF MS. Comparison of cDNA sequence with those identified in other fungi revealed significant homology. Identification of T. mentagrophytes CDO provides indispensable tools for future studies of dermatophyte pathogenicity and development of new approaches for prevention and therapy.
Attenuation of aortic calcification with lanthanum carbonate versus calcium‐based phosphate binders in haemodialysis: A pilot randomized controlled trial
Authors: TOUSSAINT NIGEL D , LAU KENNETH K , POLKINGHORNE KEVAN R , KERR PETER G
Published: October 2010

Background:  Vascular calcification (VC) contributes to cardiovascular disease in haemodialysis (HD) patients. Few controlled studies have addressed interventions to reduce VC but non‐calcium‐based phosphate binders may be beneficial. No published randomized study to date has assessed the effect of lanthanum carbonate (LC) on VC progression.

Methods:  We conducted a pilot randomized controlled trial to determine the effect of LC on VC. Forty‐five HD patients were randomized to either LC or calcium carbonate (CC). Primary outcome was change in aortic VC after 18 months. Secondary outcomes included superficial femoral artery (SFA) VC, bone mineral density (BMD) of lumbar spine and serum markers of mineral metabolism. At baseline, 6 and 18 month computed tomography was performed to measure VC and BMD. A random effect linear regression model was performed to assess differences.

Results:  Thirty patients completed the study (17 LC, 13 CC); baseline median age 58 years, 38% diabetic, 64% male. Ninety‐three per cent had aortic VC at commencement and 87% showed progression. At 18 months, there was significantly less aortic VC progression with LC than CC (adjusted difference −98.1 (−149.4, −46.8) Hounsfield units (HU), P < 0.001). There was also a non‐significant reduction with LC in left SFA VC (−25.8 (−67.7, 16.1) HU, P = 0.2) and right SFA VC (−35.9 (−77.8, 5.9) HU, P = 0.09). There was no difference in lumbar spine BMD and serum phosphate, calcium and parathyroid hormone levels between groups. Limitations to the study include small sample size and loss to follow up.

Conclusions:  Lanthanum carbonate was associated with reduced progression of aortic calcification compared with CC in HD patients over 18 months.
Slow vs standard up‐titration of paroxetine in the treatment of panic disorder: A prospective randomized trial
Authors: Buoli Massimiliano , Dell'Osso Bernardo , Bosi Monica Francesca , Altamura Carlo
Published: October 2010

Aim:  Patients with panic disorder (PD) might be sensitive to the stimulating effects of selective serotonin reuptake inhibitors (SSRI), thus requiring low dosages at treatment initiation. The aim of the present study was to assess eventual differences in terms of effectiveness and tolerability between a slow up‐titration with paroxetine and a standard one.

Methods:  In an open randomized, multicenter, primary‐care study, 60 patients (44 women and 16 men) with PD with or without agoraphobia were enrolled and randomized to receive a slow up‐titration with paroxetine (increments of 2.5 mg/day every 2 days) or a standard one (increments of 10 mg/day every week) up to a maximum daily dose of 20 mg. Repeated‐measures anova on sub‐items scores of the Panic Attack Anticipatory Anxiety Scale (PAAS) and Dosage Record and Treatment Emergent Symptom Scale (DOTES), respectively, used as outcome measures of effectiveness and tolerability, were performed. Significance level was set at 0.05 and it was not corrected.

Results:  anova showed no differences between the two treatments in terms of effectiveness and tolerability. Post hoc analysis found only one significant difference in the intensity of spontaneous panic attacks (Panic and Anticipatory Anxiety Scale) in the first 9 days of treatment between the two treatment groups, which was that this item was less intense in the slow‐titration group (treatment effect: F = 4.89, P = 0.03, effect size = 0.1).

Conclusion:  Present findings suggest only a small superiority for a slow up‐titration regimen of paroxetine compared to a standard one in the first 9 days of treatment but no differences at end‐point.
Hyperinsulinemia associated with overweight medicated bipolar patients during full remission
Authors: Chung Kuo‐Hsuan , Tsai Shang‐Ying
Published: October 2010

Aims:  Insulin resistance, quantified by hyperinsulinemia, has been identified as a preclinical state for metabolic syndrome. Acute medicated bipolar patients are vulnerable to hyperinsulinemia in early remission. We examined the proportion of fasting serum insulin levels in remitted bipolar patients and considered what factors may contribute to hyperinsulinemia.

Methods:  Measurements taken in this study included the fasting plasma levels of insulin, glucose, triglycerides, total cholesterol, high‐density‐lipoprotein‐cholesterol, low‐density‐lipoprotein‐cholesterol, and the body mass index (BMI) among 56 bipolar I manic patients in full remission. We examined serum insulin levels in order to explore the correlation between and within the hyperinsulinemia and non‐hyperinsulinemia groups.

Results:  A total of 15 patients (26.8%) were identified as having hyperinsulinemia. Among all factors, only BMI was associated with higher serum insulin level (BMI ≥ 24: odds ratio of 8.57; P < 0.01; 95% confidence interval, 1.65–44.43).

Conclusion:  Hyperinsulinemia was not more prevalent in medicated euthymic bipolar patients compared with the general population. However, increasing bodyweight may make these patients more vulnerable to hyperinsulinemia, irrespective of their mood stabilizers or antipsychotics. Weight management should not be ignored in euthymic bipolar patients to prevent the preclinical state for metabolic syndrome.
Utility and sufficiency of psychiatric inpatient units in general hospitals: A cross‐sectional study in Tokyo
Authors: Hatta Kotaro , Nakamura Hiroyuki , Usui Chie , Kurosawa Hisashi
Published: October 2010

In order to investigate the utility and sufficiency of psychiatric beds in general hospitals (GHP beds), a cross‐sectional study was performed in general hospitals all over Tokyo. Reasons for admission were acute‐phase treatment (43%), medical comorbidity (15%), electroconvulsive therapy (13%), differential diagnosis (12%), and others (17%). The number of patients who could not be admitted to GHP beds despite appropriate reasons for admission was estimated to be greater than that of inpatients without indispensable reasons for admission to GHP beds on the day of the survey. GHP beds played the expected roles, and were in short supply.
Clinical characteristics of children with 2009 pandemic H1N1 influenza virus infections
Authors: Dubnov‐Raz Gal , Somech Raz , Warschawski Yaniv , Eisenberg Gilad , Bujanover Yoram
Published: October 2010

Background:  Further understanding of the clinical manifestations, hospital course and treatment options of the 2009 pandemic H1N1 influenza virus (H1N1) is needed in preparation for future outbreaks.

Methods:  Seventy‐three children with polymerase‐chain‐reaction‐confirmed infections with H1N1 treated in a tertiary care medical center in Israel were included in the study. Clinical data were extracted from medical records, and analyzed by hospitalization status or the presence of underlying chronic medical conditions.

Results:  Prevalent symptoms were fever, cough and shortness of breath, with additional findings of conjunctivitis, seizures, chills, dizziness, purpuric rash and chest pain. Hospitalized patients were more likely to have shortness of breath (OR 26.7, 95%CI: 3.5–1150), abnormal lung auscultation (OR 11.6, 95%CI: 2.8–67), abnormal X‐ray (OR 3.3, 95%CI: 1.1–9.6), and a chronic illness (OR 5.4, 95%CI: 1.8–17), compared with non‐hospitalized ones. Disease manifestations were similar between children with or without chronic diseases. Only two (2.7%) children required intensive care, and no deaths were recorded. A high rate (18%) of thrombocytopenia was found. One child had rapid symptom resolution after intravenous immunoglobulin treatment.

Conclusion:  H1N1 infection follows a mild course, even in the presence of severe underlying diseases. Abnormal respiratory findings and the presence of a chronic disease probably contributed to the decision to hospitalize patients. A rapid resolution of H1N1 symptoms after intravenous immunoglobulin treatment warrants further study, and could be a possible therapeutic option for severe cases.
A short course for surgical supervisors and trainers: effecting behavioural change
Authors: Copertino Nicolas , Blackham Ruth , Hamdorf Jeffrey M.
Published: October 2010

Background:  The Supervisors and Trainers for the Surgical Education and Training (SAT SET) course was developed to assist surgical trainers in Australia and New Zealand with the transition to the new Surgical Education and Training framework. The aim of this study was to assess whether attendance at the course translated into behavioural change in surgical trainers and supervisors.

Methods:  An online survey tool was distributed to registered participants in the SAT SET Course. Demographic data, attitudes towards the course and perceived behavioural change since attendance was measured. Data was collected using a 5‐point Likert Scale with room for occasional free text comments.

Results:  A 35% response rate was achieved for the study. Most thought the course was well designed, easy to follow and met its key aims. The majority felt more comfortable with the use of the new in‐training assessment tools and had gained a more structured approach to analyse their trainees' performance. Most felt their roles as supervisors had been improved by attending the SAT SET course. Informal feedback to trainees had increased; however, structured feedback rates remained low. Fears that the new system would increase the workload on supervisors did not seem to have materialized. Of the respondents, 43% considered that objective assessment of trainees had improved without fear of legal implications.

Conclusions:  The SAT SET course appears to have been well received and has helped better inform participants of their roles and has resulted in an appreciable positive behavioural change in their practice as surgical supervisors.
The surgical art of Barbara Hepworth and the Garnett Passe and Rodney Williams foundation
Authors: Kane Kevin
Published: October 2010

The Garnett Passe and Rodney Williams Foundation, a major medical research foundation in Melbourne, holds two paintings by the celebrated British sculptor and artist Dame Barbara Hepworth. It recently acquired the second painting by her depicting the Foundation's nominal patron, Garnett Passe, performing a tonsillectomy. These works are two of a large series of surgical paintings she made in the years 1947 to 1949.

This article gives an account of Barbara Hepworth and the surgical series of paintings and her relationship to Garnett Passe, the Australian ENT surgeon and Norman Capener, the British orthopaedic surgeon who introduced her into this subject.

Barbara Hepworth's meeting with these two surgeons produced one of the most remarkable series of surgical paintings and drawings ever produced in Western Art.