bluuebunny/crossref_metadata_2025 huggingface dataset:
Colorectal carcinoma among Indigenous people: a public hospital‐based study in Townsville and Cairns, North Queensland, Australia
Authors: Lu Ping‐Yan , Turner Richard , Roberts Val , Ho Yik‐Hong
Published: November 2005

Introduction:  There are very little clinical and pathological data on colorectal cancer among Indigenous people in Australia.

Methods:  A retrospective study on Indigenous patients treated for colorectal cancer at the Townsville and Cairns Base Hospitals from 1999 to 2004 was carried out in order to better characterise this disease in the Indigenous population.

Results:  There were 25 patients (12 M, 13 F) with a median age of 57.3 years. The majority (56%) of the tumours were left‐sided, being in the sigmoid colon, rectosigmoid junction and rectum. Of the patients, 60% had American Joint Committee on Cancer (AJCC) staging system Stage I and II disease at presentation. There was a relatively high proportion of poorly differentiated adenocarcinomas (40%). Six patients died of the disease. The median follow‐up was 20.5 months (range 2−51).

Conclusions:  Comparisons were made with available data on colorectal cancer in the general Australian population. The limitations and deficiencies of the study, as well as problems of data collection on Indigenous people were discussed.
Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy
Authors: Soon Patsy S. H. , Magarey Christopher J. , Campbell Peter , Jalaludin Bin
Published: November 2005

Background:  Hypocalcaemia from hypoparathyroidism is a complication of total thyroidectomy. The aim of the present study was to determine whether an early postoperative level of serum parathyroid hormone (PTH) after total thyroidectomy predicts the development of significant hypocalcaemia and the need for treatment.

Methods:  Patients undergoing total thyroidectomy had their serum level of intact PTH checked 1 h after removal of the thyroid gland. Serum calcium level was checked on the following morning. Oral calcium and/or calcitriol was commenced if the patient developed hypocalcaemic symptoms, or if the corrected serum calcium level was <2.0 mmol/L.

Results:  Seventy‐nine patients were included in the present study. Thirteen patients had symptoms of hypocalcaemia on postoperative days 1 or 2 and 66 patients remained asymptomatic. The postoperative intact PTH, day 1 calcium and day 2 calcium was 0.32 ± 0.60 pmol/L, 2.01 ± 0.11 mmol/L, and 2.02 ± 0.16 mmol/L, respectively, for the symptomatic group and 1.98 ± 1.25, 2.21 ± 0.13, and 2.19 ± 0.14, respectively, for the asymptomatic group. Calcium support was given to 25 patients, of whom 14 also required calcitriol.

Conclusion:  Serum PTH 1‐h after total thyroidectomy is a reliable predictor of hypocalcaemia and can allow safe early discharge of patients from hospital.
Drainage of hepatic hydatid cyst with a surgiport
Authors: Lam Vincent W. T. , . Merrett Neil D
Published: November 2005

This article describes the safe and effective technique of hepatic hydatid cyst drainage.
Group Attachment and the Reduction of Value‐Driven Ambivalence
Authors: Rudolph Thomas J.
Published: November 2005

This article analyzes the effects of value‐driven ambivalence and group attachment on response variability in public attitudes toward campaign finance reform. The analysis demonstrates that group attachment, when activated by affective cues, moderates the effects of ambivalence on response variability. By tipping the balance of considerations in one direction or the other, group attachments make it easier for ambivalent respondents to make tradeoffs between competing values during policy choices and, as a result, dampen response variability. Methodologically, the results offer an important cautionary note about the use of linear ambivalence scales by calling into question the assumption that indifference is an intermediate state between preference and ambivalence.
NON‐WAGE LABOUR COSTS, POLICY UNCERTAINTY AND LABOUR DEMAND – A THEORETICAL ASSESSMENT
Authors: Chen Yu‐Fu , Funke Michael
Published: November 2005

Labour costs in various European countries have reached a record high in recent years. The topic of non‐wage labour costs is therefore increasingly being discussed among and between the political parties because non‐wage labour costs are likely to have major negative effects on employment. We follow the real options approach, which allows us to investigate the value to a firm of waiting to adjust labour when the firm's wage and non‐wage costs are stochastic and adjustment costs are sunk. Simulation exercises show that the interaction between hiring and firing costs, non‐wage labour costs and uncertainty can have important ramifications for employment dynamics.
TRAINING AND ESTABLISHMENT SURVIVAL
Authors: Collier William , Green Francis , Peirson John
Published: November 2005

Training decisions are affected by beliefs about the returns to training, surrounding which firms face considerable uncertainty. We model the consequent association between training, profitability and establishment survival. We propose a plausible definition of optimism about training effectiveness, and show that more optimistic firms train more. We then present estimates of the relationship between training and the likelihood of medium‐term commercial survival. We find that increased training of non‐manual workers in large establishments is associated with a greater chance of survival; however, disaggregation reveals that the association differs across occupational groups. In smaller establishments, increased training for Craft and Technical workers is associated with better chances of survival, while for Professional workers the opposite effect is found.
CONVERGENCE IN THE UK SERVICE SECTOR: FIRM LEVEL EVIDENCE, 1988–1998
Authors: Girma Sourafel , Kneller Richard
Published: November 2005

Bernard and Jones (1996) have previously argued that similarity in the technologies used by firms in the service sector helps to explain evidence of absolute convergence at the cross‐country level. This paper searches for convergence at the firm level using data for the UK service sector over the period 1988–1998. Initial mixed support for this view is partly explained by strong business cycle effects in the data. Upon closer examination we find evidence that convergence was more likely in industries that had high levels of technology investment, greater exposure to new technologies and high levels of absorptive capacity.
THE NEW THEORY OF COMMERCIAL BANKING AND BANK LENDING BEHAVIOR
Authors: Ahtiala Pekka
Published: November 2005

This paper studies the bank's lending decision, based on three observed phenomena: banks earn substantial profits from off‐balance sheet activities and services, which they take into account in their lending decisions. Secondly, the critical point in the customer relation is the loan decision: the probability of the customer staying with the bank is a function of the loan extended each time one is applied for. Third, what is at stake in the loan decision is the expected value of the entire customer relation, which is the probability times the present value of expected future profits. The bank is a maximizer of this expected present value, while making decisions on individual loan applications. It is shown that the bank is in a corner solution with respect to its good customers, and other customers often have an incentive to get to a corner. Therefore, corner solutions may be the rule rather than the exception in the bank's customer relations, and there is no mechanism making the bank indifferent, at the margin, between lending to different customers. It can be optimal to extend loans to (present and expected future) good customers at an interest rate loss. A rationed customer with a concave enough probability function can receive a larger loan by asking for less. Loyalty increases the customer's value to the bank but improves its loan terms only if the customer makes it conditional on the loan extended.
Understanding the social organisation of maternity care systems: midwifery as a touchstone
Authors: Benoit Cecilia , Wrede Sirpa , Bourgeault Ivy , Sandall Jane , Vries Raymond De , Teijlingen Edwin R. van
Published: November 2005

Theories of professions and healthcare organisation have difficulty in explaining variation in the organisation of maternity services across developed welfare states. Four countries – the United Kingdom, Finland, the Netherlands and Canada – serve as our case examples. While sharing several features, including political and economic systems, publicly‐funded universal healthcare and favourable health outcomes, these countries nevertheless have distinct maternity care systems. We use the profession of midwifery, found in all four countries, as a ‘touchstone’ for exploring the sources of this diversity. Our analysis focuses on three key dimensions: (1) welfare state approaches to legalising midwifery and negotiating the role of the midwife in the division of labour; (2) professional boundaries in the maternity care domain; and (3) consumer mobilisation in support of midwifery and around maternity issues.
What's in a care pathway? Towards a cultural cartography of the new NHS
Authors: Pinder Ruth , Petchey Roland , Shaw Sara , Carter Yvonne
Published: November 2005

Maps are increasingly understood as socio‐cultural and political constructs, rather than mirrors of nature. Drawing on the insights of cultural cartographers, this paper presents a critical analysis of a specific instance of map‐making in health policy, namely the growing use of care pathways in care planning and service delivery. Widely regarded to date as devices for ensuring quality of care, equity of treatment, optimal resource allocation and a rational division of labour between healthcare professionals, they have been seen as helpful – and technically neutral – tools for routing patients through the system. By contrast, we argue that the metaphors are misleading: lived experience and its objectification in pathway maps continually re‐create one another, as we explore the slippage between map, map‐making and mapping. This paper is based on interviews and observations with a variety of healthcare workers in three areas of south eastern England. We trace the development of a series of pathways‐in‐process, and show how they configure the patient, highlighting some aspects of their experiences, whilst silencing others. We also analyse the role of pathways in the carving up and surveillance of space round the emergence of the ‘hybrid professional’, particularly new practitioners such as GP specialists, specialist nurses, extended scope therapists and others. In considering the wider implications of care pathways as part of the contemporary discourse on policy, the paper critiques the rationalist, and sometimes evangelical assumptions underpinning their current popularity. In particular, we suggest that a critical and processual understanding of pathways might contribute to a more informed appreciation of their potential (and their limitations) as mechanisms for healthcare policy implementation.
Telephone triage, expert systems and clinical expertise
Authors: Greatbatch D. , Hanlon G. , Goode J. , O'Cathain A. , Strangleman T. , Luff D.
Published: November 2005

This paper reports on a qualitative study of the use of an expert system developed for the British telephone triage service NHS Direct. This system, known as CAS, is designed to standardise and control the interaction between NHS Direct nurses and callers. The paper shows, however, that in practice the nurses use CAS in a range of ways and, in so doing, privilege their own expertise and deliver an individualised service. The paper concludes by arguing that NHS Direct management's policy of using CAS as a means of standardising service delivery will achieve only limited success due not only to the professional ideology of nursing but also to the fact that rule‐based expert systems capture only part of what ‘experts’ do.
Reinstating the value of teachers’ tacit knowledge for the benefit of learners: using ‘Intensive Interaction’
Authors: Nind Melanie , Thomas Gary
Published: November 2005

The challenge of inclusion makes timely a review of the assumptions and precepts about teaching and learning that have dominated the discourse of special education. These have led to methodological and technical predilections which we argue have been damaging for pedagogy and for learners, often moving the focus away from the tacit knowledge and reflective skill of the teacher to a set of formulaic prescriptions for practice. This is true of special education generally and of the education of those with severe learning disabilities in particular. In this paper we urge a move to reinstate teachers’ confidence in their own knowledge and skills. We develop our argument using an exemplar of a naturalistic approach for teaching people with severe disabilities. The approach, Intensive Interaction, originated in the UK and aims to enhance the quality of teacher‐learner interaction by drawing from processes observed in caregiver‐infant interaction.
The effects of the Primary Movement programme on the academic performance of children attending ordinary primary school
Authors: Jordan‐Black Julie‐Anne
Published: November 2005

The present study investigated the prevalence of a primary reflex (the Asymmetrical Tonic Neck Reflex) in children attending ordinary primary school and how this related to attainments in a number of academic areas. The effectiveness of a specific movement intervention programme in reducing primary reflex persistence and improving academic attainment was also evaluated.

A comparative study of the progress of 683 children over a two‐year period from Years 3 and 5, who completed an intervention programme known as Primary Movement, was carried out using the relative attainments of children at the same schools and standardised scores as baseline and follow‐up measures. A second, quasi‐experimental study followed the progress of four parallel groups in each of two large schools with the experimental side completing the movement intervention programme while the other side acted as the control.

It was found that ATNR persistence was significantly associated with level of attainments in reading, spelling and mathematics and that boys were more at risk than girls for ATNR persistence. In both studies, it was found that the movement intervention programme had a very significant impact on reducing the levels of ATNR persistence in children and that this was associated with very significant improvements in reading and mathematics, in particular.

This research provides further evidence of a link between the attainment of core educational skills and the interference that may result from an underlying developmental deficit. The effectiveness of the intervention programme in reducing ATNR persistence and in increasing academic attainments suggests that this programme could be used to complement other strategies that have been shown to have a positive effect on children's learning.
Amblyopia prevalence and cigarette smoking by women
Authors: Lempert Philip
Published: November 2005

The relationship between cigarette smoking by young women and amblyopia in children was investigated in 13 population groups. Two searches were conducted on Medline using the following keywords for the first search: amblyopia, prevalence or incidence, and the names of specific countries. The keywords for the second search were smoking, cigarettes, women and the names of the same specific countries. Relevant articles were reviewed. A positive relationship between the rate of smoking among women and the prevalence of amblyopia in school‐aged children and military recruits was found. The Pearson correlation coefficient was 0.73. The occurrence of decreased visual acuity attributed to amblyopia in disparate population groups is directly related to rates of cigarette smoking by young women.
The management of systemic hypertension in optometric practice
Authors: Hurcomb Peter G. , Wolffsohn James S.
Published: November 2005

Aim:  Systemic hypertension is a silent killer that may have very few warning signs. This study examines detection and management of patients with cardiovascular disease (CVD) by optometrists in the UK.

Method:  A survey was sent out to 1402 optometrists who practice in the UK to investigate the nature and knowledge of detection of systemic hypertension.

Results:  The survey response rate was 37%. Optometrists were neutral to slightly positive towards the use of blood pressure (BP) monitors, but not on a routine basis. The most frequently asked question during history and symptoms concerned the patient's prescribed medication for systemic hypertension, and the least was that of specifying the last BP measurement. The additional test most widely used in the examination of the systemic hypertensive patient was direct ophthalmoscopy with red‐free filter. Over one‐tenth of optometric practices had a BP monitor, with automated devices being the most popular. Patients most likely to have their BP measured were suspect systemic hypertensives. Retinal haemorrhages are the most important finding in influencing an optometrist's referral criteria for suspected systemic hypertension.

Conclusion:  Although optometrists monitor the retina for signs of damage from systemic hypertension, further education in this important condition is warranted.
Association between human leukocytes antigen alleles and chronic hepatitis C virus infection in the Korean population
Authors: Yoon Seung Kew , Han Joon Yeol , Pyo Chul‐Woo , Yang Jin Mo , Jang Jeong Won , Kim Chang Wook , Chang U Im , Bae Si Hyun , Choi Jong Young , Chung Kyu Won , Sun Hee Sik , Choi Hee Baeg , Kim Tai‐Gyu
Published: November 2005

Abstract: Background/Aim: Recent data have shown that the clinical outcome of hepatitis C virus (HCV) infection may be influenced by the host genetic factor. The aim of this study was to investigate whether particular human leukocytes antigen (HLA) molecules are associated with the susceptibility to HCV infection in the Korean population.

Methods: One hundred and thirty‐seven patients with chronic HCV infection and 206 normal individuals were examined for HLA class I and II molecules.

Results: In class I antigens, the frequencies of HLA‐A3 (relative risk (RR)=3.5, P<0.04), HLA‐B35 (RR=2.0, P<0.03), and HLA‐B46 (RR=2.5, P<0.02) significantly increased in chronic HCV carriers compared with the controls. The frequencies of DRB1*0803, DQB1*0601 and DQB1*0604 were significantly higher in chronic HCV carriers than in controls (RR=2.5, P<0.005; RR=1.8, P<0.05; RR=1.9, P<0.04, respectively). On the other hand, the frequencies of DRB1*0301, DQA1*0501 and DQB1*0201 were significantly lower in chronic HCV carriers than in normal controls (RR=0.2, P<0.03; RR=0.4, P<0.004; RR=0.5, P<0.02, respectively). The haplotype DRB1*0803−DQB1*0601 significantly increased (RR=2.5, P<0.02) while the DQA1*0501−DQB1*0201 significantly decreased (RR=0.2, P<0.03) in chronic HCV carriers compared with normal controls. In stratification analysis to investigate the interrelationships among the associated alleles, DRB1*0803 and DQB1*0601 were associated with HLA‐B46, particularly in patients with chronic HCV carriers.

Conclusions: These results suggest that particular HLA alleles may have an influence on chronic HCV infection as a host genetic factor in the Korean population.
Low fibrosis progression of recurrent hepatitis C in apolipoprotein E ɛ4 carriers: relationship with the blood lipid profile
Authors: Fabris Carlo , Toniutto Pierluigi , Bitetto Davide , Minisini Rosalba , Smirne Carlo , Caldato Maya , Pirisi Mario
Published: November 2005

Abstract: Background: The histological outcome of chronic hepatitis C is better among carriers of the apolipoprotein E (ApoE) ɛ4 allele, for reasons unknown. The orthotopic liver transplantation (OLT) setting allows to separate the role played by liver‐derived ApoE (graft) from ApoE of different origin (recipient).

Patients and methods: Forty‐six OLT recipients with recurrent hepatitis C were studied. Grafts and recipients were genotyped for ApoE. In a follow‐up extending up to 4 years, the serum triglycerides‐to‐cholesterol ratio (T/C ratio) was measured 1 year after OLT, whereas fibrosis progression was assessed yearly and expressed as fibrosis units/month (FU/mo).

Results: A T/C ratio ≤0.75 was observed in 13/15 cases in which both donor and recipient were ɛ4 carriers, 10/19 cases in which ɛ4 alleles were of exclusive recipient's origin and 5/12 cases in which ɛ4 alleles were of exclusive donor's origin or absent (P<0.02). One year after OLT, a fibrosis progression ≤0.100 FU/mo was associated with a low T/C ratio (24/34 vs. 4/12, P<0.05). An Ishak staging score >2 was reached later by male recipients who were ɛ4 carriers (P<0.002).

Conclusions: Recipient's carriage of ApoE ɛ4 affects fibrosis progression of recurrent hepatitis C through gender‐specific mechanisms, associated with a peculiar, ApoE‐associated, lipid profile.
Portal hypertension: from pathophysiology to clinical practice
Authors: Laleman Wim , Van Landeghem Lien , Wilmer Alexander , Fevery Johan , Nevens Frederik
Published: November 2005

Abstract: Portal hypertension (PHT) is responsible for the more severe and often lethal complications of cirrhosis such as bleeding oesophageal varices, ascites, renal dysfunction and hepatic encephalopathy. Because of the combined impact of these complications, PHT remains the most important cause of morbidity and mortality in patients with cirrhosis. Over the years, it has become clear that a decrease in portal pressure is not only protective against the risk of variceal (re)bleeding but is also associated with a lower long‐term risk of developing complications and an improved long‐term survival. A milestone in therapy was the introduction of non‐selective β‐blockers for the prevention of bleeding and rebleeding of gastro‐esophageal varices. However, in practice, less than half the patients under β‐blockade are protected from these risks, supporting the overall demand for innovation and expansion of our therapeutic armamentarium. Recent advances in the knowledge of the pathophysiology of cirrhotic PHT have directed future therapy towards the increased intrahepatic vascular resistance, which, in part, is determined by an increased hepatic vascular tone. This increased vasculogenic component provides the rationale for the potential use of therapies aimed at increasing intrahepatic vasorelaxing capacity via gene therapy, liver‐selective nitric oxide donors and statines on the one hand, and at antagonizing excessive intrahepatic vasoconstrictor force through the use of endothelin antagonists, angiotensin blockers, α1 adrenergic antagonists or combined α1‐ and non‐selective β‐blockers or somatostatin analogues on the other. The focus of this review is to give an update on the pathophysiology of PHT in order to elucidate these potential novel strategies subsequently.
Noninvasive assessment of liver steatosis, fibrosis and inflammation in chronic hepatitis C virus infection
Authors: Schneider A. R. J. , Teuber G. , Kriener S. , Caspary W. F.
Published: November 2005

Abstract: Background: Duplex–Doppler ultrasound is a noninvasive method for the assessment of hepatic hemodynamics beyond conventional gray‐scale imaging. The clinical value of the method for the grading and staging of chronic hepatitis C virus (HCV) infection and the prediction of hepatic steatosis still has to be determined. This study aimed to compare Duplex–Doppler and ultrasound with the histologic staging and the estimation of hepatic steatosis in chronic HCV infection.

Patients and methods: One hundred and nineteen consecutive patients with chronic HCV infection underwent both liver biopsy and ultrasound with Duplex–Doppler. Maximum portal venous blood flow velocity, portal venous flow undulation, hepatic venous flow pattern and spleen size were assessed and compared with histologic findings. Histologic grading and staging was performed according to the modified HAI and hepatic steatosis was estimated.

Results: Doppler ultrasound was unable to discriminate between different degrees of fibrosis. Sensitivity/specificity of portal venous flow and undulations for the diagnosis of hepatic cirrhosis was 74.5%/53% and 76.5%/100%. The PPV and NPV of reduced undulations was 100% and 96.2%. Mono‐ or biphasic hepatic venous flow indicated advanced hepatic steatosis (sensitivity 88.2%, specificity 74.5%, PPV 36.6%, NPV 97.5%). Spleen size was significantly enlarged both in patients with cirrhosis and steatosis.

Conclusions: Although Duplex–Doppler of the portal and hepatic veins is not a substitute for histologic grading and staging, portal vein undulations can predict liver cirrhosis with considerable accuracy. Moreover, triphasic patterns of hepatic venous flow virtually exclude significant fatty liver disease. Additional studies should perform intraindividual follow‐up investigations to further define the role of Duplex–Doppler ultrasound in chronic HCV infection.
Usefulness of urine strip test in the rapid diagnosis of spontaneous bacterial peritonitis
Authors: Kim Do Young , Kim Jie Hyun , Chon Chae Yoon , Han Kwang‐Hyub , Ahn Sang Hoon , Kim Ja Kyung , Paik Yong Han , Lee Kwan Sik , Moon Young Myoung
Published: November 2005

Abstract: Purpose: Rapid and accurate diagnosis of spontaneous bacterial peritonitis (SBP) is mandatory for timely treatment in cirrhotic patients. The purpose of this study was to assess the usefulness of two different reagent strips, the UriSCAN and the Multistix10SG, for the rapid bedside diagnosis of SBP.

Methods: A total of 75 paracenteses in 53 cirrhotic patients with ascites were performed. All ascitic fluid was analyzed with the two reagent strips, and compared with the manual cell count with differential and ascitic fluid culture. SBP was defined as an ascitic polymorphonuclear cell count ≥250/mm3.

Results: SBP was diagnosed in 18 of the 75 samples. If we considered the positive UriSCAN result of 2 or more, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were all 100%. When we considered the positive UriSCAN result of 3, the sensitivity, specificity, PPV, and NPV were 67%, 100%, 100%, and 89%, respectively. When we considered the positive Multistix10SG result of 3, the sensitivity, specificity, PPV, and NPV were 50%, 100%, 100%, and 87%, respectively.

Conclusion: Urine reagent strip might be useful for rapid and accurate diagnosis of SBP in cirrhotic patients with ascites.
Multiple aneurysms in an Iranian patient with neuro‐Behcet's disease
Authors: GHORBANI Askar , SHAHRAM Farhad , MONSHI Babak , NADJI Abdolhadi , DAVATCHI Fereydoun
Published: November 2005

Arterial aneurysm, despite its rarity, is a characteristic feature of Behcet's disease. Although involvement of different arteries has been reported in the literature, few cases of carotid or subclavian aneurysms have been reported. We present here a 22‐year‐old Iranian man with Behcet's disease presenting with neurological problems (such as headache, seizure, hemiparesis, internuclear ophthalmoplegia, dysarthria and mental problems), and absent left radial pulse. He was diagnosed by digital subtraction angiography, as having multiple ischemic lesions in the brainstem, as well as multiple aneurysms in the territory of carotid and subclavian arteries. To our best knowledge this is the first case of multiple aneurysms of these arteries in a patient with Behcet's disease. Its unusual presentation as a neuro‐Behcet case, associated with hand pulselessness is the outstanding feature of this case.
Randomized clinical trials of osteoarthritis: a review
Authors: BAYAT Noushin , KEEN Helen I. , HILL Catherine L.
Published: November 2005

Aim:  The objective of this study was to review published randomized clinical trials (RCTs) of osteoarthritis (OA) in three time periods to determine the characteristics of RCTs and the types of outcome measures used and whether any changes have occurred.

Methods:  We identified RCTs assessing clinical efficacy of treatments for osteoarthritis published in English in 1987/1988, 1997/1998 and 2001/2002, using MEDLINE. RCTs were then assessed for baseline disease characteristics, treatment type and outcome measures utilized. We classified outcome measures into 10 broad subgroups.

Results:  The number of RCTs increased with each time period (31 in 1987/1988; 36 in 1997/1998; 91 in 2001/2002). The majority of RCTs were of knee, hip or both (94% in 1987/1988, 69% in 1997/1998, 71% in 2001/2002). The median duration of RCTs for all three time periods was ≤ 3 months. In 1987/1988, nonsteroidal anit‐inflammatory drugs (NSAIDs) accounted for 65% of RCTs. In 1997/1998, NSAID/COX‐2 trials accounted for 41.7%, with glucosamine (14%) and hyaluronan (11%). In 2001/2002, 28% of RCTs were related to NSAID/COX‐2 inhibitors and 25% to complementary therapies. The median number of participants was unchanged over the three time periods. The median number of outcome measures used at all three time periods was four (range 1–8). The most commonly used outcome measures were: (i) symptoms (pain, stiffness); (ii) function; (iii) global assessment (patient, physician); and (iv) composite scores (such as Western Ontario and McMaster [WOMAC] Osteoarthritis index) in order of use. There has been significant increase in use of function and composite score as outcome measures.

Conclusion:  There has been a recent increase in both the number and variety of therapeutic interventions for OA. This study shows that currently a wide variety of outcome measures are used. This reinforces the importance of using standardized responder criteria, such as the OMERACT‐OARSI set of responder criteria, which incorporate pain, function and patient's global assessment.
Position 247 of the β2‐glycoprotein I gene polymorphism in Chinese patients with antiphospholipid syndrome
Authors: CHEN Pei−Chih , LIU Ming‐Fei , GUO How‐Ran , LIANG Chun‐Ching , WANG Chrong‐Reen
Published: November 2005

Aims:  This study investigates the relationship between β2GPI gene polymorphism and antiphospholipid syndrome (APS) in Chinese subjects.

Methods:  Twenty‐five APS patients, 80 lupus patients and 100 healthy individuals were enrolled into the study. The genetic polymorphism of position 247 of β2GPI gene was analyzed by the restriction fragment length polymorphism polymerase chain reaction.

Results:  Low frequency of V allele was noted in these Chinese. The frequency of V allele was similar among healthy individuals, lupus patients and APS patients. There was statistically significant correlation between the V allele expression and the presence of anti‐β2GPI antibodies.

Conclusion:  The inter‐population differences exist in β2GPI gene polymorphism. Although there was no association of V allele at the position 247 with the Chinese APS patients, significant correlation was found between the V allele expression and the presence of anti‐β2GPI antibodies.
C3 and C4 hypocomplementemia and associated diseases in Arabians
Authors: KOSHAK Emad A.
Published: November 2005

Background:  Hypocomplementemia, which is a state of decrease in the complement (C) proteins in the serum, is frequently encountered in a wide range of diseases.

Objective:  To explore the diversity of C3 and C4 hypocomplementemia and associated diseases in patients seen at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia.

Methods:  Serum samples send to the clinical immunology laboratory with requests for the measurements of C3 and C4 tests by nephelometry were studied. Files of patients with C3 and/or C4 hypocomplementemia were reviewed for demographic and diagnostic data.

Results:  Out of 270 complement tests, C3 and/or C4 hypocomplementemia was found in 196 different tests (72.6%), and only 175 tests were studied. Their ages ranged between 1 week and 81 years (mean 26 ± 17 SD), and female sex was predominant in 143 tests (81.3%). Hypocomplementemia was detected as follows: C3 in 64 tests (23.7%) with sole C3 in 3 tests only (1.5%); C4 in 193 samples (71.5%) with sole C4 in 132 tests (67.3%); and combined C3 with C4 hypocomplementemia in 61 tests (22.6%). Cross‐tabulation revealed that 95% of C3 hypocomplementemia were significantly associated with C4 hypocomplementemia (P < 0.001). Conversely, only 31% of C4 hypocomplementemia were significantly associated with C3 hypocomplementemia (P < 0.001). SLE was the predominant disease associated with hypocomplementemia in 104 tests (53.1%), followed by kidney diseases in 20 tests (10.2%) and chronic liver disease in eight tests (4.1%).

Conclusion:  C4 hypocomplementemia was a common laboratory verdict in patients at KAUH. Of interest, most of C3 hypocomplementemia tests were associated with C4 hypocomplementemia and lone C3 hypocomplementemia is rare. The diagnosis of systemic lupus erythematosus was the predominant disease associated with hypocomplementemia. Supplementary awareness of immunopathological mechanisms leading to involvement of complement proteins in many diseases is essential to enhance its clinical utility.
Etiopathogenic role of HLA‐B27 alleles in ankylosing spondylitis
Authors: AKKOC Nurullah , KHAN Muhammad Asim
Published: November 2005

HLA‐B27 is the major genetic susceptibility factor for ankylosing spondylitis (AS). However, its precise role in the pathogenesis of AS still remains unclear, even though its gene has been cloned and sequenced, and its crystallographic structure has been defined. Arthritogenic peptide and molecular mimicry hypotheses propose mechanisms related to an antigen‐presenting function of HLA‐B27 to be responsible for disease development. However, peculiar aspects of its immunobiology, such as its misfolding and heavy chain dimerization raise the possibility of involvement of pathogenic mechanisms unrelated to its physiological function. Moreover, HLA‐B27 is not a single allele, but a family of 31 different alleles, named HLA‐B*2701 to HLA‐B*2727. Studies worldwide indicate that the relatively common alleles (subtypes) HLA‐B*2705, B*2704, and B*2702 are strongly associated with AS, whereas HLA‐B*2706 which is prevalent in South‐east Asia and HLA‐B*2709 which is prevalent on the Italian island of Sardinia, seem to lack such an association. The distinction between the disease‐associated subtypes and those that are not associated, may provide clues to the actual role of HLA‐B27 in disease pathogenesis. B*2706 differs from B*2704 by only two residues, and B*2709 differs from B*2705 by only one residue. Moreover, both B*2706 and B*2709 bind an endogenous peptide (derived from vasoactive intestinal peptide type 1 receptor) and also an exogenous peptide (latent membrane protein 2 of Epstein‐Barr virus) but in two drastically diverse conformations. These recent X‐ray diffraction studies of individual peptides in the context of different HLA‐B27 alleles broaden our perception of the possible pathogenetic role of this molecule in the development of AS and related spondyloarthopathies. In summary, the pathogenetic role of HLA‐B27 in AS seem to be quite heterogenous, and cannot be explained by a single mechanism, and new ideas have been raised based on the aberrant immunobiologic features of HLA‐B27.
Can survival of systemic lupus erythematosus be further improved?
Authors: MOK C. C.
Published: November 2005

The survival rate with systemic lupus erythematosus (SLE) has improved tremendously in the past few decades, especially in developed countries. However, late mortality is still a great concern. Roughly, one out of six to seven patients is still at risk of death 10 years after SLE diagnosis. Early diagnosis and treatment of SLE and its related complications, and the judicious use of immunosuppression is the key to improving early mortality rates in this disease. To reduce late mortality, minimizing organ damage and prevention of SLE‐ or therapy‐related complications such as thromboembolism, osteoporotic fractures and premature menopause, is essential. This article discusses the various means that may help to further improve the outcome of SLE.
The differences between manifestations of rheumatoid arthritis in men and women
Authors: SOROOSH Soosan G. , SOROOSH Mohsen G. , DASTJERDI Farhad M. , FARAHVASH Mohammad H. , NADERI Alireza , VAHEDI Homayoon
Published: November 2005

Background:  Rheumatoid arthritis (RA) is a chronic, multisystemic disease of unknown aetiology. The main feature of RA is a symmetric, additive inflammatory arthritis of small peripheral joints. The disease is more common in women. There is some evidence about the role of sex in pathogenesis and clinical features of RA.

Aim:  The aim of this study is the recognition of the aspects of RA in female and male patients.

Method:  This study includes the RA patients referred to the RA Research Clinic of Imam Hospital, Tehran, Iran, between 1998 and 1999 of which 160 were selected. One hundred and twenty‐two were female and 38 male, showing a female to male ratio of 3 : 1.

Results:  The mean age at the time of diagnosis of RA was 37 and 43 years in women and men respectively. The mean duration of disease before diagnosis was 8.8 years in women and 5.8 years in men. The indices of pain, limitation of movement and swelling of joints were higher in women, but only for the pain indices was the difference between the two sexes stastistically significant. No statistically significant difference in joint deformity was found between the two sexes but erosive joint lesions were more common in women. Involvement of the small joints of the upper limbs was more prevalent in women but hip and cervical spine involvement was more frequent in men. Considering extra‐articular involvement, rheumatoid nodules, pulmonary and cardiac involvement and vasculitis was more prevalent in men but only for cardiac involvement was a statistically significant difference between the two sexes found. Rheumatoid factor was positive in 60% of both sexes. There was no statistically significant differences in lab tests and treatment strategy between the two sexes.

Conclusion:  RA has a more severe course and worse prognosis in women; however, extra‐articular involvement is more frequent in men.
Mortality in rheumatoid arthritis: time to take it seriously
Authors: ARSHAD Anwar , SHAHID Mohammed Shahdan
Published: November 2005

Rheumatoid arthritis (RA) is often regarded as benign and not a serious disease. Yet patients with RA have a substantially reduced life expectancy. Patients with RA are particularly at risk of death from cardiovascular disease, infection and renal disease. A few variables are now recognized as important predictive markers, such as disease duration, severity, sex, educational level and treatment.
Amphibian Breeding Distribution in an Urbanized Landscape
Authors: RUBBO MICHAEL J. , KIESECKER JOSEPH M.
Published: November 2005

Abstract:  Amphibians commonly use wetlands for breeding habitat, and given the concern about their ongoing global declines, the effects of urbanization on the breeding distribution of amphibians need to be quantified. Thus, we conducted a survey of the larval amphibian community in central Pennsylvania (U.S.A.) wetlands along an urbanization gradient. Wetlands in urban areas had less surrounding forest and wetlands and greater road density than rural wetlands. Urbanization was also associated with increases in hydroperiod (i.e., wetland permanency) and the presence of fish predators. Moreover, urban wetlands had lower larval amphibian species richness than rural wetlands. This decrease in richness was attributable to a decrease in occurrence of wood frogs (Rana sylvatica) and ambystomatid salamanders (Ambystoma maculatum and A. jeffersonianum) in urban sites. Wood frogs and ambystomatid salamanders were positively associated with the amount of forest surrounding sites and negatively associated with hydroperiod. As a result, we hypothesize that these species are sensitive to the effects of urban development. The remaining species in this study appear fairly resilient to the effects of urbanization. These data demonstrate the importance of quantifying both local and landscape attributes when describing the factors that limit the breeding distribution of amphibians. We recommend that to preserve amphibian biodiversity in urbanized landscapes, it is best to focus on regional diversity, which protects a variety of sites that encompass various hydroperiods, have adequate buffer habitat, and are connected by dispersal routes.
Quantifying Rarity, Losses, and Risks for Native Fishes of the Lower Colorado River Basin: Implications for Conservation Listing
Authors: FAGAN WILLIAM F. , KENNEDY CHRISTINA M. , UNMACK PETER J.
Published: November 2005

Abstract:  We examined spatial distributions of fishes native to the lower basin of the Colorado River (25 species) at three scales to determine percent decline from historical distributions based on a regional biodiversity database. We cumulated records from 1843 to 1980 to develop a “historical distribution” for each species and used those occurrences recorded from 1981 to 1998 as “modern” records. We then contrasted historical and modern distributions to (1) quantify losses in spatial distribution; (2) determine how strongly these losses and fragmentation patterns corresponded to the perceived risk of extinction of each species, as represented by its status under the IUCN Red List of Endangered Species; and (3) update extinction risk rankings for 15 fishes endemic to the lower Colorado Basin according to the IUCN criteria. Based on presence and absence data, fish fauna of the lower Colorado Basin have suffered massive distributional losses. On average, ranges of extant species have diminished more than 45% relative to their historical distribution, and 35% of species have lost 50% or more of their occurrences. We provide nine new IUCN rankings and six updates to reflect more accurately the heightened imperilment of these species. Based on our new rankings, 7 of the 15 lower Colorado Basin endemics are critically endangered, 1 is endangered, 2 are vulnerable, and 1 is already extinct. We categorize the remaining 2 endemics as lower risk. This work demonstrates the utility of matching quantitative spatial metrics such as the scale‐area slope statistic to extinction risk criteria for species whose persistence is strongly influenced by spatial distribution.
A Synthesis of Marine Conservation Planning Approaches
Authors: LESLIE HEATHER M.
Published: November 2005

Abstract:  In the last decade, there has been increasing interest—particularly among international nongovernmental and multilateral development organizations—in evaluating the effectiveness of conservation and development projects. To evaluate success, we need more comprehensive and case‐specific information on how conservation decisions are made. I report on a database that synthesizes information on 27 marine conservation planning cases from around the world. I collected data on each case's geographic scale, primary planning objective and outcome, legal and institutional context, degree of stakeholder involvement, and the ecological criteria and tools used to facilitate conservation decisions. The majority of cases were located in North and Central America, were regional in nature, and had biodiversity conservation as the primary planning objectives. Outcomes included priority‐setting plans and implementation of marine reserves and other types of marine protected areas. Governments and local nongovernmental organizations led more participatory processes than national and international nongovernmental organizations. Eleven cases considered ecological criteria first, whereas 16 relied on integrated criteria (ecological plus socioeconomic data and other pragmatic considerations) to select priority areas for conservation and management action. Key tools for data integration and synthesis were expert workshops, maps, and reserve‐selection algorithms (i.e., computer‐based tools for priority setting and reserve design). To facilitate evaluation of success, future documentation of marine conservation planning cases should include a standard set of ecological, social, economic, and institutional elements. To develop standards for effective marine conservation, a more diverse set of documented cases is needed; for example, those that failed were located outside North and Central America, focused on the local geographic scale, or were motivated by objectives other than biodiversity conservation.
Marine Conservation in Chile: Historical Perspective, Lessons, and Challenges
Authors: FERNÁNDEZ MIRIAM , CASTILLA JUAN CARLOS
Published: November 2005

Abstract:  Chile is one of the world's leading countries in landings (catch) of marine resources. The pioneer studies of human impacts on coastal marine communities provided the scientific basis on which to establish novel resource management strategies for exploited wild populations but were not used to develop a comprehensive marine conservation plan that would also include no‐take areas. We reviewed the development of marine conservation actions since approximately 1970 to date, focusing on the (1) complex legal framework for establishment of marine protected areas, (2) scientific grounds that provided the impetus to establish areas where exploitation is regulated, (3) private efforts that were critical to creating the first marine protected areas, and (4) lessons and constraints derived from this process as well as the challenges ahead. The existing legal tools for the protection of the ocean include natural sanctuaries, marine reserves, marine parks, national monuments, and management and exploitation areas for benthic resources. These instruments may be applied in coastal marine protected areas. It is remarkable that most of the existing marine protected areas in Chile are sponsored and administered by private organizations. We think the sequence in which the development of the different conservation instruments occurred, with a high priority reserved for initiatives tending to promote exploitation of the ocean (aquaculture and fisheries), poses challenges and constraints for establishing a network of marine protected areas that combine such apparently diametrically opposing goals as exploitation and preservation of marine species. More recently, the value of preserving biodiversity became evident with the creation of the first marine parks. We encourage more scientific information on patterns of biodiversity, biological processes, and assessment of human impact to be incorporated in the process to reach the goal of preserving 10% of the representative marine habitats along Chile's coast.