bluuebunny/crossref_metadata_2025 huggingface dataset:
Molekulare Aspekte und diagnostische Wertigkeiten von Pilzallergenen
Authors: Crameri R. , Hemmann Stefanie , Mayer Christina , Appenzeller U. , Blaser K.
Published: April 2009

Zusammenfassung. Die Klonierung, Sequenzierung und Produktion von hochreinen Allergenen bietet die Möglichkeit, perfekt standardisierte Allergenpräparate herzustellen. Die Entwicklung eines neuen Klonierungssystems, das auf filamentösen Phagen basiert, führte zu einer schnellen Isolierung und Charakterisierung von Aspergillus fumigatus‐Allergenen. Die auf diesem Weg rekombinant hergestellten Proteine wurden serologisch und klinisch geprüft und ihr routinemä‐ßiger Einsatz im ImmunoCAP‐System evaluiert. Es gelang eine quantitative Übereinstimmung zwischen Hauttestergebnissen und Serologie nachzuweisen, welche das Potential rekombinanter Allergene in der Diagnostik allergischer Krankheiten aufzeigt. Darüber hinaus trägt die Charakterisierung der Pilzallergene wesentlich zum Verständnis der moiekularen Natur der allergieauslösenden Komponenten bei Zum jetzigen Zeitpunkt können, abgesehen von Proteinen mit unbekannten biologischen Funktionen, die Pilzallergene in zwei Klassen eingeteilt werden: 1. Spezies‐spezifische sezcrnierte Allergene und 2. cytoplasmatische, hoch konservierte Proteine. Diese letztgenannten Pilzallergene zeigen auch zu Proteinen aus phylogenetisch weit entfernten Organismen weitreichende Sequenzhomologien. Neben der daraus zu erwartenden IgE‐Kreuzreaktivität findet man in einigen Fällen auch eine Kreuzreaktivität mit den homologen humanen Proteinen, was auf Autoimmunreaktionen, bei Pilzalleigien hindeutet.

Summary. Cloning, sequencing and production of highly pure recombinant allergens allows to produce perfectly standardised allergen preparations. The development of a new cloning system based on filamentous phage allowed the fast isolation and characterisation of allergens from the fungus Aspergillus fumigatus. The produced recombinant allergens were tested in serological and clinical studies as well as for their performance for routine assessments in the ImmunoCAP‐system. Thereby, a perfect correlation between skin test results and serology was found showing the potential of recombinant allergens for the diagnosis of allergic diseases. Moreover, the characterisation of fungal allergens substantially contributes to our understanding of the molecular nature of proteins involved in the elication of allergic reactions. Apart from allergenic proteins with unknown biological function, fungal allergens can be subdivided into two classes: 1. Species‐specific, secreted proteins and 2. cytoplasmic, even in phylogenetically distant organisms, well conserved proteins. These fungal allergens show extended sequence similarity, a high level of IgE cross‐reactivity and in some cases also cross‐reactivity with homologous human proteins indicating autoimmune reactions involved in fungal allergy.
Zur Bedeutung von sekretorischen und stukturassoziierten Proteasen von Aspergillus fumigatus für die Pathogenese der invasiven Aspergillose
Authors: Reichard U.
Published: April 2009

Zusammenfassung. Ein Charakteristikum der invasiven Aspergillose ist, daß Aspergillus fumigatus in der Lage ist, proteinreiche Gewebsschichten des Wirtes zu penetrieren. Verantwortlich hierfür könnten sekretorische Proteasen des Pilzes sein, die fibrilläre Proteine wie Kollagen oder Elastin aufweichen und so der Hyphe das Eindringen ermöglichen. Allerdings sprechen Infektionsversuche mit Gendeletions‐Mutanten von allen bekannten sekretorischen Aspergillus‐Proteasen gegen eine entscheidende Beteiligung dieser Enzyme an der Pathogenese der invasiven Aspergillose. Ebenso deuten mikroskopische Untersuchungen an Gefäßwand‐pene‐trierenden Aspergillen nicht auf eine stärkere Auflösung des Bindegewebes, so daß auch eine rein mechanische Verdrängung der Struktur‐Proteine durch das Wachstum der Hyphe möglich wäre. Weiter vorstellbar ist auch eine streng lokalisierte Proteolyse an dén Wachstumszonen der Hyphen durch Zellwand‐assoziierte Proteasen. Kandidaten für einen solchen Mechanismus sind Aspartat‐ und Serinproteasen, deren Aktivitäten in der Zellwandfraktion von A. fumigatus gefunden wurden.

Summary. In the course of invasive aspergillosis, Aspergillus fumigatus is capable of penetrating any tissue of the host. Secretory proteinases of the fungus might facilitate the hyphae to grow through fibrillar proteins like elastin and collagen. However, using systemic infection models, no significantly reduced virulence could be shown with fungal mutants deficient for all known secretory proteinases. Thus, secretory proteinases might be of minor relevance for the pathogenesis of invasive aspergillosis. In addition, microscopic examination of aspergilli penetrating vessel walls did not reveal obvious lysis of wall proteins, thus emphasizing a mechanical disruption of fibrillar proteins by the growing hyphae. However, a strictly localized proteolysis at the tips of growing hyphae caused by wall associated proteinases might be involved. Candidates for such a mechanism art the activities of aspartic and serine proteinases which we have discovered in the cell wall fraction of A. fumigatus.
Key Note Lecture Review article Vulvovaginitis due to Candida glabrata. An emerging problem
Authors: Sobel J. D.
Published: April 2009

Summary. A review is presented of the emerging problem of resistant and chronic vaginitis due to Candida glabrata. Although accurate numbers are lacking, several investigators report encountering increased numbers of women with vaginitis due to C. glabrata. Possible reasons for this apparent increase are discussed. Risk factors and clinical manifestations of symptomatic C. glabrata vaginitis differ from those of C. albicans, C. glabrata being less susceptible to fungistatic azole agents is more difficult to eradicate. Successful management of chronic C. glabrata vaginitis constitutes a major challenge with currently available therapeutic agents.

Zusammenfassung. Es wird eine Übersicht gegeben über die zunehmende Problematik therapieresistenter und chronischer Vaginitis verursacht durch Candida glabrata. Obwohl genaue Zahlen fehlen, berichten mehrere Untersucher über steigende Zahlen von Frauen mit C. glabrata‐Vaginitis. Die möglichen Gründe für diese offensichtliche Zunahme werden diskutiert. Risikofaktoren und klinisches Bild der symptomatischen C. glabrata‐Vaginitis unterscheiden sich von denen der Candida albicans. C. glabrata ist weniger empfindlich für fungistatische Azol‐Präparate und ist schwieriger zu beseitigen. Die erfolgreiche Behandlung der chronischen C. glabrata‐Vaginitis stellt mit den derzeit verfügbaren therapeutischen Mitteln eine zunehmende Herausforderung dar.
Vergleich der Stammspezifität von Hefepilzen verschiedener Lokalisation bei Frauen mit Vaginalcandidosen
Authors: Mendling W. , Gutschmidt J. , Gantenberg R. , Andrade M. P. , Schönian Gabriele
Published: April 2009

Zusammenfassung. Bei rezidivierenden Vaginalkandidosen sind oft identische Hefepilzspezies an verschiedenen typischen Lokalisationen innerhalb einer Sexual‐partnerschaft zu finden. Bei 21 Frauen mit Vaginal‐kandidosen und bei 18 von deren asymptomatischen Partnern wurden Kulturen aus Vagina, Stuhl und Mund bzw. aus Mund und Sperma auf Sabouraud‐Glucose‐Agar bebrütet und im Fall des Hefepilznachweises auf Candida‐ID‐Agar (Biomerieux) und Reisagar sowie mit dem System Walk away (Dade) spezifiziert. Bei Speziesgleichheit wurde die Identiät durch DNS‐Fingerprinting mittels PCR verglichen. Bei 21 Frauen wurde 20mal Candida albicans und einmal Candida glabrata in der Vagina nachgewiesen. 18 Abstriche aus Mund und Stuhl waren 11mal positiv, und in 9 dieser Fälle war die Spezies identisch mit der in der Vagina. Bei 18 Partnern wurde 8mal in 13 positiven Fällen Speziesidentität mit der Vagina ihrer Frau festgestellt, wobei diese 4mal das Sperma alleine betraf. Ob eine konsequente Behandlung aller Kolonisationen zur Rezidivfreiheit der Patientin beitragen kann, wird zur Zeit prospektiv untersucht.

Sexual partners harbour often identical yeast strains in the vagina, orointestinal tract and sperm in cases of recurrent vulvovaginal candidoses. Mycologic cultures from the vagina, mouth and stool of the patient and from the mouth and sperm of her partner were cultured on Sabouraud‐Glucose‐Agar and, if positive, specified by Candida ED‐Agar (Biomerieux), rice agar and the system Walk away (Dade). Equal species were compared by DNR‐fingerprinting using PCR. The vagina of 22 women was in 21 cases infected by Candida albicans and in one case by Candida glabrata. The culture of mouth or stool of 18 women was in 11 cases identical with those of the vagina. In 13 cases of 18 sexual male partners Candida albicans was found being identical with the strain of the female partner in 8 cases. 4 of the identical strains were grown from the sperm. Future prospective investigations shall prove whether a consequent tretmant of both partners to eradicate all identical yeasts is able to improve the treatment results in such women.
Ist die Candida‐Septikämie bei Frühgeborenen eine nosokomiale Infektion?*
Authors: Laskus Anja , Mendling W. , Runge K. , Schmidt A.
Published: April 2009

Zusammenfassung. Bei unbehandelten Schwangeren findet sich zum Zeitpunkt der Geburt bei etwa 30% eine Hefepilzkolonisation der Vagina. Frühgeborene sind, bedingt durch die Unreife ihres Immunsystems, durch generalisierte Mykosen gefährdet. Der Zusammenhang der vaginalen Hefepilzkolonisation der Mütter mit der Candida‐Septikämie der Frühgeborenen war Ziel unserer Untersuchung. In einer prospektiven Studie von 12/94 bis 8/96 wurden 176 Mütter bei Aufnahme in den Kreißsaal sowie 150 von deren Frühgeborenen mit einem Geb rtsgewicht zwischen 550 und 2390 g nach der Geburt sowie wöchentlich kulturell (Mund, Ohr, Stuhl, Urin) und serologisch auf Hefepilzkolonisation bzw.‐infektion hin untersucht. In der ersten Untersuchungsgruppe wurde die orale Nystatin‐Prophylaxe nur bei Frühgeborenen mit mindestens einer positiven Pilzkultur durchgeführt (Gruppe A), in der folgenden zweiten Gruppe erhielten alle Frühgeborenen mit Antibiotika‐Therapie eine Nystatin‐Prophylaxe (Gruppe B). Nach unseren Untersuchungsergebnissen entwickelt sich die Candida‐Septikämie von Frühgeborenen sekundär als nosokomiale Infektion nach den ersten ein bis zwei Lebenswochen, vorwiegend bei Kindern mit einem Geburtsgewicht unter 1000 g. Eine primäre orale Nystatin‐Prophylaxe senkt das Risiko für diese Kinder signifikant.

Summary. yeast colonization of the vagina is found in about 30% of all pregnant women. Premature infants are severely dangered by generalized fungal infections due to their immature immune system. The objective of this study was to elucidate the relationship between vaginal yeast colonization of the mothers and Candida septicemia in their premature babies. In a prospective study, running from 12/1994 to 8/1996, 176 mothers, facing probable premature birth, were investigated, when hospitalized, for vaginal yeast colonization. 150 premature infants (birth weights ranging from 550 to 2390 g) of these mothers were culturally examined for yeasts in specimens from the mouth, ear, stool and urine immediately after birth as well as once weekly in the following weeks. The patients were divided into two groups. In group A. oral prophylaxis with nystatin was practiced only in infants with at least one positive yeast culture. In group B, all patients received nystatin prophylaxis. Candida septicemia developed one or two weeks after birth mainly in infants with birth weights below 1000 g. Primary oral prophylaxis with nystatin lowers considerably the risk of developing Candida infection.
Psycho‐soziale Risikofaktoren der Vulvovaginalmykose. Eine multivariate Langzeitstudie
Authors: Meyer H. , Göttlicher S.
Published: April 2009

Zusammenfassung. Die Ergebnisse einer multivariaten Logit‐Analyse mit den Daten einer Langzeitstudie (erhoben von 1991 bis 1994, Daten an n = 9098 Patientinnen einer gynäkologischen Praxis) belegen die Mykose‐Relevanz psycho‐sozialer Faktoren wie z. B. Berufstätigkeit, Familienstand, Rauchen usw. Anhand der Auswertungsergebnisse können die erhobenen Faktoren nach ihrer Mykose‐Relevanz geordnet werden, mit dem Faktor, Rauchen “an erster Stelle und, Virginitat” an letzter. Überraschenderweise haben Sexualkontakt und die Kontrazeptionspille keinen bedeutsamen Einfluß. Eine Checkliste unterscheidet anhand von Faktor‐kombinationen 48 Risikotypen mit unterschiedlichem Mykose‐Risiko. In Einklang mit den empirschen Befunden steht folgende Hypothese: In den meisten Fällen ist durch die psycho‐soziale Situation der Frau hervorgerufener Streß und seine Wirkung auf das Immunsystem die eigentliche Ursache der Vulvovaginalmykose.

Summary. The results of a multivariate logit‐analysis of n = 9098 (female) patients of a gynecologic practice (from 1991 to 1994) confirm the relevance of psycho‐social factors like employment, being married, smoking etc. on the incidence of the vulvovaginal mycosis. By the statistical results the studied factors can be rank‐ordered from, smoking “as the most relevant to, virginity” as the most irrelevant factor. Surprisingly sexual contact and using oral contraception had no relevance. A check‐list using factor‐combinations enables to discriminate 48 types of female with different risk of incidence. The results of the study are in accordance with the following hypothesis: In most cases stress, induced by the psycho‐social situation of the female and weakening the immune system, is the only responsible factor for the incidence of vulvovaginal mycosis.
Pilz‐Nukleinsäure‐Nachweis bei invasiven Aspergillosen
Authors: Rimek Dagmar , Garg A. P. , Kappe R. , Sonntag H.‐G.
Published: April 2009

Zusammenfassung. Ein universeller Polymerase‐Ketten‐Reaktions(PCR)‐Assay zum Nachweis von Pilz‐DNA wurde anhand von 78 Proben von 42 Patienten zur Diagnostik invasiver Aspergillosen mit Mikroskopie und Kultur verglichen.

Bei 18 Patienten lag eine invasive Aspergillose vor, 5 Patienten waren im Respirationstrakt mit Aspergillus besiedelt, 19 Patienten boten keinen Hinweis auf eine Aspergillose. Die Proben von 6 der 18 Patienten mit invasiver Aspergillose waren mikroskopisch positiv mit echtem Myzel, 15 von 18 waren kulturell positiv, 16 von 18 waren PCR‐positiv. Durch die Kombination von Mikroskopie und Kultur wurden 17 von 18 Patienten diagnostiziert, durch die Kombination von Mikroskopie und PCR 16 von 18 und durch die Kombination von Kultur und PCR alle 18 Patienten. Bei 3 der 18 Patienten brachte die PCR entscheidende diagnostische Hinweise: in zwei Biopsien wurden die histologisch gesehenen Pilzelemente als Aspergillus identifiziert, bei einer Patientin war in 3 Bronchiallavagen die PCR alleine positiv. Von 5 kulturell positiven Patienten mit Aspergillus‐Besiedlung waren 4 auch PCR‐positiv; von den 19 Patienten ohne Aspergillose war die Kultur in einem Fall, die PCR in 3 Fällen falsch positiv. Candida‐Besiedlungen im oberen Respirationstrakt oder eine Pneumocystis‐carinii‐Pneumonie führten nicht zu einem falsch positiven Aspergillus‐PCR‐Ergebnis.

Daraus ergibt sich, daß der vorliegende Pilz‐Nukleinsäure‐Nachweis konventionelle Methoden zur Diagncstik invasiver Aspergillosen sinnvoll ergänzen kann.

Summary. A universal PCR‐assay for the detection of fungal DNA was compared with microscopy and culture for the diagnosis of invasive aspergillosis using 78 samples from 42 patients.

Eighteen patients were suffering from invasive aspergillosis, 5 patients were colonized with Aspergillus in the respiratory tract, 19 patients did not show any sign of aspergillosis. Samples from 6 of the 18 patients with invasive aspergillosis were microscopically positive with true mycelia, 15 of 18 grew Aspergillus in culture, 16 of 18 were PCR‐positive. The combination of microscopy and culture led to the diagnosis in 17 of 18 patients, the combination of microscopy and PCR in 16 of 18 and the combination of culture and PCR in all the 18 patients. For 3 of 18 patients, PCR was the diagnostic key: in 2 biopsies the histologically detected fungal elements were identified as Aspergillus, in 3 bronchial lavages from 1 patient nothing but PCR was positive for Aspergillus. Four out of 5 culture positive patients with Aspergillus colonization were also PCR positive; one out of 19 patients without aspergillosis was culture positive, 3 out of 19 were falsely PCR positiv. Candida colonization in the upper respiratory tract or Pneumocystis carinii pneumonia did not lead to false positiv Aspergillus‐PCR results.

In conclusion, the evaluated fungal PCR‐assay can supplement conventional methods for the diagnosis of invasive aspergillosis.
Synthese von Fluorochromen und Pigmenten durch Malassezia furfur unter Verwendung von Trypthophan als alleiniger Stickstoffquelle
Authors: Mayser P. , Wille G. , Inkampe Anne , Thoma Wiebke , Arnold N. , Monsees T.
Published: April 2009

Zusammenfassung. Ausschließlich in der Species Malassezia furfur induzierte ein neues Minimalmedium, bestehend einzig aus L‐Tryptophan (L‐Trp) und einer Lipidquelle, die Bildung braunen Pigments, welches in den Agar diffundierte. Stämme der Species M. sympodialis und M. pachydermatis zeigten kein Wachstum auf diesem Nährboden. Die Pigmentbildung konnte in M. furfur bereits mit 0,01 g% Trp induziert werden, das pH Optimum war pH = 5. Durch gleichzeitige Gabe anderer Aminostickstoffquellen zusätzlich zu L‐Trp konnte sie unterdrückt werden. Das Extrakt aus der Kultur fluoreszierte deutlich und einige Indol‐Derivate mit einem breiten Farbenspektrum konnten mit Hilfe von Massenspektroskopie und NMR dargestellt werden. Dieser Befund könnte eine Bedeutung für das klinische Erscheinungsbild der Pityriasis versicolor haben, einer sehr häufigen Hautkrankheit, die durch lipophile Hefen der Gattung Malassezia verursacht wird. Hypothetisch könnte eine Stoffwechselanpassung von Malassezia‐Hefen an ein verändertes Stickstoffangebot der Hautoberfläche von pathophysiologischer Bedeutung sein. Tryptophan als Induktor der Pigmentbildung kumuliert möglicherweise unter ausgiebigem Schwitzen, einem bekannten Manifestationsfaktor der Pityriasis versicolor.

Summary. A new minimal medium consisting only of L‐tryptophan (L‐trp) and a lipid source induced formation of brown pigmentation only in the species Malassezia furfur. Strains of the species M. sympodialis and M. pachydermatis failed to grow on this medium. Pigmentogenesis was already induced in M. furfur by 0.01 g% tryptophan, the pH optimum was pH = 5. Alternative amino nitrogen sources given concurrently with trp suppressed pigmentogenesis. The extract of the culture exhibited remarkable fluorescence, and several indole derivatives with a broad spectrum of colors were detected by means of mass spectroscopy and NMR. This finding may have an impact on the clinical appearance of pityriasis versicolor, a very common skin disease caused by lipophilic yeasts of the genus Malassezia. We hypothesize that in pityriasis versicolor metabolic adaptation of Malassezia yeasts to altered nitrogen conditions on superficial skin might be of pathophysiological importance. Tryptophan as inductor of pigmentogenesis probably cumulates during excessive sweating, a well known manifestation factor of pityriasis versicolor.
Pharmakokinetik und Dosierung von Fluconazol bei kontinuierlichen Hämofiltrations‐ (CAVH, CVVH) und Hämodialyseverfahren (CAVHD, CVVHD)
Authors: Pittrow L. , Penk A.
Published: April 2009

Zusammenfassung. Kontiniuerliche Hämofiltrations‐(CAVH, CVVH) und Hämodialyse‐verfahren (CAVHD, CVVHD) werden zunehmend bei Patienten mit akutem Nierenversagen (ARF) eingesetzt. Zwischen den einzelnen Verfahren bestehen deutliche Unterschiede hinsichtlich der Elimination von Fluconazol aus dem Plasma*. Diese ist bei CVVHD, abhängig von der Dialysat‐ und Ultrafiltratflußrate, im Gegensatz zur CVVH und der intermittierenden Hämodialyse am stärksten ausgeprägt, wobei die Fluconazol‐Clearance bei CVVHD 2 L/h sogar über derjenigen von Gesunden liegen kann. Um unter kontinuierlichen Verfahren therapeutische Fluconazol‐Plasmaspiegei zu erreichen, sollte initial die gleiche Anfangsdosis wie bei nierengesunden Patienten appliziert werden, gefolgt von der auf die Hälfte reduzierten Erhaltungsdosis, wie sie für Patienten mit einer eingeschränkten Kreatinin‐Clearance von bis zu 11 ml/min vorgesehen ist. Aufgrund theoretischer Überlegungen wird diese halbe Erhaltungsdosis je nach gewähltem Verfahren mit einem Faktor multipliziert, der das Ausmaß der extrakorporalen Elimination der verabreichten Wirkstoffmenge berücksichtigt (CAVH, CVVH: x2,2 bei einer Ultrafiltratflußrate von 0,5 L/h; CAVHD, CVVHD: x3,8 bei einer kombinierten Dialysat‐/Ultrafiltratflußrate von 1,5 L/h). Um subtherapeutische Plasmaspiegel bei vitalen Indikationen zu*** vermeiden, empfiehlt sich ‐ auch im Hinblick auf die geringe Anzahl einschlägiger Untersuchungen mit relativ niedrigen Dosierungen bis zu 200 mg/die ‐ die Messung der Plasma(tal)spiegel von Fluconazol.

Summary. Continuous haemofiltration (CAVH, CVVH) and haemodialysis (CAVHD, CVVHD) are increasingly used in patients with acute renal failure (ARF). The elimination rates of fluconazole vary considerably among the different procedures*. In CVVHD, the elimination rate is, depending on the combined dialysate/ultrafiltrate flow rate, the most marked compared to CVVH and intermittent dialysis with a fluconazole clearance exceeding the values of healthy persons in CVVHD 2 L/h. To achieve therapeutic plasma levels during continuous renal replacement therapy, the same loading dose as in patients without renal failure should be applied, followed by the adjusted maintenance dose for anuric patients multiplied by a factor taking the extracorporeal elimination of the absorbed dose into account (CAVH, CVVH: x2.2, ultrafiltrate flow 0.5 L/h; CAVHD, CVVH: x3.8, combined dialysate / ultrafiltrate flow 1.5 L/h). Despite the broad therapeutic margin of fluconazole, drug monitoring is recommended with respect to the very limited number of in‐***
Subungual and periungual congenital blue naevus
Authors: Gershtenson Platina Coy , Krunic Aleksandar , Chen Helen , Konanahalli Madhuri , Worobec Sophie
Published: April 2009

Subungual pigmented lesions should raise concern about malignant melanoma. Blue naevus of the nail apparatus is a rare entity, with only ten cases described in the literature. We report a 21‐year‐old Hispanic woman with a slowly enlarging 1.7 × 2.3‐cm subungual and periungual pigmented plaque present since birth on her right second toe. Initial biopsy was consistent with a blue naevus of the cellular type and, given the recent clinical change and periungual extension, complete excision was recommended. The entire nail unit was resected down to periosteum with prior avulsion of the nail plate. Reconstruction was performed with a full‐thickness skin graft. Follow up at 1 year revealed well‐healed graft and donor sites with complete return of function. We present a case of a congenital subungual and periungual blue naevus of the cellular type and review the literature on this rare presentation of a congenital blue naevus.
Electronic e‐isotretinoin prescription chart: Improving physicians' adherence to isotretinoin prescription guidelines
Authors: Tang Mark BY , Tan Eugene ST , Tian Elizabeth AL , Loo SC , Chua SH
Published: April 2009

Oral isotretinoin is a highly effective treatment for refractory nodulocystic acne. However, it can be associated with serious adverse effects such as teratogenicity and hepatitis. Inadequate cumulative dosing may also result in reduced therapeutic efficacy and higher disease relapse. A preliminary audit had previously revealed a poor and inconsistent adherence to local isotretinoin prescribing guidelines by physicians. To achieve greater than 90% adherence to isotretinoin guidelines for all acne patients prescribed systemic isotretinoin at the National Skin Centre, Singapore, key areas and the reasons for non‐adherence were identified. A specifically designed ‘one‐stop’ electronic isotretinoin chart was launched within the electronic medical records (EMR) system to address important safety areas; namely, informed patient consent, pregnancy testing, baseline laboratory tests, and automatic calculation of cumulative and target doses of isotretinoin. Physician adherence to prescribing guidelines improved from a baseline of 50–60% to greater than 90% (range 95–100%) for 30 consecutive months post intervention. The e‐isotretinoin chart has resulted in significant improvement in physicians' adherence to isotretinoin prescription guidelines and highlights the utility of EMR technology in influencing safe prescribing behaviour among doctors.
Vulval fixed drug eruption due to paracetamol
Authors: Drummond Catherine , Fischer Gayle
Published: April 2009

Paracetamol is a readily available non‐prescription analgesic. Fixed drug eruption (FDE) is a well‐reported side effect of paracetamol, usually the classic, pigmenting type. In women, it may present as a chronic, erosive vulvitis. We describe a case of FDE due to paracetamol presenting as a chronic erosive vulvitis in an older woman taking multiple medications. Diagnosis was delayed because paracetamol is available without prescription, taken intermittently and may be omitted from the clinical history. Cessation of paracetamol led to prompt resolution of symptoms. Consideration should be given to paracetamol as a cause of FDE presenting as a chronic erosive vulvitis.
Allergic contact dermatitis from exposure to Grevillea robusta in New Zealand
Authors: Derraik José GB , Rademaker Marius
Published: April 2009

There are a number of reports in the literature of allergic contact dermatitis as a result of exposure to the sawdust and plant parts of Grevillea robusta. While this tree is prevalent in New Zealand, there seems to have been no previous published accounts of contact dermatitis, although anecdotal evidence indicates that such cases may be common. Two brief case reports are provided regarding severe phytodermatitis to G. robusta among professional arborists in New Zealand. As with other common plants capable of inducing allergic contact dermatitis, greater awareness among arborists, orchardists, forestry workers, gardeners, and health professionals will likely result in a reduction of cases.
Increased liver stiffness measurement by transient elastography in severe acute exacerbation of chronic hepatitis B
Authors: Wong Grace L‐H , Wong Vincent W‐S , Choi Paul C‐L , Chan Anthony W‐H , Chim Angel M‐L , Yiu Karen K‐L , Chan Francis K‐L , Sung Joseph J‐Y , Chan Henry L‐Y
Published: April 2009

Background and Aims:  The proposed cut‐off values for the degree of fibrosis as assessed by liver stiffness measurement (LSM) might not be applicable in severe acute exacerbation of chronic hepatitis B (CHB). We aimed to assess the effect of necroinflammatory activity on LSM in this condition.

Methods:  We prospectively recruited consecutive patients with severe acute exacerbation of CHB (alanine aminotransferase or ALT > 10× upper limit of normal). The relationship of ALT levels and LSM were serially assessed and liver biopsy was carried out after ALT normalization.

Results:  Eleven patients (10 male, median age 43 years) were followed up for 25 weeks; nine patients received antiviral therapy. Overall, LSM was positively correlated with ALT levels (r = 0.67, P < 0.001). At initial presentation, the median serum ALT and LSM was 1136 (581–2210) IU/L and 26.3 (11.1–33.3) kPa. A progressive reduction in LSM was observed during subsequent visits in parallel with the reduction of ALT levels. At the last visit, the median ALT was 27 (11–52) IU/L and LSM was 7.7 (4.7–10.8) kPa. Among the five patients who had liver biopsy carried out at week 25, four patients had F2 fibrosis (LSM 5.7–8.1 kPa) and one patient had F3 fibrosis (LSM 8.6 kPa).

Conclusions:  LSM using transient elastography with the current proposed cut‐off values might misdiagnose liver cirrhosis in patients suffering from severe acute exacerbation of CHB. LSM should be assessed after normalization of ALT levels in order to accurately assess the degree of fibrosis.
The effect of postoperative fasting on vomiting in children and their assessment of pain
Authors: RADKE OLIVER C. , BIEDLER ANDREAS , KOLODZIE K. , CAKMAKKAYA OZLEM S. , SILOMON MALTE , APFEL CHRISTIAN C.
Published: April 2009

Background:  Mandatory postoperative food intake has been shown to increase nausea and vomiting, and so postoperative fasting has become common practice even if patients request food or drink.

Objective:  We sought to investigate whether postoperative fasting reduces the incidence of postoperative vomiting in children when compared with a liberal regimen in which they are allowed to eat and drink upon request.

Methods:  One hundred forty‐seven children scheduled for outpatient surgery were randomized to one of two groups. After anesthesia, patients in the ‘fasting’ group were expected to fast for 6 h. The children in the ‘liberal’ group were allowed to eat and drink according to their own needs. The incidence of vomiting and the children’s well‐being were recorded at several time points over a 24‐hour period. Parents were also asked to rate, on a scale of 0–6, how much their children were bothered by fasting, pain, and nausea/vomiting.

Results:  Age (4.8 ± 2.6 years), weight (20 ± 9 kg) and gender (73% boys) were comparable between the groups. The incidence of vomiting was 15% in the liberal and 22% in the fasting group (P = 0.39) and, between 1 and 12 h after extubation, children in the liberal group were significantly happier (P < 0.001). Children in the liberal group were significantly less bothered by their pain than those in the fasting group (P < 0.001).

Conclusion:  Postoperative fasting did not reduce the incidence of vomiting after general anesthesia in children when compared with a liberal regimen. Furthermore, the ability to eat and drink at will decrease the bothersome aspects of pain and lead to happier patients.
Intraoperative opioid dosing in children with and without cerebral palsy
Authors: LONG LAWRENCE S. , VED SUDHA , KOH JEFFREY L.
Published: April 2009

Objective: To describe the differences in intraoperative opioid dosing and associated outcomes in children with and without cerebral palsy (CP).

Background: Previous work on children with cognitive impairment has suggested that they receive less intraoperative opioid than children without cognitive impairment. This finding may be due to a common concern that impaired children are hypersensitive to the adverse effects of opioids. Patterns in intraoperative opioid dosing have yet to be studied in children with motor impairment (e.g. CP).

Methods: We examined the medical records of pediatric patients with CP who underwent orthopedic surgery over the last decade at our institution, as well as the records of a randomly selected group of pediatric orthopedic patients without CP (non‐CP). Outcome variables were intraoperative opioid dosing, postoperative intensive care unit (ICU) admission, and postoperative oxygen desaturation. We collected demographic, surgical, and medical data for covariate analysis. A stepwise multivariate regression was used for each outcome.

Results: Seventy‐one (71) CP and 77 non‐CP charts were included in the study. CP children received significantly less intraoperative opioid (3.26 ± 3.01 μg·kg−1fentanyl dose equivalents) than non‐CP children (4.58 ± 3.79 μg·kg−1) (P = 0.02), and this difference was corroborated by the regression analysis, which significantly associated CP with decreased opioid dosing (P < 0.001). In addition, intraoperative opioid dosing, but not CP, predicted ICU admission (odds ratio: 1.463, 95% CI: 1.042–2.054,P = 0.03) and postoperative oxygen desaturation (odds ratio: 1.174, 95% CI: 1.031–1.338,P = 0.02).

Conclusions: Similar to prior research on children with cognitive impairment, a reduction in intraoperative opioid dosing was found in children with CP. Given the discrepant doses of intraoperative opioid between groups, it is unclear whether children with CP are at any greater risk for untoward opioid‐related events.
Influence of anesthetic management on quality of magnetoencephalography scan data in pediatric patients: a case series
Authors: KÖNIG MATTHIAS W. , MAHMOUD MOHAMED A. , FUJIWARA HISAKO , HEMASILPIN NAT , LEE KI H. , ROSE DOUGLAS F.
Published: April 2009

Background:  Magnetoencephalography (MEG) is increasingly used in the presurgical evaluation of pediatric seizure patients. Many pediatric patients require sedation or anesthesia to tolerate these exams. However, the available literature on anesthetic management in this population is very limited.

Methods:  We retrospectively reviewed the records of all patients who underwent MEG scanning at our institution with regard to the interaction of anesthetic management and quality of scan data.

Results:  High‐dose propofol infusions (≥200 μg·kg−1·min−1) were associated with high frequency artifacts that interfered with the identification of epileptiform discharges. Lower‐dose propofol infusions (≤100 μg·kg−1·min−1) did not produce artifacts but required co‐administration of fentanyl to prevent patient motion. Dexmedetomidine infusions were not associated with signal artifacts and prevented patient motion very well in our initial patients and became our standard technique.

Conclusion:  In our experience, dexmedetomidine infusions are preferable to propofol‐based techniques for pediatric MEG scans due to the absence of adverse effect on interictal activity.
New soft clinical indicators of neonatal illness severity (Accepted as a poster)
Authors: Johnson C. , Escaped M. , Hagan R. , von Ungern‐Sternberg B.S.
Published: April 2009

Background:  The Pediatric Risk of Mortality (PRISM) Score serves as a standard for assessing neonatal illness severity. Clinicians also use the Clinical Risk Index for Babies (CRIB) score, American Society of Anesthesiology (ASA) patient classification system, and Patient‐to‐Chart‐Weight Ratio (PCWR).

Aims:  This study aimed to determine whether parental behaviour itself accurately reflects illness severity.

Method:  Following Ethics Committee approval, neonates admitted to our Neonatal Intensive Care Unit (NICU) underwent a 12‐week assessment. Investigators determined weekly PRISM and CRIB scores, ASA classifications, and patient and case note weights. Additionally, investigators catalogued possessions in, around, and adhering to patients’ cribs, placing each into ‘soft toys’, ‘spiritual amulets’ or ‘other items’ categories.

Results:  Investigators followed 102 neonates, collecting 249 observations. PRISM scores correlated best with the ‘spiritual amulets’ category (R2 = 0.82). TOI (Token and Ornament Index), calculated by combining all possessions in the ‘soft toys’, ‘spiritual amulets’, and ‘other items’ categories, correlated nearly so (R2 = 0.71). CRIB Score (R2 = 0.63), ASA classification (R2 = 0.61), and ‘soft toys’ category (R2 = 0.39) all correlated to lesser degrees. Birth and current weight, post conceptual age, NICU days, and PCWR each demonstrated insignificant correlations, the latter even when adjusted for age, NICU days, birth or current weight.

Conclusion:  Through gift giving, parents reliably reflect PRISM scores and, by extension, neonatal illness severity. Specifically, number of spiritual amulets alone and TOI correlate well and may therefore serve as independent indicators of clinical status and, potentially, anaesthetic risk. Despite widespread application of PCWR, this study found no support for its validity.

Keywords:  neonatal intensive care; illness severity; PRISM score; parental behaviour.
Making Voting Pay
Authors: Saunders Ben
Published: April 2009

Those who regard low turnout as a particular problem for democracy are sometimes led to endorse compulsory voting as a solution. However, even if there is a moral duty to vote, such legal coercion seems illiberal. This article, by appeal to the analogous case of blood donations, suggests that we should consider instead paying people incentives to vote. This would achieve the aim of increasing turnout, particularly among underrepresented groups, without threatening individual liberty in the way that compulsion seems to.
Principal Agent Theory and Artificial Information Asymmetry
Authors: Poth Stephan , Selck Torsten J.
Published: April 2009

This article evaluates the potential for the concept of ‘artificial information asymmetry’ to be used in political studies which focus on principal agent theory. We present real-world examples and excerpts from political writings to support our argument that, although artificial information asymmetry appears to be an important factor in principal agent relations, the concept has been underemployed in the political science agency literature. To be able to present more realistic scenarios of delegation, political scientists might be well advised to incorporate the concept so that it can be used in applied research.
Drainage Network Modelling for Water‐Sensitive Urban Design
Authors: Kunapo Joshphar , Chandra Shobhit , Peterson Jim
Published: April 2009

While drainage network models may be relatively easy to assemble as a prerequisite to site selection for infrastructure supporting suburbanisation with Water‐Sensitive Urban Design (WSUD), this is unlikely to be the case if the terrain is very subdued. Both ab initio and retro‐fit WSUD implementation for such terrain refers, in the first instance, to a drainage network model that includes information on the scope for optimising residential space while conforming to: (1) statutory planning rules about the provision of public open space; and (2) WSUD drainage network design such that runoff waters are retained long enough to allow at least temporary storage. It is shown in this research that a technique applied to condition a LiDAR DEM can accurately model the drainage network of a basin at the land‐parcel scale. The drainage network for ab initio WSUD is best defined using multi‐flow modelling, with the relative significance of stream segments indicated by their stream order derived using the Strahler method. In contrast, when applying the retro‐fit WSUD, the relative significance of segments given by the Shreve stream order method was found to be more useful. The approaches described in this article are designed to support the initial site planning stage and avoid the need for immediate and expensive detailed field survey. At the same time they can be deployed to show how much scope there is for WSUD retro‐fit in established housing areas up‐stream of an infill development area. Thus, basin‐wide appraisal is facilitated and the need for earthmoving is minimised.
A Chain‐Code‐Based Map Matching Algorithm for Wheelchair Navigation
Authors: Ren Ming , Karimi Hassan A
Published: April 2009

Accurate vehicle tracking is essential for navigation systems to function correctly. Unfortunately, GPS data is still plagued with errors that frequently produce inaccurate trajectories. Research in map matching algorithms focuses on how to efficiently match GPS tracking data to the underlying road network. This article presents an innovative map matching algorithm that considers the trajectory of the data rather than merely the current position as in the typical map matching case. Instead of computing the precise angle which is traditionally used, a discrete eight‐direction chain code, to represent a trend of movement, is used. Coupled with distance information, map matching decisions are made by comparing the differences between trajectories representing the road segments and GPS tracking data chain‐codes. Moreover, to contrast the performance of the chain‐code algorithm, two evaluation strategies, linear and non‐linear, are analyzed. The presented chain‐code map matching algorithm was evaluated for wheelchair navigation using university campus sidewalk data. The evaluation results indicate that the algorithm is efficient in terms of accuracy and computational time.
The Effects of Quality Control on Decreasing Error Propagation in the LandScan USA Population Distribution Model: A Case Study of Philadelphia County
Authors: Patterson Lauren , Urban Marie , Myers Aaron , Bhaduri Budhendra , Bright Eddie , Coleman Phillip
Published: April 2009

LandScan USA is a 90 m population distribution model that is used for a variety of applications, including emergency management. Models should have a measure of accuracy; however, the accuracy of population distribution models is difficult to determine due to the inclusion of multiple input datasets and the lack of quantifiable, observable (validated) data to confirm model output. Validated data enables quantification of: (1) overall model accuracy and (2) changes in model output at different levels of quality control. This article examines the effect of quality control for two national school datasets incorporated as input in LandScan USA for Philadelphia County, Pennsylvania; which had a local, validated school dataset available. The effect of each stage of quality control efforts utilized throughout the LandScan USA process were assessed to determine what level of quality control was required to have a statistically significant change of the model's population distribution. The typical level of quality control for LandScan USA resulted in 36% of schools being moved to the correct location and 20% of missing student enrollments were found, compared to 87% and 98% respectively for the validated dataset. The costs of increasing quality control resulted in a six‐fold increase in labor time; however, the additional quality control did not produce statistically significant improvements in the LandScan USA model. Thus, typical quality control efforts for schools in LandScan USA produced a population distribution similar to the validated level of quality control, and can be applied with confidence for policy, planning, and emergency situations.
A Least‐Cost Approach to Personal Exposure Reduction
Authors: Davies Gemma , Whyatt Duncan
Published: April 2009

Concerns over the potential negative health effects from exposure to air pollution have led to interest in assessing personal exposure and finding ways to reduce it. As journey‐time exposure accounts for a disproportionately high amount of an individual's total exposure, this article assesses the potential to apply least‐cost techniques within a GIS in order to identify paths of lower journey‐time exposure. The methodology adopted uses pollution surfaces for PM10 and CO generated by the dispersion model ADMS, with an analysis mask derived from OS MasterMap to create a least‐cost surface. Actual routes taken by a cohort of 11–13 year old children on their journeys to school are used to compare observed journey time exposure with the exposure along alternative routes generated using the least‐cost path function. While the least‐cost approach proved to be successful in defining low exposure routes the ability to scale up this approach is constrained by the amount of editing required to successfully create an analysis mask from OS MasterMap data. Such alternative routes have the potential to assist in promoting safer environmental choices, however, their likelihood of adoption is dependant on a number of social and environmental influences which affect an individual's route choice.
Top Management Team Diversity: A Review of Theories and Methodologies
Authors: Nielsen Sabina
Published: April 2009

This paper reviews empirical research on top management team (TMT) diversity. A number of scholars have concluded that upper echelons findings, in particular in terms of the consequences of TMT heterogeneity, have been inconclusive. This review conducts an in‐depth analysis of conceptual and methodological issues related to upper echelons diversity studies and offers some directions for future research. Sixty journal articles, published in ten top international journals over a 22‐year period (1984–2005), were analyzed. The results suggest that upper echelons research is increasingly multidisciplinary in nature; however, in‐depth inquiries into the antecedents of TMT composition and the multilevel contextual influences on the implications of TMT heterogeneity are still needed. This review finds that clarity about level of analysis, both theoretically and empirically, remains an important issue in the field and thus a multilevel approach is strongly encouraged. Moreover, the complexity of diversity as a theoretical construct needs to be acknowledged and operationalized accordingly in upper echelons studies.
Children living with their grandparents: resilience and wellbeing
Authors: Downie Jill M. , Hay David A. , Horner Barbara J. , Wichmann Helen , Hislop Angela L.
Published: April 2009

Downie JM, Hay DA, Horner BJ, Wichmann H, Hislop AL. Children living with their grandparents: resilience and wellbeing Int J Soc Welfare 2010: 19: 8–22 © 2009 Curtin University of Technology, Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare.

A non‐comparative design and mixed‐methods approach was used to examine the resilience and wellbeing of 20 children in the full‐time care of their grandparents. A self‐report measure of self‐concept and emotional wellbeing, and a semi‐structured interview were used to explore the personal experiences and impact of children living with their grandparents. Scores derived from the self‐report measure indicated that the children's self‐worth and emotional health were within the range expected of children of comparative age and sex. Qualitative data, however, suggested a complex emotional environment and a continuum of responses. Analysis revealed three themes that captured broad issues around Emotional health, Material factors, Current issues and Past experiences and Coping strategies. The results of the study reveal the ongoing concerns associated with the children's family circumstances, as well as the notable adaptation and resilience of the children in managing their life experiences.
Suspicious minds: local context and attitude variation across Swedish municipalities
Authors: Sevä Ingemar Johansson
Published: April 2009

Johansson Sevä I. Suspicious minds: local context and attitude variation across Swedish municipalities Int J Soc Welfare 2010: 19: 225–235 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare.

This article investigates whether degree of suspicion of welfare abuse relates to local context in Sweden. It is suggested that certain features of Swedish municipalities can create a local information bias influencing individual suspicion of welfare abuse. Prevalence of social problems and political climate are features of the municipal context having the potential to influence opinion formation. Social problems are captured by local unemployment, social assistance and ill‐health rates. Political climate is captured by electoral support for conservatives. The results indicate that local context can influence suspicion of welfare abuse, contexts where social problems are widespread reduce such suspicion. While local political climate seems important in itself, it also interacts with social problem level, increasing suspicion if a conservative political climate and social problems coexist. While social problems seem to generate less suspicion regarding social policy abuse, they also provide ‘raw material’ for political rhetoric regarding suspicion.