bluuebunny/crossref_metadata_2025 huggingface dataset:
Quadrant root planing versus same‐day full‐mouth root planing
Authors: Apatzidou D.A. , Kinane D.F.
Published: January 2004

Objectives: The aim of this study was to test the hypothesis that same‐day full‐mouth scaling and root planing (FM‐SRP) resulted in greater clinical improvement compared to quadrant scaling and root planing (Q‐SRP) in chronic periodontitis patients over a period of 6 months.

Materials and Methods: Forty patients were recruited into this study. Subjects were randomised into two groups. The FM‐SRP group received full‐mouth scaling and root planing completed within the same day, while the Q‐SRP group received quadrant root planing at 2‐weekly intervals over four consecutive sessions. Whole‐mouth clinical measurements were recorded with a manual periodontal probe at baseline (BAS) and at reassessment 1 (R1) (approximately 6 weeks after the completion of therapy), and at reassessment 2 (R2) (6 months after the initiation of therapy). Selected site analyses were performed on the deepest site in each quadrant before and after therapy (R1 and R2) and clinical indices were recorded with an electronic pressure sensitive probe. In addition, during the active phase of treatment clinical data were collected at 2‐weekly intervals from the remaining untreated quadrants in the Q‐SRP group only.

Results: Both therapies resulted in significant improvements in all clinical indices both at R1 and R2. A continuous clinical improvement was seen for both treatment groups during the experimental period, which reached peak levels at 6 months (ΔPD=1.8 mm, ΔCAL=1.1 mm, p<0.001; PD: pocket depth; CAL: clinical attachment level). The selected‐site analysis revealed no significant differences in any clinical index between the two treatment groups at R2 (ΔPD=2.8 mm, ΔRAL=1.1 mm; RAL: relative attachment level). At the selected sites, the analysis of the deep pockets (>7 mm) showed a significantly greater gain in RAL for the FM‐SRP group compared to the Q‐SRP group at R2 (p<0.05). The results of this analysis however, should be interpreted with care due to the small number of deep pockets. Data from the Q‐SRP group provided an insight into how treated and untreated quadrants responded during the initiation of plaque control measures. There were significant reductions in PD, suppuration (SUP), modified gingival index (MGI) and plaque index (PI) in the remaining untreated quadrants in the Q‐SRP group during the initial phase of treatment (p<0.05), while minimum changes in RALs and bleeding on probing (BOP) occurred. Nevertheless, the improvement in PD was clearly inferior to that seen after scaling and root planing.

Conclusion: Following both therapeutic modalities, there were marked clinical improvements at both R1 and R2 (6 months) from baseline. The current study, in contrast to previous findings, failed to show that FM‐SRP is a more efficacious periodontal treatment modality compared to Q‐SRP. However, both modalities are efficacious and the clinician should select the treatment modality based on practical considerations related to patient preference and clinical workload.
Seasonal declines in reproductive success of the common tern Sterna hirundo: timing or parental quality?
Authors: Arnold Jennifer M. , Hatch Jeremy J. , Nisbet Ian C. T.
Published: January 2004

Reproductive success declines over the course of the breeding season in many bird species. Two categories of hypothesis have been evoked to explain this decline. The “timing” hypothesis suggests that seasonal declines in breeding success are attributable to the date of laying. The “parental quality” hypothesis suggests that seasonal declines result from the fact that young, inexperienced, or low quality birds breed later in the season. To evaluate the relative importance of timing and parental quality, egg exchanges and removals were used to manipulate hatching dates of common terns Sterna hirundo. Indices of quality, attendance, provisioning rates, and reproductive success of birds in three experimental groups (delayed hatch pairs, advanced hatch pairs, and pairs induced to relay) were compared to those of date‐matched controls. Pairs that hatched chicks early raised more chicks than pairs hatching chicks late in the season, regardless of initial laying date. This suggests that hatching chicks early is advantageous in itself. Our results, however, also support the parental quality hypothesis. There was a significant negative relationship between natural laying date and fledging success, independent of hatching date. Differences in chick growth and survival suggest that higher quality adults may be able to compensate for the disadvantages of late hatching dates and achieve similar reproductive success to that of pairs hatching chicks early. We found that pairs hatching chicks late in the season were subject to more incidents of kleptoparasitism than those hatching chicks early. This may be a proximate factor contributing to seasonal declines in reproductive success for common terns, although such a mechanism would not be likely in non‐colonial species. Failure to control for egg quality may have biased the results of some prior egg exchange experiments. Additionally, altered cost of incubation may be an unavoidable confounding factor in studies designed to manipulate timing of breeding.
Limited dispersal by Nazca boobiesSula granti
Authors: P. Huyvaert Kathryn , J. Anderson David
Published: January 2004

We documented natal and breeding dispersal at several spatial scales by Galápagos Nazca boobiesSula granti, a wide‐ranging pelagic seabird. We found exceptionally low degrees of both types of dispersal despite these birds’ vagility. Median natal dispersal distances were 26 m and 105 m for males and females, respectively. Median breeding dispersal distances for both sexes were 0 m. No natal or breeding dispersals occurred from our study site at Punta Cevallos, Isla Española to six other colonies in the Galápagos, but we did document four long‐distance natal dispersals from Punta Cevallos to islands near the South American coast. Recaptures and dead recoveries of ringed birds showed long distance non‐breeding movements to the Central American coast and elsewhere in the eastern Pacific, contrasting with the very limited dispersal to breeding sites.
Parentage and host preference in the common cuckooCuculus canorus
Authors: Skjelseth Sigrun , Moksnes Arne , Røskaft Eivin , Lisle Gibbs H. , Taborsky Michael , Taborsky Barbara , Honza Marcel , Kleven Oddmund
Published: January 2004

Microsatellite DNA markers were used to investigate parentage relationships in a population of common cuckooCuculus canorus. Thirty adults and 55 nestlings were genotyped at six loci from blood samples collected over a four‐year period. To test whether each cuckoo female specialises in parasitising one single host species (Host Preference Hypothesis), the maternal relationships were used to record each female's host choice. The results supported the Host Preference Hypothesis since no female (N=3) was recorded to have parasitised more than one of four congeneric host species breeding in the area. In contrast, the males (N=4) did not show such specialisation since two of them sired offspring reared by different host species.
Stabilising selection on wing length in reed warblers Acrocephalus scirpaceus
Authors: Susanna S. Hall K. , Ryttman Hans , Fransson Thord , Stolt Bengt‐Olov
Published: January 2004

The size of an animal is of utmost importance for its overall success and each species is thought to have its own optimal size. If this is true, size traits ought to be under stabilising selection unless the animal is living in a highly unstable environment. Wing length is a standard measurement of the size of birds, but up to date there have been few indications of stabilising selection on wing length. In this study we analyse recovery data for reed warblers Acrocephalus scirpaceus (n=771) ringed as juveniles in Sweden from 1981 until 2001. The data showed a significant relationship between juvenile wing length and survival time, with median juvenile wing lengths (66–67 mm) being the most favourable. The estimated stabilising selection differential (C=−0.094) supports that wing length of the reed warblers in our study is under stabilising selection. The reed warbler is a long‐distance migratory species and we suggest that opposing selection pressures may act on wing length during different life history stages, and that this might explain the rather broad peak of favourable wing lengths found.
Marking Single–Family Property Values to Market
Authors: Thibodeau Thomas G.
Published: January 2004

This paper is the text of the 2001 Presidential Address for the American Real Estate and Urban Economics Association. House price prediction accuracy is a function of: (1) the procedure used to identify within–metropolitan–area housing submarket boundaries, (2) the econometric technique used to estimate the parameters of the house price model and (3) the characteristics of the local housing market. This paper empirically examines several procedures for delineating within–metropolitan–area housing submarket boundaries. In addition, the paper examines the increase in prediction accuracy that can be achieved by employing spatial econometric techniques to spatially adjust ordinary least squares house price predictions. Finally, the paper examines the influence that local housing market characteristics have on house price prediction accuracy. Housing market characteristics examined here are: (1) structural characteristics of neighborhood properties, (2) heterogeneity of the neighborhood housing stock and (3) housing market liquidity. Prediction accuracy is examined using hedonic house price equations with over 40,000 single–family transactions for Dallas, Texas.
Estimating the Lagging Error in Real Estate Price Indices
Authors: Fu Yuming
Published: January 2004

Real estate indices based on appraisals or sale prices of properties are known for their slow response to market news. These indices can therefore be represented (in logarithm) as the sum of a latent “true” price index and a lagging error. We show that the latent appreciation return and the lagging error can be jointly estimated in a state–space model, which has two key features. First, it employs exogenous variables known to predict asset returns to predict the latent appreciation return. Second, it incorporates known sources of the lagging error, such as the partial adjustment in observed index to the latent appreciation return and the seasonality in reappraisal quality. We find that, after the estimated lagging errors are removed, the appraisal–based National Council of Real Estate Investment Fiduciaries returns become more informative and hence exhibit (i) greater variance, (ii) weaker auto correlation, (iii) higher correlation with the returns of the securitized real estate and (iv) more timely response to market news.
Housing Transactions and the Changing Decisions of Young Households in Britain: The Microeconomic Evidence
Authors: Andrew Mark , Meen Geoffrey
Published: January 2004

In this second of two related papers in this issue, the causes of declining levels of housing transactions in Britain during the 1990s are explored. The lower transaction levels resulted partly from the changing behavior of young individuals. Both household formation and owner–occupation rates of these groups also fell sharply. Using panel data, we investigate the causes of reduced new household formation and owner–occupation, finding that changes in the income distribution away from young cohorts have been an important factor.
Induced septic abortion: A major factor in maternal mortality and morbidity
Authors: Rana Ashma , Pradhan Neelam , Gurung Geeta , Singh Meeta
Published: January 2004

Background:  Septic abortion is an infection of the uterus and its appendages following any abortion especially, illegally performed induced abortions. It is characterized by a rise of temperature to at least 100.4°F, associated offensive or purulent vaginal discharge and lower abdominal pain and tenderness.

Aim:  To study maternal mortality and morbidity in induced septic abortions.

Methods:  Induced septic abortions were analyzed between April 1992 and September 1999 in TU Teaching hospital. Morbidity indicators were surgery other than curettage, prolonged hospitalization and permanent damage.

Results:  In 92 cases of induced septic abortions, comprising 6% of total abortions; nine deaths occurred because of disseminated intravascular coagulation, acute renal failure and adult respiratory distress syndrome. Vaginal, intraperitoneal and gum bleeding; epistaxis and malaena resulted in severe anemia (Hb < 6 gm/L) in 11 cases. Wound debridement and skin graft cured two cases of necrotizing fasciitis. One of four conservatively managed tubo‐ovarian masses spontaneously drained rectally. In 15 cases laparotomy for pus drainage, salpingectomy, salpingo‐oophorectomy, hysterotomy/uterine rent repair was conducted, along with four bowel surgeries and six hysterectomies were performed. Post‐operative complications included burst abdomen (one case) and reopened pyoperitoneum, which resulted fecal fistula in three cases, one of these patients died.

Conclusion: :  Induced abortion was proven to be a major detrimental factor for maternal mortality. Morbidity was four times higher than mortality to the extent that patients suffered hemiplegia and forced barrenness.
Combined diagnostic approach of laparoscopy and hysteroscopy in the evaluation of female infertility: Results of 612 patients
Authors: Shokeir Tarek A. , Shalan Hesham M. , El‐Shafei Mohamed M.
Published: January 2004

Aim:  To clarify the role of a combined diagnostic approach using laparoscopy and hysteroscopy in the evaluation of female infertility in developing countries.

Methods:  In a prospective study, 612 consecutive infertile women underwent complete fertility evaluation at a tertiary university infertility clinic: 300 complained of primary infertility, 221 of secondary infertility, and 91 were requesting reversal of a previous tubal ligation. All the patients were examined by simultaneous combined laparoscopy and hysteroscopy as a part of their routine infertility evaluation. Focused hysteroscopic evaluation of the region of utero‐tubal junction was attempted.

Results:  Laparoscopy was successful in 608 and hysteroscopy in 597 patients. The most frequent pathologies detected hysteroscopically in the infertile group were adhesive in nature and believed to be post‐traumatic and/or post‐phlogistic. The number of intrauterine abnormalities found by hysteroscopy was significantly greater than by hysterosalpingography. The rate of diagnosis of significant lesions by laparoscopy of 64.3% rose to 76.6% when the hysteroscopic findings were included. A significant number of women with secondary infertility had abnormal hysteroscopic findings when compared to either women with primary infertility or those requesting sterilization reversal. Hysteroscopic evaluation of the region of utero‐tubal junction revealed significant lesions believed to have caused infertility in comparison with those requesting sterilization reversal.

Conclusion:  The combined diagnostic approach of laparoscopy and hysteroscopy is recommended in the evaluation of female infertility in communities where the risk of pelvic infections is great.
Fetal heart rate and uterine contraction during automobile driving
Authors: Nakajima Yukari , Yamaji Kenji , Ohashi Kazutomo
Published: January 2004

Objective:  The purpose of this study was to clarify the influence of automobile driving in the third trimester of pregnancy on fetal heart rate and uterine contraction.

Methods:  Twenty‐nine pregnant women with singleton pregnancies after 28 weeks of gestation were monitored using a portable cardiotocogram during driving, and the results obtained before and after driving were compared.

Results:  Baseline fetal heart rate and its variability, as well as periodic fetal heart rate patterns, showed no abnormal patterns during car driving. Automobile driving in late pregnancy was not a reinforcement factor for uterine activity. Maternal systolic and diastolic blood pressure and heart rate showed no specific characteristic or adverse change during driving.

Conclusion:  The results of this study suggest that automobile driving in the third trimester of pregnancy has no adverse influences on either pregnant women or fetuses.
Uterine rupture of cesarean scar related to spontaneous abortion in the first trimester
Authors: Matsuo Koji , Shimoya Koichiro , Shinkai Tsuneo , Ohashi Hiroshi , Koyama Masayasu , Yamasaki Masato , Murata Yuji
Published: January 2004

We report the case of a 31‐year‐old Japanese female diagnosed by transvaginal ultrasonography to have a spontaneous uterine rupture in the first trimester. Her condition was complicated by diabetes mellitus type 1. Her previous pregnancy had resulted in an emergency cesarean section by transverse incision of the lower uterine segment with single‐layer suture at 37+4 weeks of gestation. Transvaginal ultrasonography displayed both a gestational sac located in the anterior lower uterine segment and a defect in the uterine wall located at the site of the previous cesarean delivery scar. Pelvic magnetic resonance imaging showed that the uterine muscle layer was discontinuous and the gestational sac was almost outside the uterine cavity, accompanied by mild hemorrhaging within the endometrial cavity. The defect in the lower uterine wall was round in shape and was 3 cm in diameter. Since uterine ruptures can occur during all gestational periods, it is important to pay attention to the uterine wall where any cesarean incision was previously made.
Schönlein–Henoch purpura during pregnancy: Case report and review of the literature
Authors: Koizumi Minako , Hagino Daisuke , Fukuyama Chiyoko , Abe Kanako , Inoue Kumiko , Arai Yuko , Takechi Kimihiro
Published: January 2004

The clinical features of Schönlein–Henoch Purpura (SHP) consist of non‐thrombocytopenic purpura in association with joint, gastrointestinal and renal involvements. Because it is uncommon in adults, there is little information on the effects of SHP on pregnancy in the literature. This report documents the clinical findings and outcome of an uncommon case of SHP affecting a woman who was 25 weeks pregnant. Prompt steroid‐therapy induced a rapidly favorable course and successful vaginal delivery at 40 weeks gestation. If SHP develops during pregnancy, it is not always easy to distinguish from obstetrical complications such as pre‐eclampsia. An early diagnosis is important especially if renal involvement exists, because the prognosis for this disease can include nephropathy and it therefore needs close monitoring.
Evaluation of depressive conditions among Japanese patients at a menopause clinic
Authors: Takamatsu Kiyoshi , Kasuga Michiko , Makita Kazuya , Nozawa Shiro
Published: January 2004

Aim:  To examine current depressive tendencies among Japanese patients visiting a menopause clinic with complaints of climacteric symptoms.

Methods:  The subjects were 389 Japanese women (age range: 45–60 years; mean: 51.4 ± 3.8 years) who visited the menopause clinic in Department of Obstetrics and Gynecology, Keio university hospital, reporting climacteric symptoms. Their depressive tendencies were examined with the SDS (Self‐rating Depression Scale, filled out by the patient).

Results:  The SDS was computed to be 42.4 ± 9.9. Ninety‐three (23.9%) suffered from an intermediate or higher level depressive tendency; 132 (33.9%) had a mild depression; and 164 (42.2%) were free of any depressive tendency. It was concluded that more than one‐half of the subjects suffered from some form of depression. Correlations between age, time after menopause/oophorectomy, and depressive tendency were ambiguous. In comparing the total scores of SDS for pre‐, peri‐, and postmenopause groups, the incidence of probable depression was higher in the second group, but no significant differences were noted among each group. When the parameters were compared in relation to their hormonal environments, the natural menopause group rated significantly higher in the scores related to sleep disturbance, hopelessness and dissatisfaction than the premenopause group. The number of those who probably exhibited mild or more exaggerated depression was significantly lower in the surgical menopause group in comparison with the natural menopause group.

Conclusion:  A depressive tendency occurred frequently among Japanese patients with menopausal disorders. It is important to evaluate the mental status of these patients with the aid of an appropriate tool.
Investigation of the incidence of hepatitis E virus among pregnant women in Turkey
Authors: Cevrioglu Arif Serhan , Altindis Mustafa , Tanir Hüseyin Mete , Aksoy Fatih
Published: January 2004

Aim:  The aim of our study was to determine the prevalence of hepatitis E virus (HEV) among pregnant and non‐pregnant women in Middle Anatolia, identify the factors that affect being HEV positive and to study the effects of HEV positivity on mother and fetus.

Methods:  The study included 245 pregnant women who applied to various health centers and 76 cases in the same age range as the control. Blood samples taken from the cases were tested in terms of anti‐HEV, IgM and IgG using the microELISA method.

Results:  None of the blood samples tested revealed anti‐HEV IgM positive, an indicator of acute infection, while 31 pregnant women (12.6%) and nine cases in the control group (11.8%) were found to have anti‐HEV IgG positive (P > 0.05). It was seen that in pregnant women such factors as advanced age, lower educational and income levels and rural residence were correlated with higher anti‐HEV IgG positive values (P < 0.05). HEV infection is endemic in Afyon and its vicinity. There were no statistical differences between pregnant women and non‐pregnant women at similar ages in terms of HEV seropositivity.

Conclusion:  It can be suggested that pregnancy does not constitute a predisposition to HEV infection.
Down‐regulation of members of glycolipid‐enriched membrane raft gene family, MAL and BENE, in cervical squamous cell cancers
Authors: Hatta Mitsuko , Nagai Hisaki , Okino Keiko , Onda Masamitsu , Yoneyama Koichi , Ohta Yujirou , Nakayama Hiroki , Araki Tsutomu , Emi Mitsuru
Published: January 2004

Persistent human papillomavirus infections cause infected epithelial cells to lose cellular polarity leading to cell transformation. Glycolipid‐enriched membrane (GEM) rafts are implicated in polarized sorting of apical membrane proteins in epithelial cells and even in signal transduction. The MAL and BENE are essential component of the GEM raft's machinery for apical sorting of membrane proteins. In this study we demonstrated down‐regulation of MAL and BENE mRNA in over two‐thirds of primary cervical squamous cell cancers (14 and 15 of 20 cases, for MAL and BENE, respectively) when compared to corresponding non‐cancerous uterine squamous cells. Allelic loss or hyper‐methylation was not accompanied by MAL or BENE mRNA down‐expression in human primary cervical cancers in microsatellite allelic analysis and HpaII‐PCR‐based methylation analysis of the MAL and BENE genomic region. In addition, we note down‐regulation of these genes in established cervical cancer cell lines. These results suggest that down‐regulation of MAL and BENE genes, which are essential components of the cellular polarized sorting system, play an important role in human cervical squamous cell cancer development.
Capturing lay perspectives in a randomized control trial of a health promotion intervention for people with osteoarthritis of the knee
Authors: Victor Christina R. , Ross Fiona , Axford John
Published: January 2004

Osteoarthritis (OA) is a common and often disabling condition that predominately affects older adults. It is the commonest cause of locomotor disability and forms a major element of the workload in primary care. Previous studies suggest that there are both deficits in the knowledge patients have about their disease and extensive ‘unmet’ information needs. This paper explores the patients’ perspective on the meaning and significance of living with arthritis, identified through quantitative and qualitative approaches undertaken during a trial that evaluated the effectiveness of a primary care‐based patient education programme. This paper draws on qualitative and quantitative data from: the baseline interview (knowledge of arthritis, satisfaction with services and support received in primary care); patient diaries (individual goals and reflections on treatment); and group teaching sessions (themes describing the patient's experience). The different data sources were interrogated for common and divergent themes. One hundred and ninety‐four participants were identified and 170 completed baseline interviews. Participants were predominantly female (73%), with a mean age of 63 and arthritis of long‐standing; 55% reported that they had had it for 5 years or more. Use of primary care services was high, with 41% consulting their GP in the 2 weeks before interview. Levels of information were low, with less than 25% receiving support/advice about the disease, pain management or its impact upon daily life. Set against negative perceptions of the quality of services, patients’ personal priorities were for improved pain management and enhanced mobility/functional ability. The combined quantitative and qualitative data provide insight into the patients’ perspective on the causes and impact of knee OA, individual goals desired from treatment and the quality of care. There is consistent evidence of unmet needs for information and support and the priority placed by patients on finding strategies to cope with OA and maintaining independence. Even within a tightly defined study sample participating in the intervention, a diversity of experience and goals were revealed, which highlights the importance of taking account of contextual factors and individual differences when evaluating complex interventions.
Evaluating the treatment of hypertension in diabetes mellitus: a need for better control?
Authors: Sequeira Reginald P. , Al Khaja Khalid A. Jassim , Damanhori Awatif H.H.
Published: January 2004

Objectives  To determine how well and to what extent blood pressure (BP) is controlled in diabetic hypertensive patients treated by primary care doctors, and to evaluate drug therapy in the backdrop of risk factors and laboratory findings.

Methods  A therapeutic audit of the medical records of diabetic hypertensives from nine primary care health centres in Bahrain.

Results  In 266 diabetic hypertensives (82 males and 184 females), the recommended target BP < 130/< 85 mmHg (WHO/ISH guidelines, 1999) was achieved in  20 (9.8%) with a BP of 119 ± 4/76 ± 5 mmHg. Among those who did not achieve target BP, 70 (34.5%) lacked systolic BP control (BP = 153 ± 17/79 ± 3 mmHg), four (2%) lacked diastolic BP control (BP = 123 ± 3/86 ± 3 mmHg) and 109 (53.7%) lacked both systolic and diastolic BP control (BP = 158 ± 20/94 ± 7 mmHg). The mean age of the group achieving target BP was significantly lower than the group which lacked systolic BP control (51.6 ± 9 vs. 63.5 ± 9 years; P < 0.0001). While there were no significant differences in fasting blood glucose, glycosylated haemoglobin, triglycerides, urea, creatinine, uric acid and serum electrolytes between the group achieving target BP vs. groups without target BP, a significant difference in total cholesterol was seen.

Patients  with ischaemic heart disease and/or isolated systolic hypertension did not achieve the target BP. Antihypertensive monotherapy was prescribed in 145 (54.5%) patients, whereas two‐ and three‐drug combinations were prescribed in 32.3 and 8.2% of patients, respectively. As monotherapy, angiotensin‐converting enzyme (ACE) inhibitors were the most frequently prescribed drugs followed by β‐blockers, calcium channel blockers (CCBs) and diuretics. As two‐drug combinations, an ACE inhibitor with a β‐blocker/diuretic and a β‐blocker with   a  CCB/diuretic  were  usually  prescribed.

Conclusions  According to the WHO/ISH 1999 guidelines, approximately one out of 10 diabetic hypertensives achieved target BP control. In many instances, the drug therapy prescribed was inappropriate considering the comorbidity in patients and their laboratory findings. Improved BP control is needed in treating high‐risk groups such as patients with diabetes mellitus, and efforts should be made to improve the treatment of hypertension in the primary care setting.
Strategies for ensuring effective surveillance in post‐transplant patients: practical organization and clinical evaluation
Authors: Jurewicz W. Adam , Miles Andrew
Published: January 2004

Results of renal transplantation have improved steadily over the years. This article reviews the current status of patient and graft survival and discusses major causes of mortality and renal allograft failure. Review of recent literature demonstrates that the traditional enemies of transplantation, acute rejection and opportunistic infections are no longer major problems facing transplantation. Chronic graft nephropathy and death with functioning graft due to cardiovascular disease are the main challenges in the current era. An impact of an early graft thrombosis, recurrent renal disease and post‐transplant malignancies are also reviewed. Chronic graft nephropathy is examined in a context of differences between two calcineurin inhibitors, cyclosporin microemulsion and tacrolimus. Strategies of post‐transplant surveillance are suggested.
Patient experience of time duration: strategies for ‘slowing time’ and ‘accelerating time’ in general practices
Authors: Buetow Stephen
Published: January 2004

Approaches to time management in general practices characteristically focus on objective ‘clock time’, for example, through appointment scheduling. No less important, however, is how patients experience time duration. Time is experienced as having passed slowly (time prolongation), quickly (time compression) or in rough synchronization with clock time. Duration has been theorized to be positively associated with information processing. This paper builds on that theory to suggest how practices can influence patients’ subjective experience of duration in the practice environment, for example, by making waiting times appear to quicken and consultations appear to slow.
Predictors of HIV/AIDS among individuals with tuberculosis: health and policy implications
Authors: Kennedy Stephen B. , Campbell James , Malanda Bernard
Published: January 2004

The purpose of this report was retrospectively to assess the application of clinical predictors (i.e. signs and symptoms) for the diagnosis of the human immunodeficiency virus (HIV) infections, including the acquired immunodeficiency syndrome (AIDS), among tuberculosis (TB)‐positive subjects enrolled within an urban heterosexual sero‐discordant couple (one partner HIV‐positive and the other HIV‐negative) cohort study at an HIV prevention and research centre in Lusaka, Zambia. Available medical, clinical and laboratory records from 1994 to mid‐1998 were reviewed, with follow‐up visits to the local chest clinics and sputum analyses laboratories instituted as additional quality assurance measures. A nested case‐control study was employed. The World Health Organization clinical case definition for HIV/AIDS (WHOCCDA) was observed to be significantly more likely to predict HIV/AIDS among TB‐positive HIV‐positive subjects than TB‐positive HIV‐negative subjects. Therefore, this report documents the relative effectiveness of the WHOCCDA in predicting HIV/AIDS cases and discusses the health and policy implications, especially for the developing world which accounts for a significant proportion and impact of HIV/AIDS. Further research studies based on prospective randomized controlled trails or other rigorous evaluation strategies are warranted to substantiate these findings.
Mental Health Link: the development and formative evaluation of a complex intervention to improve shared care for patients with long‐term mental illness
Authors: Byng Richard , Jones Roger
Published: January 2004

Aims and objectives  This study aims to develop an intervention and related conceptual framework for developing shared care for patients with long‐term mental illness, and to provide a case study of the development of a complex intervention in primary care.

Methods   A pragmatic iterative design involved a literature review and focus groups followed by a formative evaluation including reflection, questionnaires and interviews. General practices and associated community mental health teams in Southeast London were involved. Participants included community mental health workers, psychiatrists, practice nurses, general practitioners, managers and local  experts  with  an  interest  in  primary mental health care.

Results  The model for shared care includes the core components of improved communication together with the development of a register and database with systems for review and recall. Local needs assessment, audit, training and guidelines are complimentary components. The intervention, Mental Health Link, is a facilitated quality improvement programme which aims to expedite the development of services by bringing the teams together to agree on a model of shared care suited to local needs, skills and interests, and  by  supporting  the development of practice systems.

 Conclusions   A model for shared care needs to take into account interdependencies of the components as well as the relationship with the context. The heterogeneity of primary and community care need to be reflected in the development of complex interventions designed to enhance shared care. It is possible to develop a generalizable complex intervention which is sensitive to local circumstances.
Change, humanity, and the nature of exile: workforce planning and the future of the health service
Authors: Thompson Nicola
Published: January 2004

There have been many changes in the practice of medicine in the UK in the recent past, including major changes in training and trainees’ hours, treatment options and patient expectations. These, in combination with a need for better accountability and improved continuing medical education, have increased the demands on senior doctors, and made apparent the need for increased medical resource. There would seem to be four areas through which this is being addressed – increased production of doctors; changes in medical training; changes in medical practice, and retention of seniors in post. This paper examines some of the perceived advantages and potential disadvantages of these approaches. It concludes that if the health service is to have a viable long‐term future, its survival in the short term depends on maintaining within the service the skills of those seniors who have borne the brunt of recent change.
Equity and need when waiting for total hip replacement surgery
Authors: Fitzpatrick Ray , Norquist Josephine M. , Reeves Barnaby C. , Morris Richard W. , Murray David W. , Gregg Paul J.
Published: January 2004

Objectives  To explore sociodemographic and health status factors associated with waiting times both for first outpatient appointment and for total hip replacement surgery (THR).

Methods  A survey of THR in five former English regions was conducted between September 1996 and October 1997. Every patient listed for THR was asked to fill out a questionnaire preoperatively. This questionnaire included the 12‐item Oxford Hip Score (OHS) questionnaire and two questions on the length of time patients waited for an  outpatient  appointment  and  subsequently  for  their operation.

Results  From multiple logistic regression analyses, region, private vs. public sector, housing tenure and preoperative OHS were all independently associated with a waiting time for an outpatient appointment for > 3 months. Region, housing tenure and gender were also independently associated with a wait of ≥ 6 months on the surgical waiting list.

Conclusions  A large proportion of patients had long waiting times both for an outpatient appointment and while on a surgical waiting list. There were significant differences in waiting time according to social, geographical and health care system factors. Patients with a worse pain and disability at surgery waited longer for an outpatient appointment. The longer patient waited, the worse was their pain and disability, suggesting that patients were not prioritized by these criteria. Benefits of prioritizing should be tested.
Emergency department mental health triage scales improve outcomes
Authors: Broadbent Marc , Jarman Heather , Berk Michael
Published: January 2004

The assessment and management of clients with mental illness is an important facet of providing emergency care. In Australian emergency departments, it is usually the generalist registered nurses* without adequate preparation in the assessment and care for clients with mental illness who conduct the initial assessment at triage. A search of the literature revealed a limited number of publications addressing the provision of triage and management guidelines to assist nurses to make objective clinical decisions to ensure appropriate care for clients with mental illness. This paper examines the need for such guidelines and reviews a number of mental health triage scales that have been evaluated for use in emergency departments. Findings show that these triage scales have led to improvements in staff confidence and attitudes when dealing with clients with mental health problems, resulting in improved outcomes for clients. Strengths and limitations of the evaluations have also been explored. Highlighted is the need for consideration of the inclusion of clients’ reactions to the impact of this change to service delivery in future evaluations.
Picosecond time‐resolved microspectrofluorometry in live cells exemplified by complex fluorescence dynamics of popular probes ethidium and cyan fluorescent protein
Authors: Tramier M. , Kemnitz K. , Durieux C. , Coppey‐Moisan M.
Published: January 2004

Time‐resolved microspectrofluorometry in live cells, based on time‐ and space‐correlated single‐photon counting, is a novel method to acquire spectrally resolved fluorescence decays, simultaneously in 256 wavelength channels. The system is calibrated with a full width at half maximum (FWHM) of 90 ps for the temporal resolution, a signal‐to‐noise ratio of 106, and a spectral resolution of 30 (Δλ/Λ). As an exemple, complex fluorescence dynamics of ethidium and cyan fluorescent protein (CFP) in live cells are presented. Free and DNA intercalated forms of ethidium are simultaneously distinguishable by their relative lifetime (1.7 ns and 21.6 ns) and intensity spectra (shift of 7 nm). By analysing the complicated spectrally resolved fluorescence decay of CFP, we propose a fluorescence kinetics model for its excitation/desexcitation process. Such detailed studies under the microscope and in live cells are very promising for fluorescence signal quantification.
Laser scanning confocal microscopy for in situ monitoring of alkali–silica reaction
Authors: Collins C. L. , Ideker J. H. , Kurtis K. E.
Published: January 2004

Alkali–silica reaction (ASR) occurs in concrete between reactive siliceous components in the aggregate and the strongly alkaline pore solution, resulting in the formation of a potentially expansive gel product. Lithium additives have been shown to reduce expansion associated with ASR, but the mechanism(s) by which lithium reduces expansion have not been understood. Therefore, development of an in situ method to observe reactions associated with ASR is highly desirable, as it will allow for non‐destructive observation of the reaction product formation and damage evolution over time, as the reaction progresses. A technique to image into mortar through glass aggregate by laser scanning confocal microscopy (LSCM), producing three‐dimensional representations of the sample was developed. This LSCM technique was utilized to monitor the progress of alkali–silica reaction in mortar samples prepared with alkali‐reactive glass aggregate both in the presence and in the absence of lithium additives: LiNO3, LiCl or LiOH. The method proved to be effective in qualitatively monitoring crack formation and growth and product formation, within cracks and at the paste/aggregate interface. In particular, dendritic products were observed at the paste/aggregate interface only in those samples containing lithium, suggesting that these products may play a role in ASR mitigation.
Static and dynamic experiments in cryo‐electron microscopy: comparative observations using high‐vacuum, low‐voltage and low‐vacuum SEM
Authors: Stokes D. J. , Mugnier J‐Y. , Clarke C. J.
Published: January 2004

We carried out a unique comparative study between three modes of cryo‐scanning electron imaging: high‐vacuum, low‐voltage and low‐vacuum, using ice cream as a model system. Specimens were investigated both with and without a conductive coating (Au/Pd) and at temperatures for which ice either remains fully frozen (< −110 °C) or undergoes sublimation (−110 to −90 °C). At high magnification, high‐vacuum imaging of coated specimens gave the best results for ‘static’ specimens (i.e. containing fully frozen ice). Low voltages, such as 1 kV, could be used for imaging uncoated specimens at high vacuum, although slight ‘classical’ charging artefacts remained an issue, and the reduced electron beam penetration tended to decrease the definition between different microstructural features. However, this mode was useful for observing in situ sublimation from uncoated specimens. Low‐vacuum mode, involving small partial pressures of nitrogen gas, was particularly suited to in situ sublimation work: when sublimation was carried out in low vacuum in the absence of an anti‐contaminator plate, sublimation rates were significantly reduced. This is attributed to a small partial pressure of sublimated water vapour remaining near the specimen surface, enhancing thermodynamic stability.
Terminal protein‐induced stretching of bacteriophage φ29 DNA
Authors: Wang H. , Grimes S. , Anderson D. L. , Serwer P.
Published: January 2004

Stretching of DNA molecules helps to resolve detail during the fluorescence microscopy of both single DNA molecules and single DNA–protein complexes. To make stretching occur, intricate procedures of specimen preparation and manipulation have been developed in previous studies. By contrast, the present study demonstrates that conventional procedures of specimen preparation cause DNA stretching to occur, if the specimen is the double‐stranded DNA genome of bacteriophage φ29. Necessary for this stretching is a protein covalently bound at both 5′ termini of φ29 DNA molecules. Some DNA molecules are attached to a cover glass only at the two ends. Others are attached at one end only with the other end free in solution. The extent of stretching varies from ∼50% overstretched to ∼50% understretched. The understretched DNA molecules are internally mobile to a variable extent. In addition to stretching, some φ29 DNA molecules also undergo assembly to form both linear and branched concatemers observed by single‐molecule fluorescence microscopy. The assembly also requires the terminal protein. The stretched DNA molecules are potentially useful for observing DNA biochemistry at the single molecule level.
Fluorescence microscopy of colour‐tagged nanoparticles that are undergoing thermal motion
Authors: Wang H. , Huang S. , Hayes S. J. , Serwer P.
Published: January 2004

To bypass limitations of conventional biochemical analysis, single‐particle biochemical analysis is used. To improve single‐particle biochemical analysis, procedures are needed to keep nanometre‐sized particles in focus while the particles are undergoing thermal motion. A simple, inexpensive procedure is developed here for keeping particles in focus during the continuous observing/discriminating/recording of two different particles, both of which are undergoing thermal motion. This procedure concentrates the particles in a plane of solution that is in focus when the cover glass surface is in focus. An essential component of the procedure is the addition of molten, low‐melt agarose to the specimen. Motionless binding to glass is inhibited by inclusion of anti‐stick additives in the specimen. Both carrier protein (gelatin) and non‐ionic detergent (Triton X‐100) are anti‐stick additives successfully used here. Intact bacteriophages T3 and T7 are used as model particles, in anticipation of the use of the procedures developed here for the analysis of the assembly of bacteriophages. Observing/discriminating/recording of colour‐tagged bacteriophages T3 and T7 is achieved at video frame rate with image splitting to discriminate colours.
Precision of the fractionator from Cavalieri designs
Authors: Cruz‐Orive L. M.
Published: January 2004

A popular procedure to predict the variance of the fractionator consists in splitting the initial collection of fragments into two subsets, in order to use the corresponding particle counts (or any other pertinent measure), in the calculation. The current formula does not account for local or ‘nugget’ errors inherent in the estimation of fragment contents, however. Moreover, it does not account for the fact that the contribution of the variability between fragments or slices should rapidly decrease as the sampling fraction increases. For these reasons, an update to the formula is overdue. It should be stressed, however, that the formula applies to Cavalieri slices designs – its application for arbitrary partition designs is therefore not warranted.
The role of the dental team in tobacco cessation
Authors: Johnson N. W.
Published: January 2004

The dental team can play an effective role in the creation of tobacco‐free communities and individuals through participation in community and political action and in counselling their patients to quit. Maintaining a smoke‐free environment is important. There are well‐tried and cost effective methods for brief interventions in dental clinical settings, and team‐work, to which both clinical and reception/administrative staff must contribute, is fundamental. Quit rates of the order of 10%, sustained over a year or more, can be achieved and this may be increased by prescription of nicotine replacement therapies, or of buproprion, to aid nicotine withdrawal. Prevention of smoking uptake, especially by young people, is much more difficult and has a weaker evidence base. In much of Central and Eastern Europe the situation is very severe because of high smoking rates and associated diseases and where, although governments are now acting with advertising bans and other legislation arising from the Framework Convention on Tobacco Control, the healthcare professions themselves have high smoking prevalences and a comparative lack of involvement in tobacco cessation and prevention practices. In South and South‐East Asia, and in emigrant communities originating from these areas, the use of oral unsmoked tobacco, the chewing of areca nut, and various mixtures of these ingredients in the form of betel quids, is highly addictive and carcinogenic to the mouth, pharynx and oesophagus. Special and specific efforts are needed for cessation and coping strategies in these communities, for which there is a less well‐developed evidence base.
Paradigm shifts in medical and dental education: behavioural sciences and behavioural medicine
Authors: Piko B. F. , Kopp M. S.
Published: January 2004

Psychosomatic and behavioural medicine have a long tradition in Hungary. In this paper, we highlight the possibilities of teaching behavioural medicine and behavioural science in the medical and dental curricula, particularly in the field of health promotion and prevention. There are a number of possibilities for dentists in the fields of behavioural science in both research and health policy. There is a need for closer integration of teaching, research and health policy in both general medicine and dentistry, and both doctors and dentists must approach their patients in a holistic way.