bluuebunny/crossref_metadata_2025 huggingface dataset:
FANCA and FANCG are the major Fanconi anemia genes in the Korean population
Authors: Park J , Chung N‐G , Chae H , Kim M , Lee S , Kim Y , Lee J‐W , Cho B , Jeong DC , Park IY
Published: October 2012

Fanconi anemia (FA) is a rare disorder characterized by physical abnormalities, bone marrow failure (BMF), increased risk of malignancies, and cellular hypersensitivity to DNA cross‐linking agents. This study evaluated the genetic alterations in three major Fanconi genes (FANCA, FANCC, and FANCG) in 30 FA patients using multiplex ligation‐dependent probe amplification and direct sequencing. Thirteen BMF patients were genetically classified as FA‐A (n = 6, 46%) and FA‐G (n = 7, 54%). Four common founder mutations were identified and included two FANCA mutations (c.2546delC and c.3720_3724delAAACA) and two FANCG mutations (c.307+1G>C and c.1066C>T), which had previously been commonly observed in a Japanese FA population. We also detected four novel deleterious mutations: c.2778+1G>C and c.3627‐1G>A of FANCA, and c.1589_1591delATA and c.1761‐1G>A of FANCG. This study shows that mutations in FANCA and FANCG are common in Korean FA patients and the existence of four common founder mutations in an East Asian FA population. Mutation screening workflow that includes these common mutations may be useful in the creation of an international database, and to better understand the ethnic characteristics of FA.
Implant Stability and Bone Remodeling after 3 and 13 Days of Implantation with an Initial Static Strain
Authors: Halldin Anders , Jimbo Ryo , Johansson Carina B. , Wennerberg Ann , Jacobsson Magnus , Albrektsson Tomas , Hansson Stig
Published: October 2012

Objective

Bone is constantly exposed to dynamic and static loads, which induce both dynamic and static bone strains. Although numerous studies exist on the effect of dynamic strain on implant stability and bone remodeling, the effect of static strain needs further investigation. Therefore, the effect of two different static bone strain levels on implant stability and bone remodeling at two different implantation times was investigated in a rabbit model.

Methods

Two different test implants with a diametrical expansion of 0.15 mm (group A) and 0.05 mm (group B) creating initial static bone strains of 0.045 and 0.015, respectively. The implants were inserted in the proximal tibial metaphysis of 24 rabbits to observe the biological response at implant removal. Both groups were compared to control implants (group C), with no diametrical increase. The insertion torque (ITQ) was measured to represent the initial stability and the removal torque (RTQ) was measured to analyze the effect that static strain had on implant stability and bone remodeling after 3 and 13 days of implantation time.

Results

The ITQ and the RTQ values for test implants were significantly higher for both implantation times compared to control implants. A selection of histology samples was prepared to measure bone to implant contact (BIC). There was a tendency that the BIC values for test implants were higher compared to control implants.

Conclusion

These findings suggest that increased static bone strain creates higher implant stability at the time of insertion, and this increased stability is maintained throughout the observed period.
A 10‐Year Clinical and Radiographic Study of Implants Placed after Maxillary Sinus Floor Augmentation with an 80:20 Mixture of Deproteinized Bovine Bone and Autogenous Bone
Authors: Mordenfeld Arne , Albrektsson Tomas , Hallman Mats
Published: October 2012

Background

There is a need for prospective, long‐term follow‐up studies of implants placed after maxillary sinus floor augmentation (MSFA).

Purpose

The aim of the present study was to determine whether deprotenized bovine bone (DPBB) used for MSFA may result in long‐term stability of placed dental implants.

Material and Methods

Fourteen of the 20 patients included in the study were followed throughout the 10 years study period. These patients had 53 implants placed in 22 (6 unilateral and 8 bilateral) maxillary sinuses augmented with a mixture of 80% DPBB and 20% autogenous bone (80:20), and 15 implants placed in non‐grafted sites. Clinical and radiographic examinations of the implants and grafts were performed.

Results

After 10 years of functional loading 15 of the initially placed 108 implants had been lost giving a cumulative survival rate of 86%. The mean marginal bone loss was 1.6 ± 1.0 mm. There were no statistically significant differences in marginal bone level, pocket depth, or ISQ‐values between implants placed in residual or grafted bone or between smokers or non‐smokers at 10 years follow‐up. There was a statistically significant reduction (p < .01) in graft height between 3 months and 2 years but no further significant reduction up to 10 years.

Conclusions

The first 2 years after placement of implants with turned surfaces placed in sites after sinus floor augmentation with DPBB and autogenous bone seem to be critical for implant survival. At 10 years follow‐up, the remaining implants presented excellent clinical and radiological results regardless of smoking habits or implant sites (augmented or residual bone).
Evaluation of the right ventricular ejection fraction during classic orthotopic liver transplantation without venovenous bypass
Authors: Xu Haitao , Li Weiwei , Xu Zhendong , Shi Xueyin
Published: October 2012

Background

Right ventricular (RV) function is sensitive to changes in cardiac loading conditions, and RV dysfunction may contribute to hemodynamic instability during orthotopic liver transplantation (OLT). Thus, we evaluated RV function and its role in hemodynamic instability during classic OLT without venovenous bypass (VVB).

Methods

Thirty patients undergoing classic OLT without VVB were studied. Right ventricular ejection fraction (RVEF) was measured using a modified pulmonary artery catheter. Hemodynamic data were recorded at pre‐determined time points: T0, baseline; T1–T3: 5, 15, and 30 min after clamping; T4–T7: 5, 15, 30, and 120 min after reperfusion; T8 and T9: 24 and 48 h after surgery.

Results

The baseline RVEF was lower than normal value. RVEF decreased significantly from T1 to T4 and returned to baseline beginning at T5. At 24 and 48 h after surgery, RVEF was higher than baseline value. RVEF was correlated with stroke volume index and post‐reperfusion syndrome during OLT. Compared to the low MELDs group, RVEF in the high MELDs group was lower at T1, T2, and T4.

Conclusions

Right ventricular function was compromised during the anhepatic and early reperfusion stages in patients undergoing classic OLT without VVB, particularly in the high MELD score patients. Close monitoring of RV function in these patients should be considered.
Safety and tolerability of the T‐cell depletion protocol coupled with anakinra and etanercept for clinical islet cell transplantation
Authors: Takita Morihito , Matsumoto Shinichi , Shimoda Masayuki , Chujo Daisuke , Itoh Takeshi , SoRelle Jeffrey A. , Purcell Kerri , Onaca Nicholas , Naziruddin Bashoo , Levy Marlon F.
Published: October 2012

Background

Islet cell transplantation (ICT) is a promising approach to cure patients with type 1 diabetes. We have implemented a new immunosuppression protocol with antithymoglobulin plus anti‐inflammatory agents of anakinra and eternacept for induction and tacrolimus plus mycophenolate mofetil for maintenance [T‐cell depletion with anti‐inflammatory (TCD‐AI) protocol], resulting in successful single‐donor ICT.

Methods

Eight islet recipients with type 1 diabetes reported adverse events (AEs) monthly. AEs were compared between three groups: first infusion with the TCD‐AI protocol (TCD‐AI‐1st) and first and second infusion with the Edmonton‐type protocol (Edmonton‐1st and Edmonton‐2nd).

Results

The incidence of symptomatic AEs within the initial three months in the TCD‐AI‐1st group was less than in the Edmonton‐1st and Edmonton‐2nd groups, with a marginally significant difference (mean ± SE: 5.5 ± 0.3, 7.5 ± 0.5, and 8.3 ± 1.3, respectively; p = 0.07). A significant reduction in liver enzyme elevation after ICT was found in the TCD‐AI‐1st group compared with the Edmonton‐1st and Edmonton‐2nd groups (p < 0.05). Because of AEs, all patients in the Edmonton protocol eventually converted to the TCD‐AI protocol, whereas all patients tolerated the TCD‐AI protocol.

Conclusions

TCD‐AI protocol can be tolerated for successful ICT, although this study includes small cohort, and large population trial should be taken.
Recurrence of non‐alcoholic steatohepatitis and cryptogenic cirrhosis following orthotopic liver transplantation in the context of the metabolic syndrome
Authors: El Atrache Mazen M. , Abouljoud Marwan S. , Divine George , Yoshida Atsushi , Kim Dean Y. , Kazimi Marwan M. , Moonka Dilip , Huang Mary A. , Brown Kim
Published: October 2012

Background

Non‐alcoholic steatohepatitis (NASH) and cryptogenic cirrhosis (CC) are increasing indications for orthotopic liver transplantation (OLT). The aim of this study is to describe our outcomes and delineate predictors of recurrence of NASH and CC after OLT.

Methods

This is a retrospective study from 1996 to 2008. Donor and recipient demographics, metabolic profile, insulin and steroid intake, immunosuppression regimen, operative factors, outcomes, and pathologies were reviewed. Fisher's exact test, Cox regression models, and Kaplan–Meier plots were used.

Results

A total of 83 patients were included. Recurrence occurred in 20 patients. Thirty‐four percent of the patients with metabolic syndrome (MS) had recurrence of NASH or CC compared with 13% of the patients without MS (p = 0.05). Recurrence also occurred in 32% of the patients with hypertension (HTN) vs. 12% in those without HTN (p = 0.05). Thirty‐seven percent of those on insulin had recurrence vs. 6% of those not on insulin (p = 0.05). Five‐yr survival probability for patients with MS, HTN, and insulin use was 52%, 61%, and 58%, respectively.

Conclusions

Higher recurrence of NASH and CC was associated with presence of MS, HTN and insulin use. Recurrence should be further evaluated in larger studies, with special emphasis on management of MS and prevention strategies.
Toxicity of autologous hematopoietic cell transplantation in patients with multiple myeloma – comparison between two different induction regimens
Authors: Ram Ron , Magen‐Nativ Hila , Vidal Liat , Herscovici Corina , Peck Anat , Raanani Pia , Shpilberg Ofer , Yeshurun Moshe
Published: October 2012

Background

Induction therapy in patients with multiple myeloma has evolved from chemotherapy‐based to novel agents–based regimens. We compared autologous hematopoietic cell transplantation (HCT)‐associated toxicity in patients induced with VTD‐PACE (bortezomib, thalidomide, dexamethasone, cisplatinum, adriamycin, cyclophosphamide, and etoposide) to that of patients induced with novel agents–only therapy.

Methods

We reviewed medical charts of all patients with multiple myeloma who were given induction therapy and HCT.

Results

Between the years 2007 and 2011, 38 patients received VTD‐PACE, and 31 patients received novel agents–only regimen. Mean time to neutrophil and platelets recovery was longer in patients given VTD‐PACE compared with those given novel agents–only regimen (7 vs. 6 d, p = 0.0002 and 11 vs. 10 d, p = 0.04, respectively). We observed higher rates of grade 2–4 mucositis and parenteral narcotic analgesia administration in the patients given VTD‐PACE (45% vs. 19%, p = 0.05 and 37% vs. 12%, p = 0.07, respectively). Progression free survival and overall survival were not statistically significantly different between the two groups.

Conclusions

A more intensive induction regimen was associated with slightly delayed counts recovery and a higher rate of mucositis during HCT compared with novel agents–only regimens. A longer follow‐up is needed to assess long‐term disease control of the two different regimens.
The role of Thymoglobulin induction in kidney transplantation: an update
Authors: Mourad Georges , Morelon Emmanuel , Noël Christian , Glotz Denis , Lebranchu Yvon
Published: October 2012

The rabbit antithymocyte globulin Thymoglobulin first became available over 25 yr ago and is the most widely used lymphocyte‐depleting preparation in solid organ transplantation. Thymoglobulin targets a wide range of T‐cell surface antigens as well as natural killer‐cell antigens, B‐cell antigens, plasma cell antigens, adhesion molecules and chemokine receptors, resulting in profound, long‐lasting T‐cell depletion. Randomized studies have established the anti‐rejection efficacy of Thymoglobulin in kidney transplantation. Experimental and clinical data suggest that Thymoglobulin administration may ameliorate ischemia reperfusion injury, thus reducing the incidence of delayed graft function (DGF). Studies have demonstrated the benefit of using Thymoglobulin to facilitate immunosuppression minimization, both for corticosteroid and calcineurin inhibitor (CNI) withdrawal or avoidance, with potential improvement in cardiovascular and renal outcomes. The optimal cumulative dose for Thymoglobulin induction is 6–7.5 mg/kg, with vigilant short‐ and long‐term monitoring of hematological status. Induction with Thymoglobulin is now indicated in immunologically high‐risk patients, in those at increased risk of DGF and to maintain efficacy in low‐risk transplant recipients receiving steroid or CNI minimization or avoidance regimens. We suggest that in future trials Thymoglobulin be tested with costimulation signal blockers and other immunosuppressants with the objective of establishing operational tolerance.
Low‐dose fluconazole prophylaxis in kidney transplant recipients receiving tacrolimus
Authors: Sikora Magdalena B. , Truax Crystal , Lee Sabrina , Kenyon Nicole , Smith Lonnie , Corbett Jacke , Shihab Fuad S.
Published: October 2012

Background

The use of prophylactic antifungal therapy is suggested after kidney transplantation. However, efficacy of low‐dose (50 mg) oral fluconazole and its effect on tacrolimus trough levels in patients maintained on tacrolimus and mycophenolic acid, with or without corticosteroids, is unknown.

Methods

A retrospective analysis to evaluate efficacy was performed in 305 kidney transplant recipients. An additional analysis to evaluate the fluconazole–tacrolimus drug interaction was performed in 103 patients. Complete tacrolimus area under the curve measurements were also performed in seven patients to further evaluate this drug interaction.

Results

The incidence of fungal infections was very low (0.6%, n = 2). The average tacrolimus trough level at the time of discontinuation and one wk after stopping fluconazole was unchanged (11.69 ± 3.18 and 11.15 ± 3.69 ng/mL, p = 0.145, n = 103). Tacrolimus trough levels on and off of fluconazole in a subgroup of patients continued on corticosteroids, was not significantly different (p = 0.952) but was significantly lower after fluconazole discontinuation if corticosteroids were withdrawn (p = 0.037). However, data from complete tacrolimus pharmacokinetics in the corticosteroid withdrawal group demonstrated no clinically significant differences.

Conclusion

Low‐dose, once daily oral fluconazole is effective antifungal prophylaxis after kidney transplantation without significant effects on tacrolimus trough levels or overall exposure.
Prognostic role of pre‐transplantation serum C‐reactive protein levels in patients with acute leukemia undergoing myeloablative allogeneic stem cell transplantation
Authors: Akı Şahika Zeynep , Suyanı Elif , Bildacı Yelda , Çakar Merih Kızıl , Baysal Nuran Ahu , Sucak Gülsan Türköz
Published: October 2012

The aim of this study was to identify indicators of outcome prior to transplantation in allogeneic hematopoietic stem cell transplantation (HCT). Clinical data of 106 patients with acute leukemia were retrospectively analyzed. We examined the role of pre‐conditioning serum C‐reactive protein (CRP) and ferritin levels, HCT‐CI and European Group for Blood and Marrow Transplantation (EBMT) scores on transplant toxicities, transplant‐related mortality (TRM), progression‐free survival (PFS), and overall survival (OS). High pre‐conditioning serum CRP levels showed a positive correlation with higher EBMT scores (p < 0.001), HCT‐CI (p = 0.004), and ferritin levels (p < 0.001). In univariate Cox regression analysis, serum CRP ≥10 mg/L, serum ferritin ≥1500 ng/mL, and HCT‐CI ≥3 had a significant adverse effect on OS. Serum CRP ≥10 mg/L and HCT‐CI ≥3 predicted increased risk of TRM in univariate analysis. Multivariate Cox regression analysis showed that HCT‐CI score ≥3 independently predicted increased risk of TRM and CRP ≥10 mg/L predicted increased risk of disease progression. Although CRP lost its significance on TRM in multivariate analysis, as an inexpensive and readily available serum biomarker of inflammation, the prognostic role of pre‐transplant CRP levels should be analyzed in selected diseases and increased number of patient groups.
Biodiversity and land‐use change: understanding the complex responses of an endemic‐rich bird assemblage
Authors: de Lima Ricardo Faustino , Dallimer Martin , Atkinson Philip W. , Barlow Jos
Published: October 2012

Aim

Anthropogenic land‐use change is a major driver of the current extinction crisis, but the processes through which it acts on biodiversity are complex and still poorly understood. Here, we use several biodiversity metrics to make a comprehensive assessment of the response of an endemic‐rich bird assemblage to land‐use change.

Location

São Tomé Island (São Tomé and Príncipe, Africa).

Methods

We sampled bird assemblages in 220 point counts, stratified across three regions and four land‐use types. Species richness was examined using accumulation curves and generalized linear mixed‐effect models. Compositional and structural changes were analysed with ordination techniques. We used correlations and model selection to identify species traits and environmental variables associated with such changes.

Results

At the point level, there was a slight decrease of species richness in more intensive land uses. However, higher dissimilarities within these land uses led them to have higher overall species richness. Endemics dominated forest environments and, although most preferred less‐disturbed land uses, many persisted across all land uses. Non‐endemics were virtually absent from forests, but became very abundant in the more intensive land uses. Canopy cover was the best predictor of the shift between endemic and non‐endemic species, and allowed identifying regional differences in the local responses of bird assemblages to land‐use change.

Main conclusions

To better understand biodiversity, it is crucial to use several metrics simultaneously. In São Tomé, simply using species richness, the single most used biodiversity metric, could have been misleading as it concealed major shifts in the bird assemblage structure towards an endemism impoverished avifauna. Despite scarce data on land‐use cover, we demonstrate how landscape context can be vital to understand biodiversity patterns and that highly forested surroundings might overestimate the strict value of more intensive land uses. Our results raise concerns about the long‐term persistence of endemic species restricted to islands where forested land uses are being lost.
Combination therapy with GLP‐1 receptor agonists and basal insulin: a systematic review of the literature
Authors: Balena R. , Hensley I. E. , Miller S. , Barnett A. H.
Published: October 2012

Treatment algorithms for type 2 diabetes call for intensification of therapy over time as the disease progresses and glycaemic control worsens. If diet, exercise and oral antihyperglycaemic medications (OAMs) fail to maintain glycaemic control then basal insulin is added and ultimately prandial insulin may be required. However, such an intensification strategy carries risk of increased hypoglycaemia and weight gain, both of which are associated with worse long‐term outcomes. An alternative strategy is to intensify therapy by the addition of a short‐acting glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA) rather than prandial insulin. Short‐acting GLP‐1 RAs such as exenatide twice daily are particularly effective at reducing postprandial glucose while basal insulin has a greater effect on fasting glucose, providing a physiological rationale for this complementary approach. This review analyzes the latest randomized controlled clinical trials of insulin/GLP‐1 RA combination therapy and examines results from ‘real‐world’ use of the combinations as reported through observational and clinical practice studies. The most common finding across all types of studies was that combination therapy improved glycaemic control without weight gain or an increased risk of hypoglycaemia. Many studies reported weight loss and a reduction in insulin use when a GLP‐1 RA was added to existing insulin therapy. Overall, the relative degree of benefit to glycaemic control and weight was influenced by the insulin titration employed in conjunction with the GLP‐1 RA. The greatest glycaemic benefits were observed in studies with structured titration of insulin to glycaemic targets while the greatest weight benefits were observed in studies with a protocol‐specified focus on insulin sparing. The adverse event profile of GLP‐1 RAs in the reviewed trials was similar to that reported with GLP‐1 RAs as monotherapy or in combination with OAMs with gastrointestinal events being the most commonly reported.
Searching for sustainability: are assessments of wildlife harvests behind the times?
Authors: Weinbaum Karen Z. , Brashares Justin S. , Golden Christopher D. , Getz Wayne M.
Published: October 2012

The unsustainable harvest of wildlife is a major threat to global biodiversity and to the millions of people who depend on wildlife for food and income. Past research has called attention to the fact that commonly used methods to evaluate the sustainability of wildlife hunting perform poorly, yet these methods remain in popular use today. Here, we conduct a systematic review of empirical sustainability assessments to quantify the use of sustainability indicators in the scientific literature and highlight associations between analytical methods and their outcomes. We find that indicator type, continent of study, species body mass, taxonomic group and socio‐economic status of study site are important predictors of the probability of reported sustainability. The most common measures of sustainability include population growth models, the Robinson & Redford (1991) model and population trends through time. Indicators relying on population‐specific biological data are most often used in North America and Europe, while cruder estimates are more often used in Africa, Latin America and Oceania. Our results highlight both the uncertainty and lack of uniformity in sustainability science. Given our urgent need to conserve both wildlife and the food security of rural peoples around the world, improvements in sustainability indicators are of utmost importance.
Extending the concept of keystone species to communities and ecosystems
Authors: Mouquet Nicolas , Gravel Dominique , Massol François , Calcagno Vincent
Published: October 2012

Keystone species are defined as having disproportionate importance in their community. This concept has proved useful and is now often used in conservation ecology. Here, we introduce the concept of keystone communities (and ecosystems) within metacommunities (and metaecosystems). We define keystone and burden communities as communities with impacts disproportionately large (positive or negative respectively) relative to their weight in the metacommunity. We show how a simple metric, based on the effects of single‐community removals, can characterise communities along a ‘keystoneness’ axis. We illustrate the usefulness of this approach with examples from two different theoretical models. We further distinguish environmental heterogeneity from species trait heterogeneity as determinants of keystoneness. We suggest that the concept of keystone communities/ecosystems will be highly beneficial, not only as a fundamental step towards understanding species interactions in a spatial context, but also as a tool for the management of disturbed landscapes.
Poised to prosper? A cross‐system comparison of climate change effects on native and non‐native species performance
Authors: Sorte Cascade J. B. , Ibáñez Ines , Blumenthal Dana M. , Molinari Nicole A. , Miller Luke P. , Grosholz Edwin D. , Diez Jeffrey M. , D'Antonio Carla M. , Olden Julian D. , Jones Sierra J. , Dukes Jeffrey S.
Published: October 2012

Climate change and biological invasions are primary threats to global biodiversity that may interact in the future. To date, the hypothesis that climate change will favour non‐native species has been examined exclusively through local comparisons of single or few species. Here, we take a meta‐analytical approach to broadly evaluate whether non‐native species are poised to respond more positively than native species to future climatic conditions. We compiled a database of studies in aquatic and terrestrial ecosystems that reported performance measures of non‐native (157 species) and co‐occurring native species (204 species) under different temperature, CO2 and precipitation conditions. Our analyses revealed that in terrestrial (primarily plant) systems, native and non‐native species responded similarly to environmental changes. By contrast, in aquatic (primarily animal) systems, increases in temperature and CO2 largely inhibited native species. There was a general trend towards stronger responses among non‐native species, including enhanced positive responses to more favourable conditions and stronger negative responses to less favourable conditions. As climate change proceeds, aquatic systems may be particularly vulnerable to invasion. Across systems, there could be a higher risk of invasion at sites becoming more climatically hospitable, whereas sites shifting towards harsher conditions may become more resistant to invasions.
Surgical lesions of the small colon and post operative survival in aUKhospital population
Authors: de Bont M. P. , Proudman C. J. , Archer D. C.
Published: October 2012

Reasons for performing study

There is limited information about risk factors and survival associated with disorders of the small colon requiring surgical management.

Objectives

1) To document the types of surgical lesion in horses where pathology of the small (descending) colon was the primary cause of abdominal pain, 2) to describe the short‐ and long‐term survival of these cases and identify factors associated with survival and 3) to identify preoperative variables associated with localisation of a lesion to the small colon.

Methods

Clinical data and long‐term follow‐up were obtained for horses that underwent exploratory laparotomy over a 10‐year period. Descriptive data were generated for short‐ and long‐term survival and survival analysis performed to identify factors associated with reduced survival. Univariable and multivariable relationships were explored using aCox proportional hazards model. Preoperative factors associated with increased likelihood of a small colon lesion were explored, using controls randomly selected from horses undergoing exploratory laparotomy for treatment of colic unrelated to the small colon.

Results

The study population included 84 horses. Of horses with small colon lesions recovered from anaesthesia, the percentage that survived until discharge, one year and 2 years following surgery, was 91.0, 81.0 and 73.5%, respectively. Median survival time for horses in which a resection had been performed was 1029 vs. 3072 days in the nonresection group. Small colon cases were more likely to have shown a longer duration of colic signs prior to admission (P<0.001) and to develop post operative diarrhoea (P= 0.001) when compared with surgical controls.

Conclusions

Lesions of the small colon carry a good prognosis for survival following surgery. Resection and anastomosis was the only factor associated with reduced long‐term survival.

Potential relevance

This study provides information about lesion types and post operative survival that may be used to assist informed decision‐making when managing these cases.
A patient perspective of pharmacist prescribing: ‘crossing the specialisms‐crossing the illnesses’
Authors: McCann Laura M. , Haughey Sharon L. , Parsons Carole , Lloyd Fran , Crealey Grainne , Gormley Gerard J. , Hughes Carmel M.
Published: October 2012

Background

The drive for non‐medical prescribing has progressed quickly since the late 1990s and involves a range of healthcare professionals including pharmacists. As part of a commissioned research project, this qualitative element of a larger case study focused on the views of patients of pharmacist prescribers.

Objective

The aim of this study was to explore patients' perspectives of pharmacists as prescribers.

Methods

Three pharmacists working as independent prescribers in the clinical areas of (i) hypertension, (ii) cardiovascular/diabetes management, (iii) anticoagulation were recruited to three case studies of pharmacist prescribing in Northern Ireland. One hundred and five patients were invited to participate in focus groups after they had been prescribed for by the pharmacist. Focus groups took place between November 2010 and March 2011 (ethical/governance approvals granted) were audio taped, transcribed verbatim, read independently by two authors and analysed using constant comparative analysis.

Results

Thirty‐four patients agreed to participate across seven focus groups. Analysis revealed the emergence of one overarching theme: team approach to patient care. A number of subthemes related to the role of the pharmacist, the role of the doctor and patient benefits. There was an overwhelming lack of awareness of pharmacist prescribing. Patients discussed the importance of a multidisciplinary approach to their care and recognized limitations of the current model of prescribing.

Conclusion

Patients were positive about pharmacist prescribing and felt that a team approach to their care was the ideal model especially when treating those with more complex conditions. Despite positive attitudes, there was a general lack of awareness of this new mode of practice.
Development of a fragile X syndrome (FXS) knowledge scale: towards a modified multidimensional measure of informed choice for FXS population carrier screening
Authors: Ames Alice G. , Jaques Alice , Ukoumunne Obioha C. , Archibald Alison D. , Duncan Rony E. , Emery Jon , Metcalfe Sylvia A.
Published: October 2012

Background

Genetic carrier screening is increasingly possible for many conditions, but it is important to ensure decisions are informed. The multidimensional measure of informed choice (MMIC) is a quantitative instrument developed to evaluate informed choice in prenatal screening for Down syndrome, measuring knowledge, attitudes and uptake. To apply the MMIC in other screening settings, the knowledge scale must be modified.

Objective

To develop and validate a modified MMIC knowledge scale for use with women undergoing carrier screening for fragile X syndrome (FXS).

Setting and participants

Responses to MMIC items were collected through questionnaires as part of a FXS carrier screening pilot study in a preconception setting in Melbourne, Australia.

Design

Ten knowledge scale items were developed using a modified Delphi technique. Cronbach's alpha and factor analysis were used to validate the new FXS knowledge scale. We summarized the knowledge, attitudes and informed choice status based on the modified MMIC.

Results

Two hundred and eighty‐five women were recruited, 241 eligible questionnaires were complete for analysis. The FXS knowledge scale items measured one salient construct and were internally consistent (alpha = 0.70). 71% (172/241) of participants were classified as having good knowledge, 70% (169/241) had positive attitudes and 27% (65/241) made an informed choice to accept or decline screening.

Discussion and conclusions

We present the development of a knowledge scale as part of a MMIC to evaluate informed choice in population carrier screening for FXS. This can be used as a template by other researchers to develop knowledge scales for other conditions for use in the MMIC.
Patient involvement in mental health care: culture, communication and caution
Authors: Tse Samson , Tang Jessica , Kan Alice
Published: October 2012

Background

Patient or service user involvement in mental health services (MHS) is a hallmark of the recovery approach.

Objective

In this viewpoint article, we review Tambuyzer et al. paper ‘Patient involvement in mental health care: One size does not fit all’ in order to express our opinion of their work. We also suggest specific actions that may enhance the implementation of patient involvement in MHS.

Discussion

We make three main points about Tambuyzer et al. model. First, the cultural dimension of patient involvement seems underemphasized in the model. Second, the model might be improved if the increasing role of communications technology in patient involvement is taken into consideration. Third, it is important to acknowledge that the process of patient involvement is not linear, and participation is not a homogeneous experience.

Conclusions

We suggest that the model be expanded and that further work be carried out on the implementation of patient involvement in MHS.
How doctors make use of online, point‐of‐care clinical decision support systems: a case study of UpToDate©
Authors: Addison John , Whitcombe Jo , William Glover Steven
Published: October 2012

Background

Online point‐of‐care evidence‐based information tools are becoming increasingly popular.

Objectives

To discover how doctors actually use one such tool – UpToDate – in clinical practice.

Methods

An online survey was distributed to doctors at healthcare organisations in the north‐west of England which subscribed to UpToDate. Some survey questions asked for quantifiable data (e.g. demographic details), whilst other questions were open‐ended and sought examples of clinical scenarios and actual point‐of‐care use of UpToDate. Open‐ended responses were then analysed into emerging themes.

Results

The open‐ended responses include evidence illustrating a large variety of clinical scenarios in which the use of UpToDate influenced clinical practice.

Conclusions

These results show how just one point‐of‐care tool is used in a variety of ways that benefit the patient, the doctor and the healthcare organisation. Direct quotations reported will provide compelling evidence for librarians to present to senior managers who may be unsure of the value of point‐of‐care tools in clinical practice.
Stability of athlete passport parameters during extended storage
Authors: Ashenden M. , Clarke A. , Sharpe K. , d'Onofrio G. , Plowman J. , Gore C. J.
Published: October 2012

Introduction

Extended intervals between sample collection and analyses render athlete's whole‐blood specimens collected in the field for antidoping purposes susceptible to storage degradation. The aim of this study was to characterize the stability of key blood variables under different storage durations and temperatures.

Methods

We evaluated stability of full blood count indices (plus reticulocytes) in individual tubes left undisturbed during 36, 48, 72, 96, 120, 144 and 168 h of storage at approximately 4, 6 and 12 °C. Samples were measured on a Sysmex XT‐2000i instrument.

Results

The two key variables in the context of antidoping (haemoglobin concentration, reticulocytes) were stable for at least 168 h, except under 12 °C (stable 48 h only). Volume‐dependent variables changed in a predictable manner that enabled a nomogram to be generated to predict original values provided storage duration and temperature were known.

Conclusion

Key blood results can be relied upon for at least 7 days if storage temperature is kept at 4–6 °C.
Fish trophic structure in estuaries, with particular emphasis on estuarine typology and zoogeography
Authors: Harrison T. D. , Whitfield A. K.
Published: October 2012

A comparative analysis of the fish trophic structure was undertaken on some 190 South African estuaries spanning three zoogeographic regions and incorporating three broad estuarine types. Fish biomass trophic guild compositions and biomass trophic spectrum profiles were analysed using multivariate statistical techniques and included both inter‐regional (zoogeographic) and intra‐regional (estuarine typology) comparisons. Differences in the fish trophic structure of the various estuary types within each zoogeographic region were observed; these were linked to the relative biomass contribution of the various trophic guilds and also to differences in biomass trophic spectrum profiles of the fishes in each estuary type within each region. In spite of these differences in trophic structure, all estuaries were dominated by detritivores, which suggests that the main food source (detritus) is similar in all biogeographic regions. Preliminary indications are that a similar dependence by estuary‐associated fishes on detritus food sources exists on a global basis but that detailed studies are required in order to confirm this assertion.
Gambling in Britain: the application of restraint erosion theory
Authors: Orford Jim
Published: October 2012

Aim  To provide an overview of gambling and problem gambling in Britain, including historical background, current regulations and the recognition, prevalence and treatment of problem gambling.

Methods  A new theory, Gambling Restraint Erosion Theory (GRET), is used as a framework for understanding the history of gambling regulation in Britain in the 20th century and evidence about the prevalence of gambling and problem gambling, as well as public attitudes towards gambling, in Britain in the first decade of the 21st century.

Findings  Restraints on gambling were progressively dismantled as regulation moved from partial prohibition, to tolerance, and then to liberalization by the turn of the millennium. British adult gambling prevalence surveys carried out in 1999/2000, 2006/07 and 2009/10 suggest that the British public is still relatively restrained in its engagement in gambling, and is still suspicious of gambling. There is evidence from the last of those surveys that engagement in some forms of gambling, and the prevalence of problem gambling, have risen, and that attitudes have become less negative towards gambling.

Conclusions  Restraints which kept British gambling circumscribed, and the prevalence of problem gambling low, may be in the process of being eroded. Meanwhile, an effective public health response to problem gambling is constrained by lack of Department of Health interest and a failure to develop a research and treatment base independent of the gambling industry.
National gambling experiences in the United States: will history repeat itself?
Authors: Petry Nancy M. , Blanco Carlos
Published: October 2012

Aims  The aim of this paper is to offer an account of the history and current status of gambling research in the United States.

Methods  A review of the literature.

Results  Gambling has been a part of society in the United States since its early history. However, it was not until 1980 that the medical profession in the United States first recognized pathological gambling as a psychiatric disorder. Today, it is still rarely diagnosed or treated, and relatively little federal funding is available to support research in this area. With the upcoming fifth revision of the Diagnostic and Statistical Manual of Mental Disorders, pathological gambling is likely to be included alongside substance use disorders as the first non‐substance‐related addictive disorder. This change may represent an opportunity to expand research on gambling and treatment of pathological gambling.

Conclusions  We provide 10 suggestions for reducing societal and personal harm associated with this disorder.
Gambling experiences, problems, research and policy: gambling in Germany
Authors: Ludwig Monika , Kräplin Anja , Braun Barbara , Kraus Ludwig
Published: October 2012

Aims

The objective of this paper is to present an overview of gambling in Germany, including historical development, legislative and economic changes as well as treatment options and their effectiveness.

Methods

The available scientific literature and research reports on gambling in Germany were reviewed to obtain relevant information on history, commercialization, legislation, treatment and research agenda.

Results

Gambling in Germany is characterized by compromises between protective and economic efforts. At present, gambling is illegal in Germany, and provision is subject to the state monopoly. Mere gaming machines (specific slot machines) are not classified as gambling activity, permitting commercial providers. In recent years, implementing regulations for state gambling and gaming machines have been changed. Concerning the treatment of pathological gambling, various options exist; treatment costs have been covered by health and pension insurance since 2001. Information on the effectiveness of treatment in Germany is limited. Similarly, the number of peer‐reviewed publications on gambling is small.

Conclusions

German gambling legislation was subject to major changes in the past years. Based on the available body of research (longitudinal), studies on risk and protective factors and the aetiology of pathological gambling are needed. The effectiveness of pathological gambling treatment in Germany and the impact of gambling regulations on gambling behaviour also need to be investigated.
Adaptation and the physiology of ocean acidification
Authors: Kelly Morgan W. , Hofmann Gretchen E.
Published: October 2012

Ocean acidification, caused by the uptake of atmospheric CO2, is a threat to marine biodiversity, potentially rivalling the threat imposed by rising temperatures in some marine ecosystems. Although a growing body of literature documents negative effects of acidification on marine organisms, the majority of this work has focused on the effects of future conditions on modern populations, ignoring the potential effects of adaptation and physiological acclimatization.

We review current literature on the potential for adaptation to elevated pCO2 in marine organisms. Although this body of work is currently quite small, we argue that data on the physiological effects of acidification, natural variation in pH and lessons learned from previous work on thermal adaptation can all inform predictions and priorities for future research.

Spatially varying selection is one of the most important forces maintaining intraspecific genetic variation. Unlike temperature, pH lacks a strong and persistent global gradient, and so selection may maintain less adaptive variation for pH than for temperature. On the other hand, we are only beginning to amass long‐term data sets for pH variation in natural habitats, and thus, pH gradients may be more common than previously observed.

Two of the most important effects of elevated pCO2 are reduced calcification and changes in metabolism. We discuss the ways that a detailed understanding of the physiological mechanisms underlying these effects is key to predicting the capacity for acclimatization and adaptation.

Important priorities for future research will be to assess local adaptation to pH conditions and to measure the capacity for adaptation to future acidified conditions in natural populations. Tools for this work include traditional quantitative genetics, transcriptomics and the adaptation of ion‐sensitive field‐effect transistor (ISFET) technology for use in continuous seawater pH monitoring in the field.
Wide‐azimuth angle gathers for anisotropic wave‐equation migration
Authors: Sava Paul , Alkhalifah Tariq
Published: October 2012

Extended common‐image‐point gathers (CIP) constructed by wide‐azimuth TI wave‐equation migration contain all the necessary information for angle decomposition as a function of the reflection and azimuth angles at selected locations in the subsurface. The aperture and azimuth angles are derived from the extended images using analytic relations between the space‐ and time‐lag extensions using information which is already available at the time of migration, i.e. the anisotropic model parameters. CIPs are cheap to compute because they can be distributed in the image at the most relevant positions, as indicated by the geologic structure. If the reflector dip is known at the CIP locations, then the computational cost can be reduced by evaluating only two components of the space‐lag vector. The transformation from extended images to angle gathers is a planar Radon transform which depends on the local medium parameters. This transformation allows us to separate all illumination directions for a given experiment, or between different experiments. We do not need to decompose the reconstructed wavefields or to choose the most energetic directions for decomposition. Applications of the method include illumination studies in complex areas where ray‐based methods fail, and assuming that the subsurface illumination is sufficiently dense, the study of amplitude variation with aperture and azimuth angles.
Apoplastic infusion of sucrose into stem internodes during female flowering does not increase grain yield in maize plants grown under nitrogen‐limiting conditions
Authors: Peng Yunfeng , Li Chunjian , Fritschi Felix B.
Published: October 2012

Nitrogen (N) limitation reduces leaf growth and photosynthetic rates of maize (Zea mays), and constrains photosynthate translocation to developing ears. Additionally, the period from about 1 week before to 2 weeks after silking is critical for establishing the reproductive sink capacity necessary to attain maximum yield. To investigate the influence of carbohydrate availability in plants of differing N status, a greenhouse study was performed in which exogenous sucrose (Suc) was infused around the time of silking into maize stems grown under different N regimes. N deficiency significantly reduced leaf area, leaf longevity, leaf chlorophyll content and photosynthetic rate. High N‐delayed leaf senescence, particularly of the six uppermost leaves, compared to the other two N treatments. While N application increased ear leaf soluble protein concentration, it did not influence glucose and suc concentrations. Interestingly, ear leaf starch concentration decreased with increasing N application. Infusion of exogenous suc tended to increase non‐structural carbohydrate concentrations in the developing ears of all N treatments at silking and 6 days after silking. However, leaf photosynthetic rates were not affected by suc infusion, and suc infusion failed to increase grain yield in any N treatment. The lack of an effect of suc infusion on ear growth and the high ear leaf starch concentration of N‐deficient maize, suggest that yield reduction under N deficiency may not be due to insufficient photosynthate availability to the developing ear during silking, and that yield reduction under N deficiency may be determined at an earlier growth stage.