bluuebunny/crossref_metadata_2025 huggingface dataset:
The Buen Pastor cemetery in Trujillo, Venezuela: measuring dengue vector output from a public area
Authors: Abe Mayumi , McCall P. J. , Lenhart Audrey , Villegas Elci , Kroeger Axel
Published: June 2005

As vector control of dengue typically targets individual households to eliminate breeding sites or control adult mosquitoes during epidemics, public spaces are frequently neglected. To investigate the importance of such places as sources of dengue vectors, a study of Aedes aegypti productivity in a cemetery in northern Venezuela, using standard entomological indices for assessing dengue vector infestations, was carried out in the wet season in May 2003. Containers were found on 72.8% of graves; 44% of the containers held water and in 46.9% of these we found A. aegypti larvae and/or pupae. The average density of Aedes‐infested containers was 39 per hectare. There were no significant differences in infestation rates between container types (vases, planters or others) or materials (cement, plastic, glass, etc.). Containers with 1–5 l of water held the greatest proportion of the pupae found in the cemetery (46.7%); containers with <100 ml of water contained no pupae. The mean number of pupae produced in the cemetery was estimated at 4185 pupae/ha per 48 h and the daily output of potential vector mosquitoes from the entire cemetery was calculated at approximately 3000 females per day. These mosquitoes presumably left the cemetery to feed in the nearby communities, thus thwarting the environmental management and health education programmes that had reduced household dengue vector infestations. The study shows the importance of public places as sources of dengue vectors in urban areas, and the need to include such areas in vector control programmes.
Efficacy of combination therapy with artesunate plus amodiaquine compared to monotherapy with chloroquine, amodiaquine or sulfadoxine–pyrimethamine for treatment of uncomplicated Plasmodium falciparum in Afghanistan
Authors: Durrani Naeem , Leslie Toby , Rahim Sayed , Graham Kate , Ahmad Fayaz , Rowland Mark
Published: June 2005

Introduction  In South and Central Asia resistance to chloroquine (CQ) has reached unmanageable levels, and resistance to sulfadoxine–pyrimethamine (SP) is emerging. Amodiaquine (AQ) is widely used in the region, and elsewhere shows only partial resistance to CQ. In Afghanistan, one option for slowing the spread of resistance and improving treatment outcomes is the use of artemisinin combination therapy (ACT).

Methods  The efficacy of CQ, AQ, SP and amodiaquine plus artesunate (AQ/AS) in the treatment of uncomplicated falciparum malaria was investigated using standard World Health Organization (WHO) procedures. Malaria patients were randomized to four treatment groups: 268 were enrolled and 240 completed the trial.

Results  There was a high level of cross‐resistance between CQ and AQ resistance: adequate clinical and parasitological response by day 42 was 11% after CQ treatment and 9% after AQ treatment. The trend of treatment failure between AQ and CQ was almost identical. Cure rates were considerably improved by the addition of artesunate to AQ or by use of SP; adequate clinical and parasitological response being 72% for AQ/AS and 92% for SP. The combination of AS/AQ substantially reduced the odds of treatment failure relative to AQ monotherapy by day 42 [odds ratio (OR) = 0.03, 95% confidence interval (CI) 0.01–0.1] in addition to reducing the proportion of patients with gametocytes throughout the 42‐day period. Gametocyte carriage rate was only marginally higher in the SP than in the CQ‐ and AQ‐treated groups.

Conclusion  The therapeutic and parasitological cure rates with AS/AQ were inadequate, and the criteria for deploying ACT – namely to prevent further selection of drug resistance from a position of low frequency – was not met in the region. An alternative drug combination to AQ/AS is required for Afghanistan.
Clinical algorithms for malaria diagnosis lack utility among people of different age groups
Authors: Mwangi Tabitha W. , Mohammed Mahfudh , Dayo Hiza , Snow Robert W. , Marsh Kevin
Published: June 2005

We conducted a study to determine whether clinical algorithms would be useful in malaria diagnosis among people living in an area of moderate malaria transmission within Kilifi District in Kenya. A total of 1602 people of all age groups participated. We took smears and recorded clinical signs and symptoms (prompted or spontaneous) of all those presenting to the study clinic with a history of fever. A malaria case was defined as a person presenting to the clinic with a history of fever and concurrent parasitaemia. A set of clinical signs and symptoms (algorithms) with the highest sensitivity and specificity for diagnosing a malaria case was selected for the age groups ≤5 years, 6–14 years and ≥15 years. These age‐optimized derived algorithms were able to identify about 66% of the cases among those <15 years of age but only 23% of cases among adults. Were these algorithms to be used as a basis for a decision on treatment among those presenting to the clinic, 16% of children ≤5 years, 44% of those 6–14 years of age and 66% of the adults who had a history of fever and parasitaemia ≥5000 parasites/μl of blood would be sent home without treatment. Clinical algorithms therefore appear to have little utility in malaria diagnosis, performing even worse in the older age groups, where avoiding unnecessary use of anti‐malarials would make more drugs available to the really needy population of children under 5 years of age.
Polymerase chain reaction‐based differential diagnosis of Ancylostoma duodenale and Necator americanus infections in humans in northern Ghana
Authors: de Gruijter Johanna M. , van Lieshout Lisette , Gasser Robin B. , Verweij Jaco J. , Brienen Eric A. T. , Ziem Juventus B. , Yelifari Lawrence , Polderman Anton M.
Published: June 2005

We evaluated a two‐step semi‐nested polymerase chain reaction (PCR)‐based approach for the specific detection of Ancylostoma duodenale DNA in human faeces. The test was used to determine to what extent this species of hookworm is present in the regions of Bolgatanga and Garu of northern Ghana. Initially, the sensitivity and specificity of the PCR were tested using a range of well‐defined control samples. Subsequently, a total of 378 human faecal DNA samples from Bolgatanga and Garu were subjected to the PCR. The results were compared with those obtained using a previously established PCR for the specific detection of Necator americanus DNA in human faeces. Infection with A. duodenale was recorded in 74 (19.6%) samples and N. americanus in 278 (73.5%), of which 64 (16.9%), represented co‐infections with both species. While A. duodenale was predominantly detected in the samples from Bolgatanga, infections in Garu related almost exclusively to N. americanus. The results showed that the present PCR approach is a valuable complementary tool for the diagnosis of A. duodenale infection in humans in Ghana, having implications for epidemiological studies and for the monitoring of the success of control programmes in regions in Africa.
Novel glycolipid variations revealed by monoclonal antibody immunochemical analysis of weak ABO subgroups of A
Authors: Svensson L. , Rydberg L. , Hellberg Å. , Gilliver L. G. , Olsson M. L. , Henry S. M.
Published: June 2005

Background and Objectives  The chemical basis of the subgroups of A is largely unknown. We used thin‐layer chromatography immunochemical staining techniques together with a range of characterized monoclonal reagents to analyse glycolipids isolated from a variety of weak subgroups.

Materials and Methods  Glycolipids isolated from red cells collected from nine genetically defined individuals of the rare subgroups of A, including a novel A3 allele (A2 539G>A) not described previously, were subjected to a highly sensitive thin‐layer chromatographic immunochemical analysis.

Results  Semicharacterized monoclonal antibodies revealed that, in addition to the expected quantitative differences between common phenotypes and the weak subgroups, qualitative glycolipid differences (or at least an apparent qualitative basis), caused by major changes in the ratios of different structures exist. Specifically it was found that the weakest A‐expressing samples (Ael phenotype) appeared to express an unusual A structure in the 8–12 sugar region. Variable expression of several structures in one of the A weak samples were suggestive of novel blood group A structures.

Conclusions  Although no structural characterization could be undertaken, the results are clearly indicative that the variant glycosyltransferases of the rare ABO subgroups are not only inefficient, but they may potentially synthesize novel ABO structures.
Universal fresh‐frozen plasma (Uniplas): an exploratory study in adult patients undergoing elective liver resection
Authors: Solheim B. G. , Granov D. A. , Juravlev V. A. , Krawczyk M. , Kubishkin V. A. , Patutko U. I. , Raab R.
Published: June 2005

Background and Objectives  The compatibility of an ABO blood group independently applicable plasma, Uniplas, was explored in liver resection because patients undergoing liver resection frequently require the transfusion of plasma to compensate for blood loss and/or clotting factors.

Materials and Methods  One‐hundred and twenty two patients undergoing elective liver resection were enrolled; 81 patients required plasma transfusion, while 41 did not. Of those in need of plasma, 58 were blood group A, B or AB, and 23 were blood group O. Patients were monitored up to day 7 postoperatively for signs of haemolysis and haemostasis, and viral markers were assessed at baseline and 3 weeks postoperatively.

Results  Uniplas transfusions of up to 50·7 ml/kg body weight were given per treatment episode, without signs of haemolysis caused by transfusion. A total of 94/99 patients (95%) were negative in the direct antiglobulin test throughout the study. Two patients, one transfused with Uniplas, the other not, had a positive direct antiglobulin test result at baseline, while three of 64 patients transfused with Uniplas demonstrated a change from having negative to intermittently positive direct antiglobulin test results without concurrent signs of haemolysis. International normalized ratio, activated partial thromboplastin time and protein C levels were maintained by transfusion of plasma (≥ 20 ml/kg body weight). No patient underwent seroconversion for human immunodeficiency virus, hepatitis B virus or hepatitis C virus. Positivity for hepatitis A virus (HAV) immunoglobulin G (IgG) in 11 patients from the Uniplas group (who tested HAV immunoglobulin M negative), together with an apparent seroconversion for parvovirus B19 seen in two patients who received Uniplas, indicated passively transferred IgG antibodies.

Conclusions  No haemolysis was observed as a result of Uniplas transfusions up to 50·7 ml/kg body weight per treatment episode in patients undergoing liver resection. Moreover, transfusion (≥ 20 ml/kg body weight of Uniplas) maintained acceptable levels of international normalized ratio, activated partial thromboplastin time and protein C.
Hyperconcentrated platelets stored in additive solution: aspects on productivity and in vitro quality
Authors: Ringwald J. , Walz S. , Zimmermann R. , Zingsem J. , Strasser E. , Weisbach V. , Eckstein R.
Published: June 2005

Background and Objectives  New platelet (PLT) additive solutions (PASs) allow a plasma carryover of < 30% in PLT concentrates. This implicates the need to collect apheresis PLT concentrates at very high PLT concentrations: so‐called dry PLTs (DPs). We used the TRIMA, with software version 4 (TRIMA V4), to collect such DPs and investigated the in vitro quality of these PLTs when stored in the new modified PAS‐III (PAS‐IIIM).

Materials and Methods  TRIMA V4 was programmed to collect 6·0 × 1011 PLTs at a concentration of 5000 × 103 PLTs/µl. Two DPs were pooled, split into four equal parts and diluted to obtain secondary pools (SPs) consisting of 70% PAS‐III/30% plasma, 70% PAS‐IIIM/30% plasma, 80% PAS‐IIIM/20% plasma or 100% plasma. In vitro testing was performed on days 0, 1, 5 and 7. Collection efficiency (CE), collection rate (CR) and PLT yield were calculated for each donation.

Results  Thirty‐two runs with TRIMA V4 were performed, collecting 6·58 ± 0·74 × 1011 PLTs at a concentration of 4255 ± 914 × 103/µl in 99 ± 19·9 min, resulting in a CE of 65·3 ± 8·2% and a CR of 6·92 ± 1·6 × 109 PLTs/min. On day 0, 34–37% of the PLTs in the units prepared for storage were already activated. PLTs stored in 70% or 80% PAS‐IIIM showed superior in vitro quality compared to PLTs stored in PAS‐III.

Conclusions  TRIMA V4 is a suitable device for the collection of DPs. Nevertheless, improvements are desirable to further increase the ability to concentrate PLTs at very high levels. The storage of apheresis‐derived PLTs in PAS III‐M is a very promising approach, even at a plasma carryover of < 30%.
Transfusion‐related acute lung injury (TRALI): a serious adverse event of blood transfusion
Authors: Bux J.
Published: June 2005

Background and Objectives  Analyses of fatal transfusion reactions in the UK and USA have shown that transfusion‐related acute lung injury (TRALI) is among the most common causes of fatal transfusion reactions.

Material and Methods  Review of the literature was used to analyse TRALI.

Results  TRALI is characterized by acute respiratory distress and non‐cardiogenic lung oedema developing during, or within 6 h of, transfusion. In atypical cases, TRALI can become symptomatic much later. TRALI must be carefully differentiated from transfusion‐associated circulatory overload. In its fulminant presentation, TRALI can be clinically indistinguishable from acute respiratory distress syndrome occurring as a result of other causes. The severity of TRALI depends upon the susceptibility of the patient to develop a more clinically significant reaction as a result of an underlying disease process, and upon the nature of triggers in the transfused blood components, including granulocyte‐binding alloantibodies (immune TRALI) or neutrophil‐priming substances such as biologically active lipids (non‐immune TRALI). Immune TRALI, which occurs mainly after the transfusion of fresh‐frozen plasma and platelet concentrates, is a rare event (about one incidence per 5000 transfusions) but frequently (≈ 70%) requires mechanical ventilation (severe TRALI) and is not uncommonly fatal (6–9% of cases). Non‐immune TRALI, which occurs mainly after the transfusion of stored platelet and erythrocyte concentrates, seems to be characterized by a more benign clinical course, with oxygen support sufficient as a form of therapy in most cases, and a lower mortality than immune TRALI.

Conclusions  By virtue of its morbidity and mortality, TRALI has become one of the most serious current complications of transfusion. To prevent further antibody‐mediated cases, the evaluation of TRALI should include leucocyte antibody testing of implicated donors. However, further studies are necessary for the prevention of this serious transfusion complication.
The Effect of Removal of Seminal Plasma, Egg Yolk Level and Season on Sperm Freezability of Canary Buck (Capra hircus)
Authors: Cabrera F , González F , Batista M , Calero P , Medrano A , Gracia A
Published: June 2005

Contents

Goat semen is different from that of other domestic species in its limited tolerance to the inclusion of egg yolk in the freezing medium, and this tolerance depends on the presence of enzymes in the seminal plasma that react with egg yolk, producing toxic compounds to the spermatozoa. Moreover, the goat is a seasonal breeder that shows variations in semen quality throughout the year, and those variations may affect semen freezability; hence in freezing protocols, for instance, removal of seminal plasma (washing) yields varying results. This work was designed to study this problem in Canary goats: semen from six males was collected in spring, autumn or winter, washed or non‐washed, diluted in a freezing extender with 1.5, 6 or 12% egg yolk, frozen, and thawed after 2 days, 2 or 6 months of cryopreservation. The effect of egg yolk concentration in the freezing extender was far more important than the effect of washing or season on sperm cryosurvival. The quality of frozen–thawed semen tended to improve as egg yolk concentration increased regardless of the effects of season, washing or period of cryopreservation. Washing produced a positive effect on frozen–thawed semen collected during spring or autumn, but the difference decreased as the concentration of yolk increased. However, washing produced a negative effect on frozen–thawed semen collected during winter, diluted with either 6 or 12% egg yolk. There was no apparent seasonal effect on gross measures of sperm production but the seasonal effect was ever present and was reinforced by freezing.
Sex Identification of the Black Swan (Cygnus atratus) using the Locus‐specific PCR and Implications for its Reproduction
Authors: He P‐J , Yu J‐Q , Fang S‐G
Published: June 2005

Contents

Over the last 4–5 years the small captive population of black swans (Cygnus atratus) has consistently failed to reproduce at the Chengdu Research Base of Giant Panda Breeding. The probable cause was hypothesized to be an abnormal sex distribution of the population. The black swan is an example of a sexually monomorphic species. The locus‐specific polymerase chain reaction (PCR) approach based on the chromo‐helicase‐DNA‐binding 1 (CHD1) gene, was adopted for the sex determination of the black swans. For this purpose, F1, F2 and R primers were designed using the primerselect software for amplification of the CHD1 gene region. DNA agarose gel electrophoresis showed that the female control displayed two bands, whereas only a single band was found in the male control. Sequence analyses of all seven unknown sex black swans demonstrated the sex‐specific DNA band for female. Therefore, it was inferred that all the individuals of the black swan population are females, which has resulted in unfertilized eggs and reproduction failure. This method can be extended to the sexing of other monomorphic avian species and will assist in the design of breeding projects.
Chronological Appearance of Apoptosis in Bovine Embryos Reconstructed by Somatic Cell Nuclear Transfer from Quiescent Granulosa Cells
Authors: Gjørret JO , Wengle J , Maddox‐Hyttel P , King WA
Published: June 2005

Contents

Efficiency of cloning has remained low and in spite of attempts to improve this technology, many reconstructed embryos do not implant or are lost during early pregnancy. Chromosomal aberrations, deviant gene expression patterns and abnormal regulation of cell death may be involved in this increased early embryonic loss. Here, we investigate the chronological onset of both apoptotic changes in nuclear morphology and DNA degradation [detected by transferase‐mediated dUTP nick‐end labelling (TUNEL) reaction] in bovine two‐cell‐ to blastocyst‐stage embryos. Such embryos were generated either by reconstruction with nuclear transfer from quiescent granulosa cells or by regular in vitro embryo production. Nuclear condensation was observed from the two‐cell stage and TUNEL labelling was observed from the six‐cell stage in reconstructed embryos, whereas nuclear condensation was evident from the eight‐cell stage and TUNEL labelling from the 13‐cell stage in embryos derived in vitro. Furthermore, reconstructed embryos displayed elevated ratios of embryos containing apoptotic nuclei at pre‐compaction stages and higher indices of apoptotic nuclei in morula and blastocyst stages when compared with in vitro‐produced embryos.
Night‐time Melatonin Secretion and Seasonally Delayed Puberty in Gilts
Authors: Peltoniemi OAT , Tast A , Virolainen JV , Karkamo V , Heinonen M , Andersson MA
Published: June 2005

Contents

This study was conducted to determine whether the seasonal delay in puberty in autumn is driven by individual differences in night‐time melatonin secretion in domestic gilts at the attainment of puberty. A group of spring‐born gilts (n = 30) were expected to reach puberty in autumn by the age of 7 months. Eighteen of these gilts were selected in pairs on the basis of matched days of birth. By the expected time, half of the animals showed oestrous symptoms (group CYCLING, n = 9) with the rest remaining silent (group SILENT, n = 9). Afterwards, all gilts were fitted with indwelling jugular catheters for frequent blood sampling. Blood samples were collected from all animals three times during the day followed by three times in the night at 2‐h intervals for 48 h. The samples were analysed by a commercial radioimmunoassay (RIA). The results show a consistent 25‐fold rise (on average) in night‐time melatonin concentration in every animal sampled with group averages ranging from 0.28 ± 0.04 to 0.37 ± 0.06 pg/ml at day and from 10.20 ± 2.16 to 10.67 ± 0.05 pg/ml at night. Night‐time group mean values between CYCLING and SILENT gilts did not differ significantly (10.26 ± 0.67 and 10.38 ± 0.94 for the CYCLING; 10.67 ± 0.05 and 10.20 ± 2.16 for the SILENT). When 10 pg/ml was used as a threshold value, six individuals did not reach it during the night (low responders). Two of these gilts were CYCLING and four were SILENT. In conclusion, the results presented imply no involvement of the level of night‐time melatonin concentration in the seasonal delay of puberty in gilts.
In Vitro and in Vivo Developmental Competence of Dromedary (Camelus dromedarius) Embryos Produced in Vitro Using Two Culture Systems (mKSOMaa and Oviductal Cells)
Authors: Khatir H , Anouassi A , Tibary A
Published: June 2005

Contents

Development competence and pregnancy rate of in vitro‐produced (IVP) dromedary embryos were studied in two culture systems: (i) semi‐defined modified medium (mKSOMaa) and (ii) co‐culture using camel epithelial oviducal cells. Five hundred and three cumulus–oocytes complexes (COCs) were selected, allowed to mature, fertilized and cultured in vitro (38.5°C; 5% CO2, maximum humidity >95%, with concentration of oxygen of 5% for semi‐defined medium and 20% for co‐culture cells). Maturation was accomplished by incubation in TCM‐199 medium supplemented with 10% heat‐treated foetal calf serum (FCS), 10 ng/ml epidermal growth factor, 1 μg/ml follicle‐stimulating hormone, 1 μg/ml oestradiol and 500 μM cysteamine for 30 h. In vitro fertilization (IVF) was performed using fresh semen (0.5 × 106 spermatozoa/ml in modified TALP solution). Fertilized COCs were denuded by vortexing, then cultured in either mKSOMaa (10% heat‐treated FCS was added 24 h post‐IVF), under 5% O2 and 90% N2 (group 1; n = 249) or with dromedary epithelial oviducal cell monolayers in TCM‐199 with 10% heat‐treated FCS under 20% O2 (group 2; n = 254). The rate of cleavage was significant higher (p < 0.05) for group 1 (63%, 156/249) than for group 2 (51%, 130/254). No significant difference was found between the two groups in the rate of development to blastocyst (21% vs 16.5%) and their hatchability (21% vs 14%). Pregnancy rates were similar for the first 60 days. However, all pregnancies were lost after 60 days with the exception of two of six (33%) from recipients of hatched blastocysts from group 1. We conclude that both systems support in vitro production of dromedary embryos by in vitro maturation (IVM)/IVF of oocytes. However, embryos obtained by culture in the semi‐defined medium (mKSOMaa) appear to have a better in vivo development ability.
The Use of an Open‐freezing System with Self‐seeding for Cryopreservation of Mouse Ovarian Tissue
Authors: Maltaris T , Dimmler A , Müller A , Binder H , Hoffmann I , Kohl J , Siebzehnrübl E , Beckmann MW , Dittrich R
Published: June 2005

Contents

Chemoradiotherapy in young women with cancer has substantially improved life expectancy in these patients, but these treatments often cause infertility. One method of preserving fertility is to cryopreserve ovarian tissue. In this study, an automatic open‐vessel freezing system with self‐seeding was tested for cryopreservation of murine ovarian tissue; the mouse is a species widely used in human and veterinary medical research. The freezing system concerned, is used for cryopreservation of oocytes and embryos in Europe. Twenty severe combined immunodeficiency (SCID) mice were ovariectomized. The ovarian tissue was either directly transplanted heterotopically into the neck muscle (group 1, n = 6) or cryopreserved after equilibration with 1.5 M dimethylsulphoxide and propanediol. After thawing, the tissue was transplanted in SCID mice (group 2, n = 6). Before and after thawing, a part of the ovarian tissue was examined with the LIVE/DEAD fluorescent viability staining. The count of follicles revealed intact (fresh 24.1%/thawed 21.7%), impaired (fresh 35.1%/thawed 35.4%), and dead follicles (fresh 40.8%/thawed 42.9%). The healthy follicular loss because of the cryopreservation was 10.0%. All recipient mice were killed after 3 weeks. Transplanted ovarian tissue was found macroscopically in all mice. Histological examination showed several growing follicles in all developmental phases in both groups of SCID mice [group 1 (fresh grafts): 315 ± 76.3 (mean ± SD); group 2 (cryopreserved grafts): 237 ± 63.4]. These results demonstrate that the use of an open‐freezing system allows the survival of cryopreserved mouse ovarian tissue.
Renal abscess with paranephric extension in a gravid woman: Ultrasound and magnetic resonance imaging findings
Authors: Puvaneswary M , Bisits A , Hosken B
Published: June 2005

We present a case of renal abscess with perinephric and paranephric extension. Ultrasonography showed an intrarenal lesion. The extension into the perinephric and paranephric space was better defined on MRI.
Australia‐wide comparison of intensity modulated radiation therapy prostate plans*
Authors: Skala M , Holloway L , Bailey M , Kneebone A
Published: June 2005

The aim of this study was to investigate the ability of Australian centres to produce high‐dose intensity modulated radiation therapy (IMRT) prostate plans, and to compare the planning parameters and resultant dose distributions. Five Australian radiation therapy departments were invited to participate. Each centre received an identical 5 mm‐slice CT data set complete with contours of the prostate, seminal vesicles, rectum, bladder, femoral heads and body outline. The planning team was asked to produce the best plan possible, using published Memorial Sloan‐Kettering Cancer Centre prescription and dose constraints. Three centres submitted plans for evaluation. All plans covered the planning target volume adequately; however, only one plan met all the critical organ dose constraints. Although the planning parameters, beam arrangements and planning systems were different for each centre, the resulting plans were similar. In Australia, IMRT for prostate cancer is in the early stages of implementation, with routine use limited to a few centres.
Rendu–Osler–Weber syndrome presenting with pulmonary arteriovenous fistula
Authors: Halefoglu AM
Published: June 2005

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu–Osler–Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5–15% of Rendu–Osler–Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49‐year‐old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X‐ray revealed a 5‐cm mass in the left lower lobe and after magnetic resonance examination, together with 3‐D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similiar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu–Osler–Weber syndrome presenting with a pulmonary arteriovenous fistula.
Anomalous unilateral single pulmonary vein: Two cases mimicking arteriovenous malformations and a review of the literature
Authors: Hanson JM , Wood AM , Seymour R , Petheram IS
Published: June 2005

Total anomalous pulmonary venous drainage is a rare congenital anomaly. It usually involves a pulmonary to systemic venous shunt and most cases have a septal defect in order to survive. Anomalous pulmonary venous drainage with pulmonary venous shunting is an extremely rare and entirely benign entity. We present two such cases, in which there was atresia of the left superior pulmonary vein and drainage via a tortuous collateral vein to the left inferior pulmonary vein. This collateral was mistaken on plain film and CT for a pulmonary arteriovenous malformation. Awareness of this anomalous unilateral single pulmonary vein and its radiological appearances may help in avoiding unnecessary pulmonary angiography.
Opaque maxillary antrum: A pictorial review
Authors: Whyte A , Chapeikin G
Published: June 2005

The demonstration of an opaque antrum on a plain radiograph or cross‐sectional imaging leads to consideration of an extensive differential diagnosis. Relevant clinical details narrow the differential and include the patient's age, signs and symptoms, a history of recent trauma, prior surgery or dental treatment. Computed tomography remains the most useful technique in coming to a specific diagnosis. Magnetic resonance imaging adds specificity in a few selected situations and is required in conjunction with CT in the staging of malignant tumours.
Power Doppler ‘blanching’ after the application of transducer pressure
Authors: Joshua F , De Carle R , Rayment M , Bryant C , Shnier R , Edmonds J , Lassere M
Published: June 2005

The aim of this study was to determine if transducer pressure modifies power Doppler assessments of rheumatoid arthritis synovium at the metacarpophalangeal joints and metatarsophalangeal joints. Five rheumatoid arthritis patients of varying degrees of ‘disease activity’ and damage were assessed with power Doppler ultrasound scanning of the dominant hand second to fifth metacarpophalangeal joints. Two rheumatoid arthritis patients had their dominant foot first to fifth metatarsophalangeal joints assessed with power Doppler ultrasound. Ultrasonography was performed with a high frequency transducer (14 MHz) with a colour mode frequency of 10 Mhz, and a standard colour box and gain. In the joint that showed the highest power Doppler signal, an image was made. A further image was taken after transducer pressure was applied. In all patients, there was increased flow to at least one joint. After pressure was applied, power Doppler signal intensity markedly reduced in all images and in some there was no recordable power Doppler signal. Increased transducer pressure can result in a marked reduction or obliteration in power Doppler signal. This power Doppler ‘blanching’ shows the need for further studies to evaluate sources of error and standardization before power Doppler ultrasound becomes a routine measure of ‘disease activity’ in rheumatoid arthritis.
Contrast‐enhanced three‐dimensional fast‐spoiled gradient magnetic resonance angiography of the renal arteries for potential living renal transplant donors: A comparative study with digital subtraction angiography
Authors: Al‐Saeed O , Ismail M , Sheikh M , Al‐Moosawi M , Al‐Khawari H
Published: June 2005

Preoperative assessment of the arterial anatomy of prospective renal donors is essential. Various non‐invasive techniques are used for such evaluation. We conducted this study using contrast‐enhanced 3‐D fast‐spoiled gradient (CE 3‐D FSPGR) magnetic resonance angiography (MRA) on a 1.0 Tesla magnet, for preoperative definition of the renal arteries. Forty‐five preoperative living renal donors underwent CE 3‐D FSPGR MRA of the renal vessels and the results were compared with conventional digital subtraction angiography (DSA). The renal vascular anatomy, both normal and with variations, was satisfactorily defined in all 45 cases with CE 3‐D FSPGR MRA. Fifteen cases showed an accessory or aberrant arterial supply. A small aneurysm was shown in one case. All cases compared well with conventional DSA. Our study revealed that CE 3‐D FSPGR MRA on a lower field strength magnet is accurate in defining the renal vascular anatomy and its variations.
The role of psychological well‐being in retaining rural general practitioners
Authors: Gardiner Maria , Sexton Roger , Durbridge Mitchell , Garrard Kiara
Published: June 2005

Objective:  Retention of rural GPs is an increasing area of concern and is receiving considerable attention from the government, medical authorities and the media. This study aimed to examine the potential for psychological interventions to assist in the retention of rural GPs through targeting their psychological well‐being.

Design:  GPs completed a questionnaire, including questions about their level of support in rural practice, psychological health (work‐related morale and distress, distress related specifically to working in rural general practice, quality of work life) and intentions to leave rural practice.

Setting:  Rural general practices in South Australia.

Participants:  One hundred and eighty‐seven rural GPs.

Results:  Results indicated that rural GPs who were seriously considering leaving rural practice had higher work‐related distress, higher distress related specifically to working in a rural general practice and lower quality of work life. GPs who considered leaving rural practice also reported having fewer colleagues with whom to discuss professional issues.

Conclusion:  Results indicated that psychological interventions (such as cognitive behavioural training), assistance with stress reduction and coping mechanisms (such as more interaction with colleagues) may be of benefit to GPs who are considering leaving rural practice. Such training may increase the number of GPs who ultimately stay in rural practice.
Perspectives on clinic attendance, medication and foot‐care among people with diabetes in the Torres Strait Islands and Northern Peninsula Area
Authors: Wong Morva , Haswell‐Elkins Melissa , Tamwoy Elizabeth , McDermott Robyn , D’Abbs Peter
Published: June 2005

Objective:  To achieve a better understanding of the perspectives and needs of Indigenous people with diabetes in the Torres Strait and to identify ways to promote successful self‐management of diabetes.

Design:  Descriptive study collecting qualitative data in focus groups and in‐depth interviews. Analysis of three key areas of diabetes self‐care, namely attending appointments at the clinic, monitoring blood glucose levels and taking medication and foot‐care.

Setting:  Informal settings in remote communities of the Torres Strait and Northern Peninsula Area of Far North Queensland.

Subjects:  Sixty‐seven Torres Strait Islanders (26 men and 41 women) with diabetes from eight Torres Strait and Northern Peninsula Area communities.

Main outcome measures:  A better understanding of the views, enabling factors and barriers that people experience when managing their diabetes in remote Torres Strait communities.

Results:  Participants who expressed satisfaction with clinical‐initiated sessions when called highlighted positive relationships and encouraging feedback from doctors. People's attitudes and practices related to oral and injectable treatments varied widely, possibly linked to levels of understanding. Widespread knowledge of foot‐care and fear of amputation in an environment highly conducive to foot sores and infection was evident. Generally, participants wanted more education and personal support in all areas of diabetes care. Service providers in health and other sectors need to place more emphasis on supporting self‐management of diabetes within the family and community environment.
An analysis of the development of a successful medical collaboration to create and sustain family physician anaesthesiology capacity in rural Canada
Authors: Lockyer Jocelyn , Norton Peter
Published: June 2005

Background:  Initial efforts to increase the availability of training positions, standardise training, and obtain national recognition for family physicians who wished to practise anaesthesia had stalled.

Objective:  To describe the work undertaken to create and sustain family medicine anaesthesiology capacity in Canada.

Methods:  In our review, we examined the critical aspects of successful intersectoral work, namely, involvement by key stakeholders; the development of decision‐making mechanisms; clearly defined objectives, roles and responsibilities; official support and legitimisation from participating organisations and adequate resources for partnership building.

Setting:  Canadian rural family medicine anaesthesiology practice.

Results:  A small steering committee obtained funding for a national meeting of stakeholders and subsequent committee work over an 18‐month period. The national meeting brought together the necessary stakeholders to review and discuss the issues and agree on a group‐determined agenda, determine a work plan, identify priority areas and allow the College of Family Physicians of Canada to be the lead organisation in moving the work ahead. Within 18 months, the boards of the key organisations had accepted a common set of standards for training and a national curriculum. Work remains in the longer term to identify sustainable funding for training of family physician as well as the provision of continuing medical education for those trained.

Conclusions:  Appropriate attention to the key components of successful intersectoral work may enable previously stalled and complex work to move ahead despite opposition.
Barriers to accessing rural paediatric speech pathology services: Health care consumers’ perspectives
Authors: O'Callaghan Anna M. , McAllister Lindy , Wilson Linda
Published: June 2005

Objective:  An investigation of consumers’ perceived barriers to access paediatric speech pathology services.

Design:  Self‐administered, mail‐out questionnaire.

Setting:  Rural and remote New South Wales (NSW).

Subjects:  Three hundred and twenty‐nine members of the NSW branch of the Isolated Children's and Parents’ Association.

Results:  Consumers living in rural and remote areas experience a number of barriers that affected their ability to access speech pathology services. These barriers include the lack, and limited choice, of speech pathologists in rural areas; long distances to travel to access services, expensive travel costs, lack of public transport; poor awareness of speech pathology services; and delays in treatment due to waiting lists.

Conclusion:  Barriers to access paediatric speech pathology services limit rural and remote consumers’ usage of health services, regardless of need, indicating a possible inequity if compared to larger, more accessible urban areas.
A strategy to increase the palliative care capacity of rural primary health care providers
Authors: Reymond Liz , Charles Margaret , Israel Fiona , Read Trish , Treston Pat
Published: June 2005

Objective:  To pilot and evaluate an intervention aimed at increasing the palliative care capacity of primary health care providers in rural and remote communities.

Design:  Pre‐ and post‐workshop, and three months follow‐up questionnaires.

Setting:  Four locations in Far North Queensland.

Subjects:  One hundred and forty‐nine primary health care providers ranging from personal care workers to general practitioners (GPs).

Interventions:  Fourteen workshops were conducted. These were tailored to local palliative case loads facilitated by a specialist palliative care team from the Mt Olivet Hospice Service. Workshop content consisted of introductory didactic teaching based on participant‐nominated topics, small group case management discussions and a session devoted to psychosocial and counselling inputs.

Main outcome measures:  Cost, GP reach, evaluation of educational and clinical objectives.

Results:  Average cost per participant – excluding wages – was $271. Thirty‐two per cent of local GPs attended the workshops and 93.2% of participants reported that the workshops had satisfied their educational learning objectives. Evaluation of GP clinical performance revealed significant improvements in confidence regarding palliative care knowledge and skill levels as well as the management of common palliative symptoms. Evaluation of other primary health care providers’ clinical performance showed significant improvements in skills, management and rated knowledge.

Conclusions:  This intervention is relatively inexpensive, has reasonable reach and is effective as measured by educational and clinical outcomes.
Reducing unmet needs: A prevocational medical training program in public health medicine and primary health care in remote Australia
Authors: Mak Donna B. , Plant Aileen J.
Published: June 2005

Objectives:  To describe the development and implementation of a prevocational medical training program in public health medicine and primary health care in remote Australia and to evaluate the program's adherence to adult learning principles.

Methods:  Reports, funding applications and other relevant material relating to the program were reviewed to document learning objectives, and teaching and program implementation strategies.

Results:  The 24‐week program employs two prevocational medical practitioners each year and comprises four weeks at Fremantle Hospital's sexual health clinic followed by 20 weeks in the Kimberley. Curriculum objectives include clinical and public health aspects of sexually transmitted infection management, immunisation, clinical audit and quality improvement, primary health care in remote Aboriginal communities, oral and written presentation skills and working as part of an interdisciplinary team. Teaching strategies used were in accordance with adult learning principles.

Conclusions:  Prevocational medical training in public health medicine and primary health care in remote Australia is achievable and reduces current gaps in prevocational medical education.
Diversity decreases invasion via both sampling and complementarity effects
Authors: Fargione Joseph E. , Tilman David
Published: June 2005

Complementarity and sampling effects may both contribute to increased invasion resistance at higher diversity. We measured plant invader biomass across a long‐term experimental plant diversity gradient. Invader species’ biomass was inhibited in more diverse plots, largely because of the presence of strongly competitive C4 bunchgrasses, consistent with a sampling effect. Invader biomass was negatively correlated with resident root biomass, and positively correlated with soil nitrate concentrations, suggesting that competition for nitrogen limited invader success. Resident root biomass increased and soil nitrate concentrations decreased with the presence of C4 grasses and also across the diversity gradient, suggesting that diverse plots are more competitive because of the presence of C4 grasses. In addition to this evidence for a sampling effect, we also found evidence for a complementarity effect. Specifically, the percentage of plots that had lower invader biomass than did the best resident monoculture (i.e. that had invader ‘underyielding’) increased across the species richness gradient. This pattern cannot be explained by a sampling effect and is a unique signature of complementarity effects. Our results demonstrate the importance of multiple mechanisms by which diversity can increase invasion resistance.
Facilitative interactions rather than resource partitioning drive diversity‐functioning relationships in laboratory fungal communities
Authors: Tiunov Alexei V. , Scheu Stefan
Published: June 2005

We manipulated the number of saprotrophic fungi in either a complex multi‐resource substratum (sterilized forest soil), or a single‐resource substratum (powdered cellulose). The substrates were inoculated with five common species of soil fungi in all possible combinations (from monocultures to five species in combination). In both substrates, the rate of organic matter decomposition was positively associated with species richness. The effect of fungal diversity was much stronger in the uniform single‐resource substrate (r2 = 0.455,P < 0.0001) than in soil (r2 = 0.154,P < 0.0001). The results document that species richness of microbial decomposers strongly affects decomposition processes, at least at the species poor end of the diversity gradient. Both, ‘sampling effect’ and ‘species complementarity effect’ contributed to the community response with the latter being much more pronounced in uniform substrate than in soil. This indicates that facilitative interactions are more important than resource partitioning for positive effects of species richness.
The importance of plant relatedness for host utilization among phytophagous insects
Authors: Ødegaard Frode , Diserud Ola H. , Østbye Kjartan
Published: June 2005

Current methods for measuring similarity among phytophagous insect communities fail to consider the phylogenetic relationship between host plants. We analysed this relation based on 3580 host observations of 1174 beetle species associated with 100 species of angiosperms in two different forest types in Panama. We quantified the significance of genetic distance as well as taxonomic rank among angiosperms in relation to species overlap in beetle assemblages. A logarithmic model describing the decrease in beetle species similarity between host‐plant species of increasing phylogenetic distance explains 35% of the variation. Applied to taxonomic rank categories the results imply that except for the ancient branching of monocots from dicots, only adaptive radiations of plants on the family and genus level are important for host utilization among phytophagous beetles. These findings enable improvements in estimating host specificity and species richness through correction for phylogenetic relatedness between hosts and consideration of the host‐specific fauna associated with monocots.
Nitrogen/phosphorus leaf stoichiometry and the scaling of plant growth
Authors: Niklas Karl J. , Owens Thomas , Reich Peter B. , Cobb Edward D.
Published: June 2005

We adopted previous N : P stoichiometric models for zooplankton relative growth to predict the relative growth rates of the leaves μL of vascular plants assuming that annual leaf growth in dry mass is dictated by how leaf nitrogen NL is allocated to leaf proteins and how leaf phosphorus PL is allocated to rRNA. This model is simplified provided that NL scales as some power function of PL across the leaves of different species. This approach successfully predicted the μL of 131 species of vascular plants based on the observation that, across these species, NL scaled, on average, as the 3/4 power of PL, i.e. NL ∝ P. When juxtaposed with prior allometric theory and observations, our findings suggest that a transformation in N : P stoichiometry occurs when the plant body undergoes a transition from primary to secondary growth.