bluuebunny/crossref_metadata_2025 huggingface dataset:
Library Orientation and Instruction — 1986
Authors: Rader Hannelore B.
Published: May 2008

The following is an annotated list of materials dealing with orientation to library facilities and services, instruction in the use of information resources, and research and computer skills related to retrieving and using information. The thirteenth annual such review in Reference Services Review, the article covers items in English published in 1986. A few items are without annotations because the compiler was unable to secure copies of them for this review.
Management Budgeting
Authors: Wooff D.
Published: May 2008

Management budgeting was seen by the Griffiths Inquiry team as a key element in the general management process. It sought to involve clinicians, nurse managers and other budget holders in understanding their own management roles, with a view to improving services through more effective management at local level, and it was stressed that management budgeting should not be seen as an accounting exercise or as a device for containing costs. How was this system to be introduced in the UK health service, why was it felt to be necessary and, in mid‐1986, what lessons have been learnt from the implementation of the projects to date?
Inequity in health care — A proposed model
Authors: Ellencweig A.Y. , Grafstein MPH O.
Published: May 2008

The paper defines the concept of inequity in health care and reviews the various approaches to identify causal relationships which lead to inequitable health outcomes. Notably, the input and process of health care delivery, the medical and social need factors, the external environment and the indirect influences channeled through ‘mediating’ factors. It further proposes a comprehensive model which integrates the combined effects of the several categories of components involved in determining inequitable outcomes between groups and individuals. While not exhaustive, the model provides a systematic attempt to define and trace inequities in health and potential causes of such, in operational terms. It can be used, therefore, for practical measurement of levels of inequity in outcomes.
HMOs — A new management model from the United States
Authors: Butler Eamonn
Published: May 2008

Perhaps the most remarkable event in the US medical market in the last ten years has been the astonishing growth of the new kinds of health‐care delivery systems that are collectively known as health maintenance organisations (HMOs). Indeed, they are now posing a serious threat to the conventional insurance sector which has traditionally covered most Americans. According to data collected by the US Department of Health and Human Services and the Minnesota research foundation, InterStudy, some 18.9 million people were enrolled in an HMO in June 1985, so that the 400 HMOs then in existence accounted for roughly nine per cent of the health‐care market. Today's figures are undoubtedly higher, and one New York investment company expects that ‘by 1990, 75 million people, or 30 per cent of the population, will be members of HMOs’, with the organisations achieving ‘membership expansion and revenue growth of 30–40 per cent a year’
Cost information and decision‐making in the NHS
Authors: Prowle Malcolm
Published: May 2008

In recent years there has been an increasing emphasis in the UK National Health Service (NHS) on the provision of management information. This has been mainly manifested through the Körner initiatives, but other developments such as management budgeting and performance indicators also have a major implication for the provision of information. In its simplest form, the management information provided could be classified twofold, namely information on service provision and information on the use of resources.
DRGs: The European scene A general analysis
Authors: Rodrigues Jean Marie
Published: May 2008

A conference entitled ‘The Management and Financing of Hospital Services’ was held in London in December 1986. It was concerned with the implementation of a uniform patient classification system (DRG) for management and financing for certain cases in 15 European countries.
With cat‐like tread, the DRGs are coming
Authors: Thompson John D.
Published: May 2008

As an American participant in ‘Management and Financing of Hospital Services’, the DRG Convention held in London on llth‐13th December, 1986, I had looked forward to the presentations with a great deal of happy anticipation. That may seem a strange attitude unless one recognises that the life of a ‘DRG expert’ in the USA today is not necessarily a happy one. Like it or not, we are viewed as policemen. Much of the continuous, carping and often self‐serving criticism levelled against us can be described as woeful pleas from a band of corsairs; not very bloodthirsty ones mind you, but rapacious nonetheless.
Professionals in Health Care: Perceptions of Managers
Authors: McCartney Sean , Berman Brown Reva , Bell Louise
Published: May 2008

Reports the findings of a qualitative piece of research that was undertaken with professionals in the health field. There are numerous professionals working in the health/social services fields. Those who were the respondents in the research included chiropodists, nurses, doctors, psychologists and art psychotherapists. The sample was taken mainly from Essex, with input from a wider environment which included Newcastle, Southend, Manchester and Burnley. The researchers gave a brief scenario prior to asking open‐ended, qualitative questions about professionals' perceptions of: the physical appearance of managers; the roles of managers in the NHS. The comments made by the respondents indicate a disturbing degree of hostility towards and misapprehension about managers in the reformed NHS.
A Rationale for Rationing? A Possible Framework
Authors: Atherton Frank , Smith Iain , Kernohan Elizabeth
Published: May 2008

The health needs assessment (HNA) process is being used to enhance the effectiveness and efficiency of health and health care services and to continue to make them more sensitive and appropriate for local populations. The process is currently being undertaken in a number of key service areas, and is being followed in one commissioning authority in the United Kingdom with a population of nearly half a million: Bradford uses the Health Care Cube framework for information analysis. This activity is regarded as being essential to the improvement of the health of the population of Bradford and in keeping with the Health of the Nation ethos. It extends the process from assessment of need for a single client group or disease/condition, e.g. heart disease, HIV/AIDS, maternity services, to enable resource allocations to be directed towards one programme for health improvements compared with another, or indeed several others, e.g. heart disease or HIV/AIDS or maternity services.
Mutation analysis of carbamoyl phosphate synthetase: Does the structurally conserved glutamine amidotransferase triad act as a functional dyad?
Authors: Hart Emily J. , Powers‐Lee Susan G.
Published: May 2008

Evolutionarily conserved triad glutamine amidotransferase (GAT) domains catalyze the cleavage of glutamine to yield ammonia and sequester the ammonia in a tunnel until delivery to a variety of acceptor substrates in synthetase domains of variable structure. Whereas a conserved hydrolytic triad (Cys/His/Glu) is observed in the solved GAT structures, the specificity pocket for glutamine is not apparent, presumably because its formation is dependent on the conformational change that couples acceptor availability to a greatly increased rate of glutamine cleavage. In Escherichia coli carbamoyl phosphate synthetase (eCPS), one of the best characterized triad GAT members, the Cys269 and His353 triad residues are essential for glutamine hydrolysis, whereas Glu355 is not critical for eCPS activity. To further define the glutamine‐binding pocket and possibly identify an alternative member of the catalytic triad that is situated for this role in the coupled conformation, we have analyzed mutations at Gln310, Asn311, Asp334, and Gln351, four conserved, but not yet analyzed residues that might potentially function as the third triad member. Alanine substitution of Gln351, Asn311, and Gln310 yielded respective Km increases of 145, 27, and 15, suggesting that Gln351 plays a key role in glutamine binding in the coupled conformation, and that Asn311 and Gln310 make less significant contributions. None of the mutant k cat values varied significantly from those for wild‐type eCPS. Combined with previously reported data on other conserved eCPS residues, these results strongly suggest that Cys269 and His353 function as a catalytic dyad in the GAT site of eCPS.
Diagnostic value of pyrosequencing for the BRAFV600E mutation in ultrasound‐guided fine‐needle aspiration biopsy samples of thyroid incidentalomas
Authors: Jo Young Suk , Huang Songmei , Kim Yun‐Jeung , Lee Ihn‐Suk , Kim Song‐Soo , Kim Je‐Ryong , Oh Taejeong , Moon Youngho , An Sungwhan , Ro Heung‐kyu , Kim Jin‐Man , Shong Minho
Published: May 2008

Context  Dideoxy sequencing is the most commonly used method for detecting the BRAFV600E mutation in thyroid cancer and melanoma. However, this gold standard method often makes less definite results in detecting the BRAFV600E mutation when there are relatively low amounts of the mutant template in biopsy specimens, which are invariably contaminated with normal tissues. Pyrosequencing, which measures the incorporation of each of the four nucleotides at each template position and indicates the amounts of mutant template present, may be more useful in such situations.

Objective  To investigate the diagnostic efficiency of pyrosequencing for the mutant BRAF allele in ultrasound (US)‐guided fine needle aspiration biopsies (FNABs) of thyroid incidentalomas.

Design, setting and subjects  A total of 101 thyroid incidentaloma cases were included prospectively. Cytological diagnoses of the FNAB samples were made according to the American Thyroid Association (ATA) guidelines, 2006. The presence of the BRAFV600E mutation was investigated by pyrosequencing and dideoxy sequencing.

Results  On the basis of cytological analysis, the thyroid incidentalomas were classified into benign (n = 43), malignant (n = 30), indeterminate or suspicious neoplasm (n = 24), and nondiagnostic (n = 4) categories. Pyrosequencing detected the BRAFV600E mutation in 30 cases: 22 malignant cases, 7 indeterminate cases, and 1 nondiagnostic case. Dideoxy sequencing also detected the BRAFV600E mutation in 28 of the same cases but failed to clearly distinguish the mutant allele from the wild‐type allele in one indeterminate case and one nondiagnostic case. Histopathological analysis ascertained that all BRAFV600E‐positive cases were papillary thyroid carcinomas.

Conclusions  Pyrosequencing may be suitable for detecting the BRAFV600E mutation in thyroid incidentaloma and may be superior to dideoxy sequencing when low amounts of the mutant template are present in the biopsy.
Food resources of shredders and other benthic macroinvertebrates in relation to shading conditions in tropical Hong Kong streams
Authors: LI AGGIE O.Y. , DUDGEON DAVID
Published: May 2008

1. Gut content analyses (GCA) of benthic macroinvertebrates, supplemented by carbon and nitrogen stable isotope analyses (SIA), were used to determine the relative contribution of leaf litter and autochthonous food sources to consumer biomass in five shaded and five unshaded streams in tropical Hong Kong.

2. Only four obligate shredders and two facultative shredders were identified out of 58 morphospecies dissected. Non‐shredder taxa consumed little (<23% food eaten) coarse particulate organic matter (CPOM) in spite of its abundance in streams, and GCA revealed that fine particulate organic matter was the major food (25–99%) of most primary consumers.

3. Stable isotope analysis results were in general agreement with the findings of GCA, and confirmed that three of the four obligate shredders had a high dependence (55–78% of assimilated carbon) on CPOM.

4. Autochthonous energy sources were important in all streams: non‐shredding primary consumers examined, which accounted for 72% of total macroinvertebrate abundance in shaded streams, derived (on average) 61% of their biomass from autochthonous foods; the equivalent values for unshaded streams were 72% (abundance) and 71% (biomass).
Modeled interactive effects of precipitation, temperature, and [CO2] on ecosystem carbon and water dynamics in different climatic zones
Authors: LUO YIQI , GERTEN DIETER , LE MAIRE GUERRIC , PARTON WILLIAM J. , WENG ENSHENG , ZHOU XUHUI , KEOUGH CINDY , BEIER CLAUS , CIAIS PHILIPPE , CRAMER WOLFGANG , DUKES JEFFREY S. , EMMETT BRIDGET , HANSON PAUL J. , KNAPP ALAN , LINDER SUNE , NEPSTAD DAN , RUSTAD LINDSEY
Published: May 2008

Interactive effects of multiple global change factors on ecosystem processes are complex. It is relatively expensive to explore those interactions in manipulative experiments. We conducted a modeling analysis to identify potentially important interactions and to stimulate hypothesis formulation for experimental research. Four models were used to quantify interactive effects of climate warming (T), altered precipitation amounts [doubled (DP) and halved (HP)] and seasonality (SP, moving precipitation in July and August to January and February to create summer drought), and elevated [CO2] (C) on net primary production (NPP), heterotrophic respiration (Rh), net ecosystem production (NEP), transpiration, and runoff. We examined those responses in seven ecosystems, including forests, grasslands, and heathlands in different climate zones. The modeling analysis showed that none of the three‐way interactions among T, C, and altered precipitation was substantial for either carbon or water processes, nor consistent among the seven ecosystems. However, two‐way interactive effects on NPP, Rh, and NEP were generally positive (i.e. amplification of one factor's effect by the other factor) between T and C or between T and DP. A negative interaction (i.e. depression of one factor's effect by the other factor) occurred for simulated NPP between T and HP. The interactive effects on runoff were positive between T and HP. Four pairs of two‐way interactive effects on plant transpiration were positive and two pairs negative. In addition, wet sites generally had smaller relative changes in NPP, Rh, runoff, and transpiration but larger absolute changes in NEP than dry sites in response to the treatments. The modeling results suggest new hypotheses to be tested in multifactor global change experiments. Likewise, more experimental evidence is needed for the further improvement of ecosystem models in order to adequately simulate complex interactive processes.
Changes in dissolved organic material determine exposure of stream benthic communities to UV‐B radiation and heavy metals: implications for climate change
Authors: CLEMENTS WILLIAM H. , BROOKS MARJORIE L. , KASHIAN DONNA R. , ZUELLIG ROBERT E.
Published: May 2008

Changes in regional climate in the Rocky Mountains over the next 100 years are expected to have significant effects on biogeochemical cycles and hydrological processes. In particular, decreased discharge and lower stream depth during summer when ultraviolet radiation (UVR) is the highest combined with greater photo‐oxidation of dissolved organic materials (DOM) will significantly increase exposure of benthic communities to UVR. Communities in many Rocky Mountain streams are simultaneously exposed to elevated metals from abandoned mines, the toxicity and bioavailability of which are also determined by DOM. We integrated field surveys of 19 streams (21 sites) along a gradient of metal contamination with microcosm and field experiments conducted in Colorado, USA, and New Zealand to investigate the influence of DOM on bioavailability of heavy metals and exposure of benthic communities to UVR. Spatial and seasonal variation in DOM were closely related to stream discharge and significantly influenced heavy metal uptake in benthic organisms. Qualitative and quantitative changes in DOM resulting from exposure to sunlight increased UV‐B (290–320 nm) penetration and toxicity of heavy metals. Results of microcosm experiments showed that benthic communities from a metal‐polluted stream were tolerant of metals, but were more sensitive to UV‐B than communities from a reference stream. We speculate that the greater sensitivity of these communities to UV‐B resulted from costs associated with metal tolerance. Exclusion of UVR from 12 separate Colorado streams and from outdoor stream microcosms in New Zealand increased the abundance of benthic organisms (mayflies, stoneflies, and caddisflies) by 18% and 54%, respectively. Our findings demonstrate the importance of considering changes in regional climate and UV‐B exposure when assessing the effects of local anthropogenic stressors.
Uncertainties in the relationship between atmospheric nitrogen deposition and forest carbon sequestration
Authors: SUTTON MARK A. , SIMPSON DAVID , LEVY PETER E. , SMITH ROGNVALD I. , REIS STEFAN , Van OIJEN MARCEL , De VRIES WIM
Published: May 2008

In a recent study, Magnani et al. report how atmospheric nitrogen deposition drives stand‐lifetime net ecosystem productivity (NEPav) for midlatitude forests, with an extremely high C to N response (725 kg C kg−1 wet‐deposited N for their European sites). We present here a re‐analysis of these data, which suggests a much smaller C : N response for total N inputs. Accounting for dry, as well as wet N deposition reduces the C : N response to 177 : 1. However, if covariance with intersite climatological differences is accounted for, the actual C : N response in this dataset may be <70 : 1. We then use a model analysis of 22 European forest stands to simulate the findings of Magnani et al. Multisite regression of simulated NEPav vs. total N deposition reproduces a high C : N response (149 : 1). However, once the effects of intersite climatological differences are accounted for, the value is again found to be much smaller, pointing to a real C : N response of about 50–75 : 1.
Mutational spectrum of F8 gene and prothrombotic gene variants in haemophilia A patients from Southern Italy
Authors: SANNA V. , ZARRILLI F. , NARDIELLO P. , D'ARGENIO V. , ROCINO A. , COPPOLA A. , DI MINNO G. , CASTALDO G.
Published: May 2008

Summary.  Haemophilia A (HA) is an X‐linked recessive haemorrhagic disorder caused by a deficiency of coagulation factor VIII. Disease causative mutations are heterogeneous and spread all over the F8 gene sequence, with the exception of intron 22 inversion occurring in about 50% of severe patients. To define the specific mutational repertoire and mutation detection rate, we analysed F8 gene, by polymerase chain reaction and direct sequencing, in 128 unrelated patients from Southern Italy with severe (n = 108), moderate (n = 9) or mild (n = 11) HA. We identified 120 mutations, including 64 cases of intron 22 inversion (53.3%), three of intron 1 inversion (2.5%), one large deletion (0,8%) and 52 point mutations (43.3%). In particular, 19/120 were novel and 7/52 point mutations (13.5%) occurred at CpG sites. We also investigated eight prothrombotic genetic variants in a subgroup of 74 severe HA patients to evaluate their possible protective effect on the severity of clinical expression. Methylenetetrahydrofolate reductase A1298C and plasminogen activator inhibitor‐1 4G variants recurred more frequently in HA patients with a less‐severe phenotype. Clinical impact of these findings needs large‐scale studies to further define the role of these prothrombotic variants as possible modifier factors of HA phenotype.
Inhalation of Stachybotrys chartarum causes pulmonary arterial hypertension in mice
Authors: Ochiai Eri , Kamei Katsuhiko , Watanabe Akira , Nagayoshi Masaru , Tada Yuji , Nagaoka Tetsutaro , Sato Koichi , Sato Ayaka , Shibuya Kazutoshi
Published: May 2008

Inhalation of Stachybotrys chartarum, a ubiquitous fungus in our living environment, has been suspected as a cause of acute idiopathic pulmonary haemorrhage in infants, but its relation to human diseases is not yet known. The aim of present study was to investigate the effect of repeated intratracheal injection of the fungus into mice, paying special attention to the pulmonary vascular system. Spores of S. chartarum were injected into the trachea of mice from 6 to 18 times over 4–12 weeks, and the lungs were examined by histopathology, morphometrics and haemodynamics. When 1 × 104 spores/mouse were injected, histopathological examination showed the development of pulmonary arterial hypertension (PAH). Symmetrical thickening of the intima and media of the pulmonary arterial walls was seen after six injections over 4 weeks. Right ventricular hypertrophy was also evident after 12 injections. PAH was confirmed by the elevation of right ventricular systolic pressure (20.1 ± 5.7 mmHg in the injected group vs. 12.0 ± 2.4 mmHg in the control group, P < 0.01). This study showed that the inhalation of S. chartarum caused PAH in mice, suggesting a potential of S. chartarum as a cause of human health problem such as PAH.
A survey of tobacco‐related knowledge, attitudes and behaviours of primary care providers in Mississippi
Authors: Applegate Bradford W. , Sheffer Christine E. , Crews Karen M. , Payne Thomas J. , Smith Patrick O.
Published: May 2008

Rationale  Relative to other regions in the USA, Mississippi has a high prevalence of tobacco use and tobacco‐related disease. This study assessed the tobacco‐related knowledge, attitudes and intervention behaviours of family doctors, dentists and nurse practitioners in the state of Mississippi.

Methods  The Provider Attitude Survey, an 85‐item measure of tobacco‐related knowledge, attitudes and intervention behaviours was mailed to all members of Mississippi's Family Medicine, Dentistry and Nurse Practitioner professional organizations (N = 2043).

Results  Over one‐third (n = 802, 39.2%) of eligible providers responded. Just 24.3% had received training in tobacco cessation and 33.7% were aware of the Public Health Service clinical practice guideline. Over 90% indicated that it was their role to prevent tobacco use; felt rewarded when they helped patients quit; and were bothered and upset by the health effects of tobacco. Doctors assisted more patients than nurses or dentists. Doctors and nurses reported more self‐efficacy, motivation and preparedness for treating tobacco use than dentists. Providers with training performed more interventions and reported more self‐efficacy, preparedness and fewer barriers than those without training. Training was associated with greater increases in self‐efficacy, preparedness and intervention behaviours for dentists than for the other groups.

Conclusions  Despite a high prevalence of tobacco use and tobacco‐related disease in Mississippi, primary care providers in Mississippi provide tobacco cessation interventions at an unacceptably low frequency relative to other regions. Training is likely to increase the frequency of intervention behaviours.
Patient‐centredness, self‐rated health, and patient empowerment: should providers spend more time communicating with their patients?
Authors: Rohrer James E. , Wilshusen Laurie , Adamson Steven C. , Merry Stephen
Published: May 2008

Objective  Patient‐centred communication is often employed as a strategy for empowering patients. The purpose of this study was to investigate the relationship between a direct measure of patient empowerment, feeling that one is in control of one's own health and patient satisfaction with communication.

Design  A cross‐sectional survey of family medicine patients was used to test the theory that, in primary care patients, empowerment is related to satisfaction with several aspects of communication after adjusting for health status, age and gender. Interviews were completed with 680 adult patients for whom complete data were available.

Results  Multiple logistic regression analysis revealed that being highly satisfied with overall communication [adjusted odds ratio (AOR) = 2.08], explanations (AOR = 2.04), listening (AOR = 2.63), use of understandable words (AOR = 2.41) and involvement in decisions (2.34) were positively associated with empowerment. Self‐rated health was more strongly related to empowerment than satisfaction with communication in every model tested (AORs ranged from 2.8 to 3.0).

Conclusions  Reliance solely on patient‐centred communication to promote empowerment may be insufficient as well as costly. Instead, improved one‐to‐one communication between patients and providers should be reserved for clinically complex and urgent situations. For other health matters, referral of patients to community health promotion and education programmes should be considered because this may offer a lower‐cost approach to empowerment.
The experiences of adults with intellectual disabilities and their carers in general hospitals: a focus group study
Authors: Gibbs S. M. , Brown M. J. , Muir W. J.
Published: May 2008

Background  People with intellectual disabilities (ID) have higher levels of health needs compared with the general population, many of which are unrecognised and unmet. While there has been interest and research into the primary health provision for this group, there has been a more limited focus on addressing their care received in general hospitals. Access to health care has predominated in the literature, with less attention being paid to the experiences of people with ID as users of general hospital care.

Method  A qualitative focus group methodology was used. Eleven adults with ID, nine parents and five paid carers of adults with ID participated. The focus groups were audiotaped and transcriptions were analysed using principles of grounded theory.

Results  The analysed data highlighted key themes identified from the experiences of participants. These were the interrelated issues of feelings, particularly anxiety and fear, communication and behaviour problems; the practicalities of being in or attending hospitals, including the role played by carers; and issues around perceived discrimination and negative comments.

Conclusions  The experiences of participants in this study concur with and add to concern expressed in recent reports and published research. Wide ranging implications are discussed for further research, wider policy development, clinical practice, local health service provision and education of health professionals.
A gene expression signature of confinement in peripheral blood of red wolves (Canis rufus)
Authors: KENNERLY ERIN , BALLMANN ANNE , MARTIN STANTON , WOLFINGER RUSS , GREGORY SIMON , STOSKOPF MICHAEL , GIBSON GREG
Published: May 2008

The stresses that animals experience as a result of modification of their ecological circumstances induce physiological changes that leave a signature in profiles of gene expression. We illustrate this concept in a comparison of free range and confined North American red wolves (Canis rufus). Transcription profiling of peripheral blood samples from 13 red wolf individuals in the Alligator River region of North Carolina revealed a strong signal of differentiation. Four hundred eighty‐two out of 2980 transcripts detected on Illumina HumanRef8 oligonucleotide bead arrays were found to differentiate free range and confined wolves at a false discovery rate of 12.8% and P < 0.05. Over‐representation of genes in focal adhesion, insulin signalling, proteasomal, and tryptophan metabolism pathways suggests the activation of pro‐inflammatory and stress responses in confined animals. Consequently, characterization of differential transcript abundance in an accessible tissue such as peripheral blood identifies biomarkers that could be useful in animal management practices and for evaluating the impact of habitat changes on population health, particularly as attention turns to the impact of climate change on physiology and in turn species distributions.
A transcriptomic analysis of the stress induced by capture–release health assessment studies in wild dolphins (Tursiops truncatus)
Authors: MANCIA A. , WARR G. W. , CHAPMAN R. W.
Published: May 2008

The health of wild bottlenose dolphins (Tursiops truncatus) is typically evaluated by the study of animals that are captured and released back into the wild after examination. The impact of such studies on gene expression in peripheral blood cells was investigated using microarray and quantitative polymerase chain reaction methods. Significantly increased expression was observed in two major classes of genes: (i) energy metabolism, and (ii) responsiveness to stress and trauma, the latter effect suggesting the initiation of an acute‐phase response. The value of data obtained in capture/release studies may need to be weighed against the potential physiological impacts of such studies.
Towards a differential definition of atopy: Anisakis simplex and the relationship between parasites and arthropods in respiratory allergy
Authors: DASCHNER A. , CUÉLLAR C. , VALLS A.
Published: May 2008

Protective as well as enhancing effects of parasite infections on allergic disease have been postulated. Previous studies on this relationship focused frequently on skin test reactivity against aeroallergens, being house dust mites (HDM) the main agents responsible for a positive atopy outcome.

We aimed to analyse the possible relationship between human parasite infection induced Anisakis simplex urticaria and respiratory allergy.

A total of 86 patients with gastro‐allergic Anisakiasis and 203 patients with chronic urticaria sensitized against A. simplex were studied for sensitization against aeroallergens and evaluated for rhinoconjunctivitis or bronchial asthma (RCBA). We compared the results with a control group of 250 consecutive patients referred for evaluation of allergic RCBA and atopy prevalence data of our region.

Whereas no effect of A. simplex related disease on the overall allergic respiratory disease could be detected, a highly significant higher prevalence of RCBA associated HDM sensitization, but diminished allergy against other common aeroallergens (pollen, mould or dander) was observed in these groups.

The relationship between A. simplex parasitism‐associated acute or chronic urticaria on one side and allergic respiratory disease on the other side depends on the definition of atopy. We propose a differential definition of atopy, with a special emphasis on arthropod related sensitization.
Cross‐linking induces non‐haemolytic antigen‐loss from transfused red blood cells: a potential role for rheumatoid factor
Authors: Cadwell C. M. , Zimring J. C.
Published: May 2008

Transfusion of cross‐match incompatible blood can lead to haemolysis. However, in some cases, incompatible transfused red blood cells are bound by antibody and then converted to being negative for both the incompatible antigen and the direct antiglobulin test. Using a murine model of this phenomenon, we have recently reported that antibodies binding to multiple epitopes are required. Herein, we report that antibodies against one epitope can induce antigen‐loss if an anti‐immunoglobulin G (IgG) antibody is also present. These findings support a model of cross‐linking being required, and raise the possibility that naturally occurring anti‐IgG, such as rheumatoid factor, may contribute to antigen‐loss.
Transfer of Bovine Blastocysts Derived from Short‐term In Vitro Culture of Low Quality Morulae Produced In Vivo
Authors: Alvarez RH , Meneghel M , Martinez AC , Pires RML , Schammass EA
Published: May 2008

Contents

The aim of this study was to evaluate if blastocysts arising from in vitro culture of Grade 3 bovine morulae produced in vivo can promote acceptable pregnancy rates when transferred into recipients. Embryos of different stages and qualities were recovered from superovulated Bos taurus and B. indicus donors. Grade 3 morulae were cultured in either Holding Plus® or TCM‐199 (supplemented with 10% bovine fetal serum) media for 24 h at 38.5°C. After this culture period, the resulting blastocysts were morphologically classified (Grades 1, 2 and 3) and transferred into recipients previously synchronized with the donors. Non‐cultured Grades 1 and 3 morulae were used as control. Pregnancy diagnosis was carried out 60 days after embryo transfer and the data were analysed by logistic regression, considering variables, such as embryo quality (Grade), donor breed, culture medium, donor‐recipient synchrony and seasonality. Embryo quality was the only variable, showing significant effect on the pregnancy rate. Pregnancy rates for non‐cultured Grade 1 and 3 morulae, and blastocysts arising from cultured Grade 3 morulae were 58.1% (n = 31), 17.1% (n = 35) and 51.1% (n = 47), respectively (p < 0.05). There were no statistical differences between non‐cultured Grade 1 morulae and cultured blastocysts. Pregnancy rates for Grades 1 (65.0%) and 2 (60.0%) were higher than Grade 3 (29.4%) cultured blastocysts (p < 0.05). It was concluded that short‐term in vitro culture is a very convenient method of identifying morphologically low quality morulae with higher chances of continuing development after the transfer into recipients.
Inhibitory Effect of Selenium Supplementation on the Reproductive Performance in Synchronized Merino Sheep at Range Conditions in a Selenium‐deficient Area
Authors: Sánchez J , Jiménez A , Regodón S , Andrés S
Published: May 2008

Contents

The effect of selenium (Se) supplementation on the reproductive performance of Merino ewes mated out of the normal breeding season was studied in a 2 (no Se supplementation vs Se supplementation) × 2 (ewes mated at natural oestrus vs synchronized oestrus) factorial design with 50 ewes per treatment combination. Synchronization of oestrus was achieved by intravaginal insertion of 40 mg cronolone sponges for 14 days and administration of 440 IU PMSG at sponge withdrawal. Se supplementation was by the addition to the concentrate with 0.5 mg/kg of Se in the form of selenomethionin, for the 3 months prior to the mating and during gestation. Ewes were kept under range conditions in south‐west Spain, and exposed to Merino rams at a female: male ratio of 4 : 1 from 2 days following sponge withdrawal, or the equivalent time, for 21 days. Se supplementation alone did not improve significantly ewe fertility or lamb birth weight, but there was a positive effect of synchronizing ewes mated out of the breeding season as more of these ewes lambed and produced more lambs than those not synchronized. However, a strong interaction was found between synchronization and Se supplementation, causing a deleterious effect on the reproductive performance of ewes. This negative effect, presumably related to high embrionary mortality caused by Se toxicity, should be taken into account for oestrus synchronizing in Se‐deficient areas. The supplementation with Se, for the prevention of nutritional myodystrophy degeneration in lambs, should be conducted in a fashion which does not generate high levels of Se in the ewes around the mating period.
Junior doctors' working hours: Perspectives on the reforms
Authors: Wilkinson Carol
Published: May 2008

The European Working Time Directive for junior doctors came into force in Britain in August 2004. The reforms themselves have been a long time in development and implementation since the inception and debates regarding the New Deal, to the current formations under health and safety legislation. This study, undertaken within a hospital trust setting in England, provides an insight into the perspectives of doctors, nurses and human resources managers in relation to the European Working Time Directive. Critical consideration is given to the impact of the reforms upon the National Health Service and more specifically to daily working relationships at the point of implementation. The results demonstrate some ambivalence towards the reforms because of the major shift in culture for the professions per se, but also for the future of health‐care delivery where there are considerable tensions.
Development of a new nomogram for predicting the probability of a positive initial prostate biopsy in Japanese patients with serum PSA levels less than 10 ng/mL
Authors: Kawamura Koji , Suzuki Hiroyoshi , Kamiya Naoto , Imamoto Takashi , Yano Masashi , Miura Junichiro , Shimbo Masaki , Suzuki Noriyuki , Nakatsu Hiroomi , Ichikawa Tomohiko
Published: May 2008

Objectives:  Although several nomograms for prostate cancer detection have been developed for Western populations, the models constructed on Japanese data would be more useful for the Japanese population because of various differences between Western and Asian populations. We previously developed a model for predicting the probability of a positive initial prostate biopsy using clinical and laboratory data from Japanese males. In the present study, a predictive model for Japanese males with a prostate‐specific antigen (PSA) < 10 ng/mL was developed to guide decision‐making for prostate biopsies.

Methods:  The age, total PSA level, free to total PSA ratio, prostate volume, and the digital rectal examination findings of 1037 Japanese males with a PSA < 10 ng/mL undergoing initial prostate biopsy as part of individual screening were analyzed. For study validation, 20% of these data was randomly reserved. Logistic regression analysis estimated relative risk, 95% confidence intervals, and P‐values.

Results:  Age and the independent predictors of a positive biopsy result (elevated PSA, decreased free to total PSA ratio, small prostate volume, and abnormal digital rectal examination findings) were used to develop a predictive nomogram. The area under the receiver operating characteristic curve was significantly higher for the model (73.0%) than for PSA alone (55.0%). If externally validated, the use of this nomogram could reduce unnecessary biopsies by 26% and overall prostate biopsies by 7.8%.

Conclusions:  This predictive nomogram could provide more precise risk‐analysis information for individual Japanese patients with PSA levels less than 10 ng/mL and may help to identify patients who need a prostate biopsy.
Achieving a natural glanular meatus for distal hypospadias with a narrow and shallow plate: Tubularized incised plate versus modified Barcat repair
Authors: Hayashi Yutaro , Kojima Yoshiyuki , Mizuno Kentaro , Kurokawa Satoshi , Nakane Akihiro , Kohri Kenjiro
Published: May 2008

Objectives:  Although the tubularized incised plate (TIP) repair has become the most popular surgical procedure for distal hypospadias, some authors suggest that this is not suitable for hypospadias with a narrow plate or shallow groove.

Methods:  The configuration and position of the reconstructed meatus were postoperatively analyzed in patients with distal hypospadias whose preoperative urethral plates were shallow or narrow. The findings were compared between six patients undergoing TIP repair and seven patients undergoing modified Barcat (BAVIS) repair.

Results:  Among those undergoing the TIP procedure, a slit‐like meatus at the tip of the glans was achieved in one patient, a slit‐like meatus at the mid portion of the glans in four patients and a round meatus at the mid portion of the glans in one patient. In those repaired by the BAVIS procedure, a slit‐like meatus at the tip of glans was achieved in three patients, a round or irregularly shaped meatus at the tip of the glans in two patients, an irregularly shaped meatus at the mid portion of the glans in one patient and neourethral dehiscence in one patient.

Conclusions:  The present study confirms that a higher rate of achieving slit‐like meatus but a lower rate of locating in the glans tip can be attained after TIP repair. On the other hand, there is a higher rate of locating the meatus in the glans tip but a lower rate of achieving a slit‐like meatus after BAVIS repair.
The misuse of the faecal occult blood test under the lower gastrointestinal two week wait rule
Authors: Shaw A. G. , Lund J. N. , Longman C. , Tierney G. M. , Goddard A. F.
Published: May 2008

Aim  To find the proportion of patients with a faecal occult blood (FOB) performed as part of the referral for the lower gastrointestinal two week wait (2WW) referral system, and whether this correlates with the cancer status.

Method  All patients referred to the colorectal cancer service using the 2WW referral criteria, between August 2005 and August 2007, were identified using the hospital’s cancer audit database. Faecal occult bloods and cancer status were recorded for each patient.

Results  Two thousand one hundred and fifty‐nine patients (1177 female: 903 male; median age 58; age range 18–98) were referred by general practitioners. The FOBT was only performed on three samples in all cases. In total, 172 of 2159 patients (7.9%) had an FOB performed prior to their referral, with 55 of 172 patients (31.9%) as part of the referral for 2WW. Sixteen of 172 patients (9.3%) had an FOB performed in the presence of overt rectal bleeding. In only 2 of 172 patients (1.1%) the FOB correlated with a colorectal cancer. Unnecessary testing for FOB costs has cost £4072.96 in total.

Discussion  A significant number of faecal occult bloods are being performed and the detection rate, even in this symptomatic group of patients, is very low. It is evident that the test is being performed in the community on three samples and not six. This, combined with the high false positive rate, leads to patients not only undergoing unnecessary psycho‐social consequences but could potentially lead to significant risks from unnecessary invasive investigation as well as the added financial burden of test itself.
Current considerations in the management of rectovaginal fistula from Crohn’s disease
Authors: Hannaway C. D. , Hull T. L.
Published: May 2008

Rectovaginal fistulas are dreaded complications of Crohn's disease. Accurate assessment is essential for planning management. Treatment options range from observation to medical therapeutics to the need for surgical intervention. Ultimately, establishing reasonable expectations is mandatory when treatment algorithms are considered. In this article, we review the evaluation of these fistulas and the current options to consider in the treatment of Crohn's related rectovaginal fistula.
Virtual colonoscopy vs conventional colonoscopy in patients at high risk of colorectal cancer – a prospective trial of 150 patients
Authors: White T. J. , Avery G. R. , Kennan N. , Syed A. M. , Hartley J. E. , Monson J. R. T.
Published: May 2008

Objective  Virtual colonoscopy (VC)/CT colonography has advantages over the well‐documented limitations of colonoscopy/barium enema. This prospective blinded investigative comparison trial aimed to evaluate the ability of VC to assess the large bowel, compared to conventional colonoscopy (CC), in patients at high risk of colorectal cancer (CRC).

Method  We studied 150 patients (73 males, mean age 60.9 years) at high risk of CRC. Following bowel preparation, VC was undertaken using colonic insufflation and 2D‐spiral CT acquisition. Two radiologists reported the images and a consensual agreement reached. Direct comparison was made with CC (performed later the same day). Interobserver agreement was calculated using the Kappa method. Postal questionnaires sought patient preference.

Results  Virtual colonoscopy visualized the caecum in all cases. Five (3.33%) VCs were classified as inadequate owing to poor distension/faecal residue. CC completion rate was 86%. Ultimately, 44 patients had normal findings, 44 had diverticular disease, 11 had inflammatory bowel disease, 18 had cancers, and 33 patients had 42 polyps. VC identified 19 cancers – a sensitivity and specificity of 100% and 99.2% respectively. For detecting polyps > 10 mm, VC had a sensitivity and specificity (per patient) of 91% and 99.2% respectively. VC identified four polyps proximal to stenosing carcinomas and extracolonic malignancies in nine patients (6%). No procedural complications occurred with either investigation. A Kappa score achieved for interobserver agreement was 0.777.

Conclusion  Virtual colonoscopy is an effective and safe method for evaluating the bowel and was the investigation of choice amongst patients surveyed. VC provided information additional to CC on both proximal and extracolonic pathology. VC may become the diagnostic procedure of choice for symptomatic patients at high risk of CRC, with CC being reserved for therapeutic intervention, or where a tissue diagnosis is required.
The long‐term impact of ferritin level on treatment and complications of type 2 diabetes
Authors: Jiang L. , Wang A. , Molyneaux L. M. , Constantino M. I. , Yue D. K.
Published: May 2008

Aim:  To investigate if high‐serum ferritin has long‐term impact on response to treatment and the development of diabetic complications in patients with type 2 diabetes.

Research design and methods:  We analysed the record of 90 consecutive type 2 diabetic subjects who had serum ferritin level determined soon after diagnosis of diabetes and who also had long‐term follow‐up data.

Results:  Patients with higher serum ferritin level had slightly worse triglyceride, blood pressure and liver enzyme levels at the end of follow up. However, ferritin level had no impact on the initial or final requirements for diabetic medication and the development of diabetic complications.

Conclusions:  Although elevated serum ferritin is a marker of insulin resistance and chronic inflammation, it is not necessarily a bad prognostic indicator that should affect the clinician’s approach to management.
Fair Value and the IASB/FASB Conceptual Framework Project: An Alternative View
Authors: Whittington Geoffrey
Published: May 2008

This paper analyses various controversial issues arising from the current project of the IASB and FASB to develop a joint conceptual framework for financial reporting standards. It discusses their possible implications for measurement and, in particular, for the use of fair value as the preferred measurement basis. Two competing world views are identified as underlying the debate: a Fair Value View, implicit in the IASB's public pronouncements, and an Alternative View implicit in publicly expressed criticisms of the IASB's pronouncements. The Fair Value View assumes that markets are relatively perfect and complete and that, in such a setting, financial reports should meet the needs of passive investors and creditors by reporting fair values derived from current market prices. The Alternative View assumes that markets are relatively imperfect and incomplete and that, in such a market setting, financial reports should also meet the monitoring requirements of current shareholders (stewardship) by reporting past transactions and events using entity‐specific measurements that reflect the opportunities actually available to the reporting entity. The different implications of the two views are illustrated by reference to specific issues in recent accounting standards. Finally, the theoretical support for the two views is discussed. It is concluded that, in a realistic market setting, the search for a universal measurement method may be fruitless and a more appropriate approach to the measurement problem might be to define a clear measurement objective and to select the measurement method that best meets that objective in the particular circumstances that exist in relation to each item in the accounts. An example of such an approach is deprival value, which is not, at present, under consideration by the IASB.