bluuebunny/crossref_metadata_2025 huggingface dataset:
Nurse‐led primary healthcare walk‐in centres: an integrative literature review
Authors: Desborough Jane , Forrest Laura , Parker Rhian
Published: August 2011

desborough j., forrest l. & parker r. (2012) Nurse‐led primary healthcare walk‐in centres: an integrative literature review. Journal of Advanced Nursing 68(2), 248–263.

Aims.  This paper is a report of an integrative review of the international literature examining established nurse‐led primary healthcare walk‐in centres and their outcomes to understand whether they are effective in improving access to primary health care.

Background.  Reviews of nurse‐led primary care walk‐in centres have included centres staffed by family physicians and general practitioners. There is a paucity of evidence about walk‐in centres staffed solely by nurses.

Data sources.  Studies were identified through an electronic search using the databases Medline, Cinahl and EBSCO from 1990 until July 2010. Papers were included if they examined walk‐in centres providing nurse‐led primary care for the general community. Only peer reviewed studies published in English were included.

Review methods.  An integrative approach utilizing Bowling’s checklist facilitated a systematic appraisal of studies in regard to clarity of aims, objectives, methods and appropriate analysis of data.

Results.  Thirteen publications were categorized into five themes: ‘users of walk‐in centres’, ‘quality of care provided at walk‐in centres’, ‘impact on other healthcare providers’, ‘perceptions of walk‐in centres’ and ‘satisfaction with walk‐in centres’.

Conclusion.  The possibility that walk‐in centres create demand highlights the need for clearer evidence of the drivers of demand for health care in walk‐in centres. Innovations in healthcare provision need to be matched with adaptation to nursing education to ensure an adequately prepared nursing workforce. Improvement in access to primary healthcare needs to be measured in terms of equity and the capacity this access has to fill identified gaps in primary healthcare provision in the community.
A profile of older emergency department attendees: findings from an Irish study
Authors: Fealy Gerard M. , Treacy Margaret , Drennan Jonathan , Naughton Corina , Butler Michelle , Lyons Imogen
Published: August 2011

fealy g.m., treacy m., drennan j., naughton c., butler m. & lyons i. (2011) A profile of older emergency department attendees: findings from an Irish study. Journal of Advanced Nursing 68(5), 1003–1013.

Aims.  This paper is a report of a study of older emergency department attendees’ demographic, health and social profiles.

Background.  Relative to the general population, older people are higher users of hospital emergency departments. Attendance is most often associated with medical need, including a chronic condition and related morbidities.

Method.  A series of standardized health and social profiling questionnaires was administered to a non‐probability sample of 307 older emergency department attendees. The sample was recruited during the spring‐summer and autumn‐winter periods in 2008 and 2009 at two hospitals in the city of Dublin. Subjects who met the inclusion criteria were recruited as they presented to the emergency department during the hours 8 am to midnight. The sample was stratified into those admitted and those discharged, with the aim of equally representing each stratum. Data were collected at the time of the index visit or shortly following hospital admission.

Findings.  Medical conditions accounted for almost half of all reasons for attendance and the health profile of the sample was characteristic of a population of chronically ill older people. Relative to the national picture for older people’s social networks in Ireland, a proportion of the sample was at risk of social isolation.

Conclusions.  In the absence of other avenues to treatment and based on health profile and diagnostic category, older people’s attendance at the emergency department was appropriate. The hospital emergency department remains a major arm of the Irish health service in dealing with the morbidity associated with enduring illness.
Historical biogeography of the arid‐adapted velvet antSphaeropthalma arota(Hymenoptera: Mutillidae) reveals cryptic species
Authors: Wilson Joseph S. , Clark Sarah L. , Williams Kevin A. , Pitts James P.
Published: August 2011

Aim To investigate the phylogeographic patterns among populations of the wide‐ranging velvet antSphaeropthalma arotato (1) examine the biogeographic patterns within this species, and (2) associate major genetic divergences to historical vicariance events in order to gain insight into the processes that drove diversification in arid‐adapted organisms.

Location Western North America.

Methods Phylogenetic relationships were determined by analysing the two ribosomal DNA internal transcribed spacers (ITS1 and ITS2) in MrBayes. Divergence dates were estimated for major nodes using two different molecular dating analyses: a penalized likelihood approach to rate smoothing using the programr8s, and a Bayesian MCMC averaging approach to rate smoothing using the programbeast. Both analyses were calibrated using fossils from Dominican amber. Haplotype networks were estimated usingtcs. Ecological niche models (ENMs) were developed using six bioclimatic variables from the WorldClim data set in the program Maxent.

Results The phylogenetic reconstructions indicate thatS. arotacan be split into four deeply divergent lineages that probably represent distinct species. No morphological characters were found that can be used to identify these four species, making theS. arotaspecies complex the first documented cryptic species complex in the family Mutillidae. Ecological niche models provide estimated distributions, which indicate that each of the four species inhabits a distinct niche. Divergence date estimates suggest that major diversification events occurred in the late Neogene.

Main conclusions Sphaeropthalma arotais composed of four genetically distinct species that cannot be distinguished morphologically based on current methods. We suggest that the members of this group be identified as theS.arotaspecies complex. Major diversification events in this species complex can be linked to late Neogene mountain building and aridification events, specifically the uplift of the mountain ranges in southern California and the expansion of the Bouse Sea.
Biogeography of tuna and billfish communities
Authors: Reygondeau Gabriel , Maury Olivier , Beaugrand Gregory , Fromentin Jean Marc , Fonteneau Alain , Cury Philippe
Published: August 2011

Aim  The aims of this study were: (1) to identify global communities of tuna and billfish species through quantitative statistical analyses of global fisheries data; (2) to describe the spatial distribution, main environmental drivers and species composition of each community detected; and (3) to determine whether the spatial distribution of each community could be linked to the environmental conditions that affect lower trophic levels by comparing the partitions identified in this study with Longhurst’s biogeochemical provinces.

Location  The global ocean from 60° S to 65° N.

Methods  We implemented a new numerical procedure based on a hierarchical clustering method and a nonparametric probabilistic test to divide the oceanic biosphere into biomes and ecoregions. This procedure was applied to a database that comprised standardized data on commercial longline catches for 15 different species of tuna and billfish over a period of more than 50 years (i.e. 1953–2007). For each ecoregion identified (i.e. characteristic tuna and billfish community), we analysed the relationships between species composition and environmental factors. Finally, we compared the biogeochemical provinces of Longhurst with the ecoregions that we identified.

Results  Tuna and billfish species form nine well‐defined communities across the global ocean. Each community occurs in regions with specific environmental conditions and shows a distinctive species composition. High similarity (68.8% homogeneity) between the spatial distribution of the communities of tuna and billfish and the biogeochemical provinces suggests a strong relationship between these species and the physical and chemical characteristics of the global ocean.

Main conclusions  Despite their high tolerance for a wide range of environmental conditions, these highly migratory species are partitioned into clear geographical communities in the ocean at a global scale. The similarity between biogeochemical and biotic divisions in the ocean suggests that the global ocean is a mosaic of large biogeographical ecosystems, each characterized by specific environmental conditions that have a strong effect on the composition of the trophic web.
Breastfeeding: validation of a reduced Breastfeeding Assessment Score in a group of Italian women
Authors: Zobbi Virna Franca , Calistri Daniela , Consonni Dario , Nordio Francesco , Costantini Walter , Mauri Paola Agnese
Published: August 2011

Aim and objective.  To assess the accuracy of a reduced Breastfeeding Assessment Score in a group of Italian women; the reduced Breastfeeding Assessment Score considers only five of the eight original Breastfeeding Assessment Score items studied, those not indicating a pathology.

Background.  The World Health Organization recommends exclusive breastfeeding for the first 6 months of life because of its many benefits. A prognostic approach that identifies mothers at increased risk of early breastfeeding cessation is needed to provide preventive support. The Breastfeeding Assessment Score is useful to this approach.

Design.  This is a descriptive, prospective study. This study involves two Italian hospitals.

Method.  We included healthy Italian mothers who gave birth from 7 July 2008–15 January 2009. The exclusion criteria on the convenience sample were: non‐Italian nationality, birth under 36 weeks and twin birth. The authors calculated a reduced Breastfeeding Assessment Score (‘reduced’ because the original eight items studied by Hall, were reduced to five) 48 hours after birth. After 4 weeks a structured follow‐up telephone interview was carried out: the primary outcome was breastfeeding cessation.

Results.  We recruited 386 women, with six lost during follow‐up. Out of 380 women, 127 (33·4%) stopped breastfeeding. With a cut off point of 8, the reduced Breastfeeding Assessment Score sensitivity was 52·0%, which increased to 77·9% by using a cut‐off point of 9. We also calculated a modified Breastfeeding Assessment Score with different age categories, which is adequate based on the Italian situation: in this case sensitivity was 70·1%. This study suggests that a reduced Breastfeeding Assessment Score with a different cut‐off point or modified with a different age classification is useful in identifying Italian mothers who will discontinue breastfeeding, as in both cases sensitivity does increase.

Relevance to clinical practice.  Italian midwives could use this modified Breastfeeding Assessment Score to identify mothers at increased risk of early breastfeeding cessation.
The educator inside the patient: students’ insights into the use of high fidelity silicone patient simulation
Authors: Reid‐Searl Kerry , Eaton Anne , Vieth Lea , Happell Brenda
Published: August 2011

Aim and objective.  To explore undergraduate nursing students’ experiences of High Fidelity Patient Silicone Simulation.

Background.  Use of simulation as an educational tool is rapidly gaining popularity. Simulation provides a safe learning environment and helps overcome difficulties securing sufficient clinical placements. However, several limitations have been identified with this approach, particularly in relation to cost and authenticity.

Design.  Exploratory qualitative methodology informed the development of knowledge in this under‐researched area.

Methods.  Focus group interviews were conducted with 21 nursing students and first year graduates. Participants had experienced High Fidelity Patient Silicone Simulation during the program. This involved their lecturer simulating a patient by adopting mannerisms and behaviours of a person, based on a predeveloped character and using masks and appropriate clothing to establish the visual image of a simulated patient. Thematic analysis was undertaken to identify main areas of interest to participants.

Results.  Two main themes are reported in this paper: ‘realism of the character’ and ‘skills of the teacher’. Characters presented to students were viewed as realistic which enabled participants to engage with the character and take the process seriously. Knowledge and skill of the teacher was used to direct student learning experience and maximise learning benefits to be gained.

Conclusion.  High Fidelity Patient Silicone Simulation was perceived by student participants as a highly effective teaching tool. Participants found the experience positive and believe it impacted on the quality of learning experiences.

Relevance to clinical practice.  Clinical experience is necessary for the development of safe and competent registered nurses. Simulation has been acknowledged as a useful adjunct to clinical experience, particularly when placements are limited. High Fidelity Patient Silicone Simulation may be used to promote realism, enhance student learning and contribute to an increase in clinical competence and confidence in nursing students.
Calm, irritated or infected? The experience of the inflammatory states and symptoms of pin site infection and irritation during external fixation: a grounded theory study
Authors: Santy‐Tomlinson Julie , Vincent Maria , Glossop Nicola , Jomeen Julie , Pearcey Patricia
Published: August 2011

Aim.  To explore patients’ experiences of the symptoms of suspected wound infection in external fixator pin sites.

Background.  Pin site infection is painful and distressing and can threaten the success of treatment. It is difficult for patients and clinicians to differentiate between pin site infection and irritation or foreign body reaction to the pin. There is no validated outcome measure for infection that enables the success of interventions for prevention and management to be evaluated. There is a need to develop accurate patient‐orientated assessment criteria.

Design.  Qualitative design, using grounded theory.

Method.  Following written informed consent, a theoretical sample of 16 adults with an external fixation device that had been in situ for at least 12 weeks was recruited. They had experienced a pin site infection in the previous four weeks. Data were collected using semistructured interviews, and data collection was stopped when saturation was achieved. Analysis took place using constant comparative analysis.

Results.  Participants described three ‘clinical states’ of pin site wounds: calm, irritated and infected. They described the differences in each state in relation to pain, redness, swelling, discharge and general symptoms. Symptoms were absent or varied in intensity depending on whether the pin sites were calm, irritated or infected.

Conclusion.  This study provides insight into patients’ experiences of the symptoms of pin site infection resulting in an emerging theory based on conceptualisation of this experience, which is that of dimensions of inflammatory pin site states. The detail given will enable clinicians and researchers to be more accurate in recognising infection and begins to clarify the difference between a wound that is irritated and a wound that is infected. The findings will enable the development of a patient‐orientated outcome questionnaire for pin site infection.

Relevance to clinical practice.  There is a need for patients and clinicians to be able to differentiate between infected, not infected and irritated pin sites.
The effects of a sacrococcygeal pilonidal sinus wound on activities of living: thematic analysis of participant interviews
Authors: Stewart Ann M , Baker Jacqueline D , Elliott Doug
Published: August 2011

Aims and objective.  To describe the effects sacrococcygeal pilonidal sinus wounds had on participants’ activities of living.

Background.  A sacrococcygeal pilonidal sinus commonly occurs in healthy young people and is associated with considerable morbidity and discomfort. Surgery is frequently required, and patients are often discharged home with large open wounds. Most research has addressed the technical aspects of surgery and treatment.

Design.  An interpretive descriptive approach guided by The Model of Living framework.

Methods.  Purposive sampling was used to recruit four women and seven men, age range 17–39 years, from a metropolitan hospital in NSW, Australia. Data were collected through semi‐structured interviews that were audio‐taped, transcribed verbatim and analysed using thematic analysis.

Results.  Three themes and eight subthemes emerged from the analysis: (1) ‘Adaption’ included subthemes, learning to live with the wound, difficulty living with the wound and living life despite the wound; (2) ‘Perception’ embraced subthemes, embarrassment, lack of understanding and changed body image; and (3) ‘Control’ included subthemes, loss of control and gaining control. Participants whose pain was not managed, who were unprepared for the postoperative recovery at home or experienced delayed wound healing had most difficulty with activities of living.

Conclusions.  This research gives some insight into the pilonidal wound experience from the person’s perspective. All activities of living were affected by the pilonidal sinus wound. The effect was variable and influenced by pain, embarrassment and a general lack of understanding about the condition and the care of the wound. The specific wound location was an underlying factor causing problems for participants.

Relevance to clinical practice.  Individualised care will help in reducing discomfort and improving life experiences following surgery. Patients who are prepared for the postoperative recovery at home, have adequate analgesia and do not experience delayed wound healing are more likely to manage activities of living.
Plasticity in leaf and stem nutrient resorption proficiency potentially reinforces plant–soil feedbacks and microscale heterogeneity in a semi‐arid grassland
Authors: Lü Xiao‐Tao , Freschet Grégoire T. , Flynn Dan F. B. , Han Xing‐Guo
Published: August 2011

1. The potential resorption of substantial amounts of nutrients from all vegetative organs of plants has large implications for the plant nutrient economy and for biogeochemical cycles. So far, most studies have focused on leaf nutrient resorption only. Besides, while evidence is growing that soil fertility changes impact on leaf nutrient resorption at a large spatial scale, hardly anything is known of such coupling at a small spatial scale.

2. Here we show that nitrogen (N) in culms of four dominant grasses of northern Chinese steppes contributed from 17% to 36% to the total pool of N resorbed from above‐ground senescing parts and accounted for 25–52% of above‐ground litter N. These results demonstrate the tremendous importance of non‐leaf organs for plant nutrient economy and ecosystem nutrient cycling.

3. More importantly, we found that even microscale variations in resource availability (soil inorganic N; soil moisture) can strongly impact on both leaf and culm N resorption proficiencies (RP) and absolute leaf N resorption of grasses. Moreover, plasticity was responsible for 86% and 43% of within‐site variance in leaf and culm RP, respectively, with the remainder owing to interspecific differences between the four grasses. These results imply a much larger role of plant plasticity in driving ecosystem functioning than previously assumed.

4. Synthesis. Our results suggest that plant litter quality varies even at the microscale with heterogeneity in soil resource availability, thereby potentially feeding back on soil properties and sustaining microscale soil fertility patchiness. In parallel, plants of more fertile patches resorbed a greater absolute amount of N, likely benefiting their competitive and reproductive abilities.
Competition, species interaction and ageing control tree mortality in boreal forests
Authors: Luo Yong , Chen Han Y. H.
Published: August 2011

1. Tree mortality has important influences on forest structure and composition, but the mechanisms that cause tree mortality are not well understood. Asymmetric competition is known to be a dominant cause of plant mortality, but this idea has not received much attention in studies of long‐lived trees.

2. We hypothesised that while tree mortality is dependent on size relative to neighbours as a result of asymmetric competition, tree mortality of shade‐tolerant species varies little with size because of their physiological and morphological adaptations to shaded environments. Furthermore, we hypothesised that tree mortality is higher in more crowded stands because of higher average resource competition, in conspecific stands because of potential negative intra‐specific interactions, and in older stands because of the physiological limitations and susceptibility to minor disturbances of large trees.

3. Using data from repeatedly measured permanent sampling plots that covered a wide range of tree sizes, stand developmental stages and stand compositions in boreal forests, we simultaneously tested, by boosted regression tree models, the effects of an individual’s relative size, stand crowding, species interaction and ageing on mortality of Pinus banksiana, Populus tremuloides, Betula papyrifera and Picea mariana.

4. Mortality increased strongly with decreasing relative size for all study species, and the size‐dependent mortality was stronger for shade‐intolerant than for shade‐tolerant species. With increasing stand basal area, mortality increased for Pinus banksiana, Populus tremuloides and Picea mariana but decreased for Betula papyrifera. Mortality was higher in stands with more conspecific neighbours for Populus tremuloides, Betula papyrifera and Picea mariana, but was slightly lower for Pinus banksiana. Mortality also increased with stand age for all species. Furthermore, the size‐dependent mortality was generally stronger in more crowded stands.

5. Synthesis. Our findings show that tree mortality over a wide range of tree sizes, stand developmental stages and stand compositions in non‐equilibrium boreal forests was strongly controlled by competition, but species interactions and ageing were also important mechanisms. Furthermore, the relative importance of these mechanisms to tree mortality differed with the shade tolerance of species.
Health policy, patient‐centred care and clinical ethics
Authors: McClimans Leah. M. , Dunn Michael , Slowther Anne‐Marie
Published: August 2011

Rationale, aims and objectives  Patient‐centred care has been a central part of US and UK health policy for over a decade, but, despite its importance, the policy literature often fails to provide an adequate theoretical justification for why and how we should value it. This omission is problematic because it renders the status, content and appropriate evaluation of patient‐centredness unclear. In this paper we aim to examine two different accounts of patient‐centred care.

Method  We draw upon methods of conceptual and ethical analysis.

Results  We argue that neither of the two accounts of patient‐centred care identified appropriately grounds patient‐centredness because neither of them takes into account the inherently moral nature of terms such as ‘respect’ and ‘dignity’, terms that are central to discussions of patient‐centred care.

Conclusions  We suggest that clinical ethics can help to provide a theoretical justification for patient‐centred care, and that clinical ethical practices can further patient‐centred initiatives through ethics consultation, education and policy development and review.
Effect of leukotriene inhibitors on evolution of experimental brain contusions
Authors: Voigt C. , Donat C. K. , Hartig W. , Förschler A. , Skardelly M. , Stichtenoth D. , Arendt T. , Meixensberger J. , Schuhmann M. U.
Published: August 2011

C. Voigt, C. K. Donat, W. Hartig, A. Förschler, M. Skardelly, D. Stichtenoth, T. Arendt, J. Meixensberger and M. U. Schuhmann (2012) Neuropathology and Applied Neurobiology38, 354–366

Effect of leukotriene inhibitors on evolution of experimental brain contusions

Aims: Leukotriene levels increase in cerebrospinal fluid (CSF) following controlled cortical impact (CCI) injury in rats. We investigated the impact of two different leukotriene inhibitors in the CCI model on CSF leukotriene levels, brain water content (BWC), brain swelling (BS) contusion size and cellular response. Methods: 134 male Sprague Dawley rats were investigated at 4, 24 and 72 h after CCI for CSF leukotriene levels and BWC/BS, lesion size in T2‐weighted magnetic resonance imaging and immunohistochemistry. Animals received vehicle, MK‐886, an inhibitor of 5‐lipoxygenase activating protein, or Boscari®, a mixture of boswellic acids, acting as competitive nonredox 5‐lipoxygenase inhibitors before trauma and then every 8 h until sacrifice. Results: The intracranial pressure (ICP) was unaffected by treatment. Boscari treatment reduced CSF leukotriene C4 increase by −45% at 4 h (P < 0.03) and increase of BWC and BS by 49% (P < 0.05) and −58% at 24 h. Treatment with both substances showed a reduction of lesion volume at 72 h by −21% (P < 0.01) in T2‐weighted magnetic resonance imaging, which was reflected in a smaller lesion area determined from a NeuN labelled section (−17% to −20%, P < 0.05). Triple immunofluorescence and Fluoro‐Jade B staining showed rarefaction of neurones, glia and vasculature in the contusion core, whereas in the pericontusional zone astro‐ and microglia were upregulated in the presence of dying neurones. Treatment resulted in an improved survival of NeuN labelled neurones in the pericontusional cortex (+15% to +20%, P < 0.05). Conclusions: Leukotriene inhibition should be further investigated as therapeutic option to counteract secondary growth of traumatic brain contusions and to possibly improve pericontusional neuronal survival.
Self‐report versus medical record – perinatal factors in a study of infant leukaemia: a study from the Children's Oncology Group
Authors: Jurek Anne M. , Greenland Sander , Spector Logan G. , Roesler Michelle A. , Robison Leslie L. , Ross Julie A.
Published: August 2011

Jurek AM, Greenland S, Spector LG, Roesler MA, Robison LL, Ross JA. Self‐report versus medical record – perinatal factors in a study of infant leukaemia: a study from the Children's Oncology Group. Paediatric and Perinatal Epidemiology 2011; 25: 540–548.

In a case–control study of infant leukaemia, we assessed agreement between medical records and mother's self‐reported pregnancy‐related conditions and procedures and infant treatments. Interview and medical record data were available for 234 case and 215 control mothers. Sensitivity, specificity and predictive values for maternal report were estimated for case and control mothers separately, taking the medical record as correct. For most perinatal conditions, sensitivity and specificity were over 75%. Low sensitivity was observed for maternal protein or albumin in the urine (cases: 12% [95% exact confidence interval (CI) 8%, 18%]; controls: 11% [95% CI 7%, 17%]) and infant supplemental oxygen use (cases: 25% [95% CI 11%, 43%]; controls: 24% [95% CI 13%, 37%]). Low specificity was found for peripheral oedema (cases: 47% [95% CI 37%, 58%]; controls: 54% [95% CI 43%, 64%]). Sensitivity for maternal hypertension appeared much lower for cases (cases: 46% [95% CI 28%, 66%]; controls: 90% [95% CI 70%, 99%]; P = 0.003). We did not detect other case–control differences in recall (differentiality), even though the average time between childbirth and interview was 2.7 years for case and 3.7 years for control mothers. Many conditions exhibited notable differences between interview and records. We recommend use of multiple measurement sources to allow both cross‐checking and synthesis of results into more accurate measures.
Maternal prenatal cigarette, alcohol and illicit drug use and risk of infant leukaemia: a report from the Children's Oncology Group
Authors: Slater Megan E. , Linabery Amy M. , Blair Cindy K. , Spector Logan G. , Heerema Nyla A. , Robison Leslie L. , Ross Julie A.
Published: August 2011

Slater ME, Linabery AM, Blair CK, Spector LG, Heerema NA, Robison LL, Ross JA. Maternal prenatal cigarette, alcohol and illicit drug use and risk of infant leukaemia: a report from the Children's Oncology Group. Paediatric and Perinatal Epidemiology 2011; 25: 559–565.

Several case–control studies have evaluated associations between maternal smoking, alcohol consumption and illicit drug use during pregnancy and risk of childhood leukaemia. Few studies have specifically focused on infants (<1 year) with leukaemia, a group that is biologically and clinically distinct from older children. We present data from a Children's Oncology Group case–control study of 443 infants diagnosed with acute leukaemia [including acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML)] between 1996 and 2006 and 324 population controls. Mothers were queried about their cigarette, alcohol and illicit drug use 1 year before and throughout pregnancy. Odds ratios (ORs) and 95% confidence intervals [CI] were calculated using adjusted unconditional logistic regression models. Maternal smoking (>1 cigarette/day) and illicit drug use (any amount) before and/or during pregnancy were not significantly associated with infant leukaemia. Alcohol use (>1 drink/week) during pregnancy was inversely associated with infant leukaemia overall [OR = 0.64; 95% CI 0.43, 0.94], AML [OR = 0.49; 95% CI 0.28, 0.87], and leukaemia with mixed lineage leukaemia gene rearrangements (‘MLL+’) [OR = 0.59; 95% CI 0.36, 0.97]. While our results agree with the fairly consistent evidence that maternal cigarette smoking is not associated with childhood leukaemia, the data regarding alcohol and illicit drug use are not consistent with prior reports and are difficult to interpret. It is possible that unhealthy maternal behaviours during pregnancy, some of which carry potential legal consequences, may not be adequately measured using only self‐report. Future case–control studies of childhood leukaemia that pursue these exposures may benefit from incorporation of validated instruments and/or biomarkers when feasible.
Comparing wing loading, flight muscle and lipid content in ant‐attended and non‐attended Tuberculatus aphid species
Authors: YAO IZUMI , KATAGIRI CHIHIRO
Published: August 2011

Although all Tuberculatus aphids possess wings, some species associated with ants exhibit extremely low levels of dispersal compared with those not associated with ants. Furthermore, phylogenetic interspecific comparisons find significantly higher wing loading (i.e. higher ratio of body volume to wing area) in ant‐attended species. This observation indicates that ant‐attended species may allocate more of their body resources to reproductive traits (i.e. embryos) rather than flight apparatus (i.e. wings, flight muscle and lipid). The present study focuses on two sympatric aphid species and aims to investigate the hypothesized trade‐off in resource investment between fecundity and the flight apparatus; specifically, the ant‐attended Tuberculatus quercicola (Matsumura) and non‐attended Tuberculatus paiki Hille Ris Lambers. Species differences are compared in: (i) morphology, (ii) embryo production, (iii) triacylglycerol levels and (iv) wing loading and flight muscle. The results show that T. quercicola has a larger body volume, higher fecundity and higher wing loading compared with T. paiki, which has a smaller, slender‐shaped body, lower fecundity and lower wing loading. No significant difference is found between the species with respect to the percentage of triacylglycerol content in dry body weight. The flight muscle development is significantly lower in T. quercicola than in T. paiki. These results indicate that the additive effect of higher wing loading and the lower amount of flight muscle development in T. quercicola may increase the physical difficulty of flight, and hence be responsible for its lower dispersal ability. The trade‐off between fecundity and dispersal documented in wing‐dimorphic insects may therefore be applicable to T. quercicola, which has fully developed wings.
The role of the transmembrane domain in determining the targeting of membrane proteins to either the inner envelope or thylakoid membrane
Authors: Froehlich John E. , Keegstra Kenneth
Published: August 2011

Chloroplastic membrane proteins can be targeted to any of three distinct membrane systems, i.e. the outer envelope membrane (OEM), inner envelope membrane (IEM), and thylakoid membrane. This complex structure of chloroplasts adds significantly to the challenge of studying protein targeting to various membrane sub‐compartments within a chloroplast. In this investigation, we examined the role played by the transmembrane domain (TMD) in directing membrane proteins to either the IEM or thylakoid membrane. Using the IEM protein, Arc6 (Accumulation and Replication of Chloroplasts 6), we exchanged the stop‐transfer TMD of Arc6 with various TMDs derived from different IEM and thylakoid membrane proteins and monitored the subcellular localization of these Arc6‐hybrid proteins. We showed that when the Arc6 TMD was replaced with a TMD derived from various thylakoid membrane proteins, these Arc6(thylTMD) hybrid proteins could be directed to the thylakoid membrane rather than to the IEM. Conversely, when the TMD of the thylakoid membrane proteins, STN8 (State Transition protein kinase 8) or Plsp1 (Plastidic type I signal peptidase 1), was replaced with the stop‐transfer TMD of Arc6, STN8 and Plsp1 were halted at the IEM. From our investigation, we conclude that the TMD plays a critical role in targeting integral membrane proteins to either the IEM or thylakoid membrane.
Antiretroviral treatment uptake and attrition among HIV‐positive patients with tuberculosis in Kibera, Kenya
Authors: Tayler‐Smith K. , Zachariah R. , Manzi M. , Kizito W. , Vandenbulcke A. , Sitienei J. , Chakaya J. , Harries A. D.
Published: August 2011

Using data of human immunodeficiency virus‐positive patients with tuberculosis from three primary care clinics in Kibera slums, Nairobi, Kenya, we report on the proportion that started antiretroviral treatment (ART) and attrition (deaths, lost to follow‐up and stopped treatment) before and while on ART. Of 427 ART eligible patients, enrolled between January 2004 and December 2008, 70% started ART, 19% were lost to attrition and 11% had not initiated ART. Of those who started ART, 14% were lost to attrition, making a cumulative pre‐ART and ART attrition of 33%. ART uptake among patients with TB was relatively good, but programme attrition was high and needs urgent addressing.
Parental views on informed consent for expanded newborn screening
Authors: Moody Louise , Choudhry Kubra
Published: August 2011

Background  An increasing array of rare inherited conditions can be detected as part of the universal newborn screening programme. The introduction and evaluation of these service developments require consideration of the ethical issues involved and appropriate mechanisms for informing parents and gaining consent if required. Exploration of parental views is needed to inform the debate and specifically consider whether more flexible protocols are needed to fit with the public perception of new developments in this context.

Objective  This study has been undertaken to explore perceptions and attitudes of parents and future parents to an expanded newborn screening programme in the United Kingdom and the necessary information provision and consent processes.

Design and participants  A mixed methods study involving focus groups (n = 29) and a web‐survey (n = 142) undertaken with parents and future parents.

Results and conclusions  Parents want guaranteed information provision with clear decision‐making powers and an awareness of the choices available to them. The difference between existing screening provision and expanded screening was not considered to be significant enough by participants to warrant formal written, informed consent for expanded screening. It is argued that the ethical review processes need to be more flexible towards the provision of information and consent processes for service developments in newborn screening.
Effects of acclimation and latitude on the activity thresholds of the aphid Myzus persicae in Europe
Authors: Alford L. , Blackburn T. M. , Bale J. S.
Published: August 2011

Activity thresholds were measured in nine anholocyclic clones of the peach‐potato aphid Myzus persicae collected along a latitudinal cline of its European distribution from Sweden to Spain. The effects of collection origin and intra‐ and intergenerational acclimation on these thresholds were investigated. Low‐temperature (10°C) acclimation for one generation depressed the movement threshold and chill coma temperatures, with the largest reduction in movement threshold recorded for clone UK 1 (8.8–2.5°C) and in chill coma for UK 2 (4.8–2.0°C). High‐temperature (25°C) acclimation for one generation increased the heat movement threshold and heat coma temperature with the largest increase in the movement threshold (40.1–41.1°C) and heat coma (41.4–42.3°C) recorded for clone Swed 1. There was no further intergenerational acclimation over three generations. High‐temperature activity thresholds were less plastic than low‐temperature thresholds, and, consequently, thermal activity ranges were expanded following low‐temperature acclimation. No constant affect of acclimation was observed on chill coma recovery, although clonal differences were observed with Swed 1 and 3 requiring some of the longest complete recovery times. There was no relationship between latitude and activity thresholds with the exception of heat coma data where Scandinavian clones Swed 2 and 3 consistently displayed some of the lowest heat coma temperatures (e.g. 41.3°C for both clones at 20°C) and Mediterranean clones Span 1, 2 and 3 displayed some of the highest (e.g. 42.1, 41.9 and 42.5°C, respectively, at 20°C). These data suggest that clonal mixing could occur over a large scale across Europe, limiting local adaptation to areas where conditions enable long‐term persistence of populations, e.g. adaptation to higher temperatures in the Mediterranean region. It is suggested that aphid thermal tolerance could be governed more by clonal type than the latitudinal origin.
Substituted 2‐aminothiophenes: antifungal activities and effect on Microsporum gypseum protein profile
Authors: Fogue Pythagore Soubgwi , Lunga Paul Keilah , Fondjo Emmanuel Sopbué , De Dieu Tamokou Jean , Thaddée Boudjeko , Tsemeugne Joseph , Tchapi Amandine Tienga , Kuiate Jules‐Roger
Published: August 2011

The increasing recognition and importance of fungal infections, the difficulties encountered in their treatment and the increase in resistance to antifungal agents have stimulated the search for therapeutic alternatives. The objective of this study was to evaluate the antifungal activities of three substituted 2‐aminothiophenes (1, 2 and 3) against some fungal species. The synthesis of substituted 2‐aminothiophenes was carried out through the most versatile synthetic method developed by Gewald et al. The antifungal activity was performed against yeast, dermatophytes and Aspergillus species using the broth microdilution method. The effect of these aminothiophenes was examined on the protein content and profile. Compound 2 was the most active (MIC varying from 2.00 to 128 μg ml−1). All the three substituted 2‐aminothiophenes had a relatively important dose‐dependent effect on Microsporum gypseum protein profile and content. These compounds affected the structure and dye fixation of macroconidia of this fungus. The overall results indicate that the tested substituted 2‐aminothiophenes can be used as precursors for new antifungal drugs development.
Improved polycross breeding of tall fescue through marker‐based parental selection
Authors: Amini Fatemeh , Mirlohi Aghafakhr , Majidi Mohamad M. , ShojaieFar Samira , Kölliker Roland
Published: August 2011

With 2 figures and 6 tables

The aim of this study was to investigate whether key agronomic traits of tall fescue synthetic progeny could be improved by using genetically diverse parents selected from a large breeding pool. Syn1 progeny of four polycrosses composed using six parental plants with contrasting levels of diversity based on phenotypic and expressed sequence tag (EST)‐simple sequence repeat (SSR) markers were investigated together with the progeny of a fifth polycross composed using six genotypes with highest general combining ability. Syn1 progeny from parents with high general combining ability generally showed lower values for most traits investigated when compared to progeny derived from other polycrosses. Progeny from parents selected for high molecular genetic diversity showed comparable or higher values than the other progeny for all traits investigated. The assessment of phenotypic and molecular genetic diversity of the five Syn1 populations showed high congruence with the diversity observed among the respective parental plants and decreased from parents to Syn1 as expected. Our results demonstrate that EST‐SSR markers provide a reliable means to predict genetic diversity in Syn1 progeny that may allow for efficiently selecting parental genotypes and enhancing tall fescue breeding programmes.
Incidence rate trends in childhood Type 1 diabetes in Yorkshire, UK 1978–2007: effects of deprivation and age at diagnosis in the south Asian and non‐south Asian populations
Authors: Harron K. L. , McKinney P. A. , Feltbower R. G. , Bodansky H. J. , Norman P. D. , Campbell F. M. , Parslow R. C.
Published: August 2011

Diabet. Med. 28, 1508–1513 (2011)

Aims  Incidence of Type 1 diabetes in children is increasing worldwide. Earlier studies suggest that UK south Asian immigrants develop similar rates to the overall UK population, although incidence is lower in their country of origin. This study examines incidence rate trends of childhood Type 1 diabetes in Yorkshire 1978–2007, focusing on differences between south Asians and non‐south Asians.

Methods  Data from the population‐based Yorkshire Register of Diabetes in Children and Young People were used to estimate incidence (per 100 000 childhood population < 15 years per year) of Type 1 diabetes, stratified by sex, age and ethnicity validated using two name‐recognition programs. Age–sex standardized rates were calculated for 1978–2007 and assessed by ethnic‐group and deprivation for 1990–2007. We used Poisson regression to assess incidence trends and predict rates until 2020.

Results  From 1978–2007, 3912 children were diagnosed. Overall incidence was 18.1 per 100 000 childhood population (< 15 years) per year (95% CI17.6–18.7) and increased significantly over time: 13.2 (1978–1987) to 17.3 (1988–1997) to 24.2 (1998–2007). Average annual percentage change was 2.8% (2.5–3.2). Incidence for non‐south Asians (21.5; 20.7–22.4) was significantly higher than for south Asians (14.7; 12.4–17.1). Average annual percentage change increased significantly over 18 years (1990–2007) in non‐south Asians (3.4%; 2.7–4.2) compared with a non‐significant rise of 1.5% (−1.5 to 4.6) in south Asians. Deprivation score did not affect overall incidence.

Conclusions  Type 1 diabetes incidence rose almost uniformly for non‐south Asians, but not for south Asians, contrary to previous studies. Overall rates are predicted to rise by 52% from 2007 to 2020 to 39.0 per 100 000 per year.
A web‐based pedometer programme in women with a recent history of gestational diabetes
Authors: Kim C. , Draska M. , Hess M. L. , Wilson E. J. , Richardson C. R.
Published: August 2011

Diabet. Med. 29, 278–283 (2012)

Aims  Women with remote histories of gestational diabetes mellitus can reduce their diabetes risk through lifestyle changes, but the effectiveness of interventions in women with more recent histories of gestational diabetes has not been reported. Therefore, we conducted a pilot study of a low‐intensity web‐based pedometer programme targeting glucose intolerance among women with recent gestational diabetes.

Methods  Women with a gestational diabetes delivery within the past 3 years were randomized to a 13‐week intervention consisting of a structured web‐based pedometer programme which gave personalized steps‐per‐week goals, pedometers and education regarding lifestyle modification, or to a letter about diabetes risk reduction and screening after delivery for gestational diabetes (control condition). The main outcome measures were change in fasting plasma glucose and 2‐h glucose levels on a 75‐g oral glucose tolerance test between baseline and 13‐week follow‐up. Weight was a secondary outcome and behavioural constructs (self‐efficacy, social support, risk perception) were also assessed.

Results  Forty‐nine women were enrolled. At 13‐week follow‐up, women randomized to the intervention did not have significant changes in behavioural constructs, physical activity or anthropometrics compared with women in the control group. Changes in fasting plasma glucose (–0.046 mmol/l vs. 0.038 mmol/l, P = 0.65), 2‐h glucose values (–0.48 mmol/l vs. –0.42 mmol/l, P = 0.91) and weight (–0.14 kg vs. –1.5 kg, P = 0.13) were similar between the control and intervention groups, respectively.

Conclusions  Structured web‐based education utilizing pedometers is feasible although uptake may be low. Such programmes may need to be supplemented with additional measures in order to be effective for reduction of diabetes risk.
Key Competences in Europe: interpretation, policy formulation and implementation
Authors: Halász Gábor , Michel Alain
Published: August 2011

The evolution in Europe towards more competence‐based curricula in the last ten years or so is the result of several exogenous factors and a determined European policy. The Reference Framework of Key Competences for Lifelong Learning, a Recommendation approved by the European Parliament and the Council in 2006, and the work carried out within the Open Method of Coordination as well as by European research bodies have had a significant impact on Member States' curriculum reforms. This article shows that some terminology issues, both conceptual and practical, may explain, together with other causes, the diverse formulations of key competences and the way in which they are being integrated into the compulsory education curricula by the Member States or at intra‐national levels. The focus of the article is on cross‐curricular competences because these are the key competences which require the most significant innovations in teaching and learning practices, on assessment tools and procedures, and school organisation. The analysis illustrates the main differences and convergences in policy formulation and implementation strategies among the EU Member States. It also identifies key obstacles that must be overcome for an effective implementation before suggesting some policy recommendations.