bluuebunny/crossref_metadata_2025 huggingface dataset:
A mechanism for Ikaros regulation of human globin gene switching
Authors: Keys Janelle R. , Tallack Michael R. , Zhan Ye , Papathanasiou Peter , Goodnow Christopher C. , Gaensler Karin M. , Crossley Merlin , Dekker Job , Perkins Andrew C.
Published: March 2008

The human β globin locus consists of an upstream LCR and functional genes arranged sequentially in the order of their expression during development: 5′‐HBE1, HBG2, HBG1, HBD, HBB‐3′. Haemoglobin switching entails the successive recruitment of these genes into an active chromatin hub (ACH). Here we show that the transcription factor Ikaros plays a major role in the formation of the β‐globin ACH, and in haemoglobin switching. In Plastic mice, where the DNA‐binding region of Ikaros is disrupted by a point mutation, there is concomitant marked down‐regulation of HBB, and up‐regulation of HBG expression. We show for the first time Ikaros and its family member Eos, bind to critical cis elements implicated in haemoglobin switching and deletional hereditary persistence of fetal haemoglobin (HPFH). Chromatin conformation capture (3C) data demonstrated that Ikaros facilitates long‐distance DNA looping between the LCR and a region upstream of HBD. This study provides new insights into the mechanism of stage‐specific assembly of the β‐globin ACH, and HPFH.
Outcome of BEAM‐autologous and BEAM‐alemtuzumab allogeneic transplantation in relapsed advanced stage follicular lymphoma
Authors: Ingram Wendy , Devereux Stephen , Das‐Gupta Emma P. , Russell Nigel H. , Haynes Andrew P. , Byrne Jennifer L. , Shaw Bronwen E. , McMillan Andrew , Gonzalez Juan , Ho Aloysius , Mufti Ghulam J. , Pagliuca Antonio
Published: March 2008

The role of haematopoietic stem cell transplantation (HSCT) in relapsed follicular lymphoma remains controversial. This study analysed 126 patients with relapsed, advanced stage follicular lymphoma who received BEAM (BCNU [carmustine], cytarabine, etoposide, melphalan)‐alemtuzumab allogeneic HSCT (BEAM‐allo) (n = 44) or BEAM‐autologous HSCT (BEAM‐auto) (n = 82). The BEAM‐allo group had a younger median age (48 years vs. 56 years, P < 0·001) but received a higher median number of therapies pretransplant (P = 0·015) compared with the BEAM‐auto group. There was a higher non‐relapse mortality (NRM) in the BEAM‐allo group compared with the BEAM‐auto group at 1 year (20% vs. 2%, P = 0·001). Older age and heavily pretreated patients were associated with a higher NRM and poorer survival in the BEAM‐allo group. There was, however, a significantly lower relapse rate (20% vs. 43%, P = 0·01) at 3 years with BEAM‐alemtuzumab, with no relapses after 2 years, compared with a continued pattern of relapse in the autologous group. No difference in overall survival (OS) (P = 0·99) or disease‐free survival (DFS) (P = 0·90) was identified at 3 years, whereas a plateau in OS and DFS with crossing of the survival curves in favour of BEAM‐allo group was observed. Furthermore, the ability to re‐induce remissions with donor leucocytes provides additional benefit in favour of allogeneic HSCT.
Montelukast inhibits tumour necrosis factor‐α‐mediated interleukin‐8 expression through inhibition of nuclear factor‐κB p65‐associated histone acetyltransferase activity
Authors: Tahan F. , Jazrawi E. , Moodley T. , Rovati G. E. , Adcock I. M.
Published: March 2008

Background
Montelukast is a potent cysteinyl leukotriene‐1 receptor antagonist possessing some anti‐inflammatory effects although the molecular mechanism of these anti‐inflammatory effects is unknown. In this study, we aimed to investigate the effect of montelukast on nuclear factor (NF)‐κB‐associated histone acetylation activity in phorbol myristate acetate (PMA)‐differentiated U937 cells.

Methods
We examined the inhibitory effects of montelukast on TNF‐α‐induced IL‐8 production in PMA‐differentiated U‐937 cells. U‐937 cells were exposed to PMA (50 ng/mL) for 48 h to allow differentiation to macrophages. Macrophages were then exposed to TNF‐α (10 ng/mL) in the presence or absence of montelukast (0.01–10 μm) for 24 h. After this time, the concentration of IL‐8 in the culture supernatant was measured by sandwich‐type ELISA kit. The effect of signalling pathways on TNF‐α‐induced IL‐8 release was examined pharmacologically using selective NF‐κB/IKK2 (AS602868, 3 μm), (PD98059, 10 μm) and p38 mitogen activated protein kinase (MAPK) (SB203580, 1 μm) inhibitors. NF‐κB DNA binding activity was measured by a DNA‐binding ELISA‐based assay. NF‐κB‐p65‐associated histone acetyltransferase (HAT) activity was measured by immunoprecipitation linked to commercial flourescent HAT.

Results
TNF‐α‐induced IL‐8 release was suppressed by an NF‐κB inhibitor but not by MEK or p38 MAPK inhibitors. Montelukast induced a concentration‐dependent inhibition of TNF‐α‐induced IL‐8 release and mRNA expression that reached a plateau at 0.1 μm without affecting cell viability. Montelukast did not affect NF‐κB p65 activation as measured by DNA binding but suppressed NF‐κB p65‐associated HAT activity.

Conclusion
Montelukast inhibits TNF‐α‐stimulated IL‐8 expression through changes in NF‐κB p65‐associated HAT activity. Drugs targeting these enzymes may enhance the anti‐inflammatory actions of montelukast.
Evidence that fungi can oxidize NH4+to NO3−in a grassland soil
Authors: Laughlin R. J. , Stevens R. J. , Müller C. , Watson C. J.
Published: March 2008

The contribution of bacteria and fungi to NH4+and organic N (Norg) oxidation was determined in a grassland soil (pH 6.3) by using the general bacterial inhibitor streptomycin or the fungal inhibitor cycloheximide in a laboratory incubation study at 20°C. Each inhibitor was applied at a rate of 3 mg g−1oven‐dry soil. The size and enrichment of the mineral N pools from differentially (NH415NO3and15NH4NO3) and doubly labelled (15NH415NO3) NH4NO3were measured at 3, 6, 12, 24, 48, 72, 96 and 120 hours after N addition. Labelled N was applied to each treatment, to supply NH4+‐N and NO3−‐N at 3.15 μmol N g−1oven‐dry soil. The N treatments were enriched to 60 atom % excess in15N and acetate was added at 100 μmol C g−1oven‐dry soil, to provide a readily available carbon source. The oxidation rates of NH4+and Norgwere analysed separately for each inhibitor treatment with a15N tracing model. In the absence of inhibitors, the rates of NH4+oxidation and organic N oxidation were 0.0045 μmol N g−1 hour−1and 0.0023 μmol N g−1 hour−1, respectively. Streptomycin had no effect on nitrification but cycloheximide inhibited the oxidation of NH4+by 89% and the oxidation of organic N by more than 30%. The current study provides evidence to suggest that nitrification in grassland soil is carried out by fungi and that they can simultaneously oxidize NH4+and organic N.
Increasing pH releases colloidal lead in a highly contaminated forest soil
Authors: Klitzke S. , Lang F. , Kaupenjohann M.
Published: March 2008

Colloids can play an important role in the leaching of lead (Pb) in soils, and liming to increase pH may produce conditions conducive to colloid release. We studied the effect of pH and the role of counterion valency on the mobilization of Pb in two topsoil horizons of a former shooting range. In batch experiments, the release of both dissolved and colloidal Pb was studied at a pH range between 3 and 7. The pH was adjusted with solutions of nitric acid (pH 3) and KOH and Ca(OH)2 (pH 4–7) and the chemical composition, size and charge of the mobilized colloids were determined. In the presence of the monovalent K+‐ion concentrations of colloidal and dissolved Pb increased markedly with increasing pH. Colloids were stabilized not only by electrostatic but also by steric repulsion. Organic colloids seem to dominate at low pH of the KOH‐treatment; at pH > 4 mineral particles were also dispersed. Even though the presence of the Ca2+ ion reduced the concentrations of colloidal Pb more than did the K+ ion, our results of the Ca(OH)2 treatment show that the relevance of both colloidal and dissolved Pb increases at a pH of about 5.8. Risk assessment on limed sites should therefore take into account both dissolved and colloidal Pb in judging the likelihood of Pb leaching.
Responses in organic matter accumulation and processing to an experimental wood addition in three headwater streams
Authors: ENTREKIN SALLY A. , TANK JENNIFER L. , ROSI‐MARSHALL EMMA J. , HOELLEIN TIMOTHY J. , LAMBERTI GARY A.
Published: March 2008

1. Additions of large wood are being used to restore streams that have been subjected to channelization, wood removal or riparian timber harvest. This added wood potentially increases channel stability, habitat complexity and organic matter retention and improves habitat and productivity of higher trophic levels. However, few stream restorations monitor restoration effectiveness after project completion.

2. We added 25 aspen logs (each 2.5 m length × 0.5 m diameter) to 100‐m reaches of each of three forested headwater streams in the Upper Peninsula of Michigan, U.S.A. These wood‐poor streams drain forests that were completely harvested of timber over a century ago and have been selectively logged for the past 50–60 years. An upstream unmanipulateds 100‐m reach in each stream served as the control.

3. We evaluated responses in organic matter processing by measuring red maple leaf decomposition 1 year before and 2 years after wood addition. We also quantified coarse organic matter standing stocks in the main channel and in debris accumulations associated with large wood. In response to wood addition, we predicted both organic matter standing stocks and leaf decomposition rates would increase, thereby enhancing resource availability to higher trophic levels.

4. Leaf decomposition rates did not change following wood addition. Temporal variation in rates among streams was mostly explained by differences in degree days, water velocity, scour/burial and water column inorganic nitrogen concentrations, but not large wood. Variation within streams across years was explained by differences in degree days, water velocity and shredder biomass.

5. Contrary to our prediction, organic matter standing stocks did not increase significantly at the reach scale. However, the experimentally added wood retained c. 4% of total annual coarse benthic organic matter (CBOM) in the first year and an additional c. 15% in the second year, suggesting accumulation over time in the manipulated reaches. The CBOM held by the new logs may be more biologically available because it is less susceptible to burial and transport than material in the streambed.

6. Some shredding macroinvertebrates responded to changes caused by the wood additions. In particular, the common caddisfly shredder, Lepidostoma sp., increased in abundance in leaf bags following wood addition, whereas the biomass of the winter stoneflies, Capniidae, declined in the first year.

7. Considerable funds are spent to restore in‐stream habitat, but few restorations are monitored, particularly over long periods (>5 years). Our results show that longer‐term monitoring is needed to determine the efficacy of these restorations on ecosystem function; organic matter decomposition in our low‐gradient streams did not respond to a substantial increase in large wood after 2 years.
Foetal sex determination in maternal blood from the seventh week of gestation and its role in diagnosing haemophilia in the foetuses of female carriers
Authors: BUSTAMANTE‐ARAGONES A. , RODRIGUEZ DE ALBA M. , GONZALEZ‐GONZALEZ C. , TRUJILLO‐TIEBAS M. J. , DIEGO‐ALVAREZ D. , VALLESPIN E. , PLAZA J. , AYUSO C. , RAMOS C.
Published: March 2008

Summary.  The existence of foetal DNA in maternal blood, discovered in 1997, opened new possibilities for noninvasive prenatal diagnosis. This includes foetal sex assessment by the detection of specific Y chromosome sequences in maternal blood, particularly important when a foetus may be affected by an X‐linked disorder such as haemophilia. This study aims to validate this sex assessment method and to test its clinical utility in the diagnosis of 15 potentially affected pregnancies in female carriers of haemophilia. In the validation study, 316 maternal blood samples from 196 pregnant women at gestations ranging from 5 weeks to 12 weeks were analysed. In the clinical study, 15 pregnancies at risk of having a haemophilic foetus were tested. All pregnancies in the validation study were correctly diagnosed. The accuracy and specificity of the methodology from the seventh week of gestation was 100%. The sex of all 15 pregnancies identified as being at risk of bearing a haemophilic foetus was correctly diagnosed. Foetal sex assessment by detecting specific Y chromosome sequences in maternal blood is now routinely used in our hospital because of its high accuracy from the seventh week of gestation. Reliable foetal gender determination from maternal blood of pregnant women carriers of haemophilia in the first trimester of gestation can avoid more conventional, invasive methods of prenatal diagnosis.
Phthalates: metabolism and exposure
Authors: Wittassek Matthias , Angerer Jürgen
Published: March 2008

Summary In human metabolism studies we found that after oral application of di(2‐ethylhexyl) phthalate (DEHP), diisononyl phthalate (DiNP) and di(2‐propylheptyl) phthalate (DPHP), at least 74, 44 and 34%, respectively, are excreted via urine. In contrast to the short chain phthalates, their oxidized products, not the simple monoesters, were found to be the main metabolites. Based on urinary phthalate metabolite concentrations we estimated in 102 German subjects between 6 and 80 years of age median daily intakes (μg/kg/day) of 2.7 for DEHP, 2.1 for di‐n‐butyl phthalate, 1.5 for diisobutyl phthalate, 0.6 for DiNP, and 0.3 for butylbenzyl phthalate. In general, children have higher exposures compared to adults and seem to have a more effective oxidative metabolism of phthalates. For individual phthalates tolerable daily intake (TDI) values have been deduced. However, in rats some phthalates have been shown to act as endocrine disrupters via a common mechanism of action in a dose‐additive manner. Therefore, the concept of a cumulative TDI value may be more appropriate for the consideration of the overall exposure and the potential human health risks resulting from everyday and simultaneous exposure to several phthalates.
Microflora of the seminal fluid of healthy men and men suffering from chronic prostatitis syndrome
Authors: Ivanov Iuri B. , Kuzmin Michael D. , Gritsenko Viktor A.
Published: March 2008

Chronic prostatitis syndrome (CPS) is a common urologic condition that many clinicians find difficult to diagnose and treat effectively. The information about the composition of the flora of the seminal fluid in healthy men and patients with CPS is limited. The aim of this study was to define the microbial communities present in the seminal fluid of healthy men and patients with CPS and at in vitro detection of decomplementary activity (DCA) phenotypes of isolates along with their comparison with isolates from patients with or without CPS. The bacteriological study was carried out to 48 healthy men and 60 men with CPS. Culture specimens were spread on various selective media. Bacterial DCA was tested by measuring the decrease in complement activity (CH50) under the influence of culture supernatants. The most common isolates in both groups were coryneforms, lactobacilli, coagulase‐negative staphylococci, micrococci and streptococci. Enterobacteriaceae, enterococci and Staphylococcus aureus were isolated only from the CPS group. The organisms from seminal fluid of healthy men exerted DCA at 3.56 ± 2.15; 2.47 ± 1.23 and 4.36 ± 2.2 anti‐CH50 for staphylococci, micrococci and diphtheroids respectively. The DCA of staphylococci, coryneforms, Enterobacteriaceae, enterococci and micrococci from CPS group were 12.8 ± 2.1 (p < 0.05), 4.4 ± 3.6 (p > 0.05), 16.8 ± 2.1, 7.2 ± 1.9 and 11.6 ± 3.3 (p < 0.05) anti‐CH50 respectively. The data obtained in this study testify the microecological disorders in microbiota of seminal fluid in CPS.
The European Male Ageing Study (EMAS): design, methods and recruitment
Authors: Lee David M. , O’Neill Terence W. , Pye Stephen R. , Silman Alan J. , Finn Joseph D. , Pendleton Neil , Tajar Abdelouahid , Bartfai Gyorgy , Casanueva Felipe , Forti Gianni , Giwercman Aleksander , Huhtaniemi Ilpo T. , Kula Krzysztof , Punab Margus , Boonen Steven , Vanderschueren Dirk , Wu Frederick C. W. ,   the EMAS study group
Published: March 2008

Life expectancy is increasing in most developed countries, in part due to improved socioeconomic conditions and in part to advances in healthcare. It is widely acknowledged that the promotion of healthy ageing by delaying, minimizing or preventing disabilities or diseases is one of the most important public health objectives in this century. In contrast to the menopausal transition in females, we know relatively little about the contribution of androgens and anabolic hormones to the quality of ageing in men. The European Male Ageing Study (EMAS) is a multicentre prospective cohort designed to examine the prevalence, incidence and geographical distribution of gender‐specific and general symptoms of ageing in men, including their endocrine, genetic and psychosocial predictors. Men aged 40–79 years were recruited from eight European centres: Florence (Italy), Leuven (Belgium), Lodz (Poland), Malmö (Sweden), Manchester (UK), Santiago de Compostela (Spain), Szeged (Hungary) and Tartu (Estonia). Subjects were recruited from population registers and those who agreed to take part completed a detailed questionnaire including aspects of personal and medical history, lifestyle factors and sexual function. Objective measures of body size, cognition, vision, skeletal health and neuromuscular function were obtained. Blood and DNA specimens were collected for a range of biochemical and genetic analyses. After an average of 4 years, it is planned to resurvey the participants with similar assessments. A total of 3369 men with a mean age of 60 ± 11 years were recruited. The mean centre response rate was 43%, and highest in those aged 50–59 years. Those who participated were marginally younger than those who were invited but declined to participate (60.0 vs. 61.1 years). Participants left education slightly later than a sample of non‐participants, though there were no consistent differences in levels of general health, physical activity, or smoking. EMAS will provide new population‐based data concerning the main features that characterize ageing in men and its critical determinants, particularly with reference to age‐related changes in hormone levels. Such information is an important prerequisite to develop effective strategies to reduce age‐related disabilities and optimise health and well‐being into old‐age.
Stainless steel crown versus modified open‐sandwich restorations for primary molars: a 2‐year randomized clinical trial
Authors: ATIEH MOMEN
Published: March 2008

Objective.  The aim of this study was to investigate the clinical performance and survival of stainless steel crown (SSC) restoration and modified open‐sandwich technique using resin‐modified glass ionomer cement.

Design.  Randomized clinical trial.

Setting.  General dental practice.

Materials and methods.  A total of 87 children aged 4–7 years at baseline with one or more primary molars that have undergone pulp therapy were randomly assigned to receive either SSC or modified open‐sandwich restoration. One hundred and sixty restorations were placed and evaluated after 6, 12, 18, and 24 months using the Ryge criteria.

Results.  Comparable survival rates were observed for both SSC and modified open‐sandwich restoration. With only four SSCs and six modified open‐sandwich restorations failing over 24 months, the survival rates were high for both materials (2‐year survival rate: 95.0% for SSCs and 92.5% for modified open‐sandwich restorations). Significantly better gingival health (P < 0.05) was observed for the modified open‐sandwich restorations compared with SSCs, as only one modified open‐sandwich restoration was rated Charlie compared to 13 SSCs. No significant differences were observed between the two materials for marginal integrity, proximal contact, occlusion, or recurrent caries.

Conclusion.  The 2‐year results indicated that the modified open‐sandwich restoration is an appropriate alternative to SSC in extensive restorations, particularly where aesthetic considerations are important.
Fear of blood, injury, and injections, and its relationship to dental anxiety and probability of avoiding dental treatment among 18‐year‐olds in Norway
Authors: VIKA MARGRETHE , SKARET ERIK , RAADAL MAGNE , ÖST LARS‐GÖRAN , KVALE GERD
Published: March 2008

Background:  More knowledge about the relationship between blood–injury–injection phobia (BIIP) and dental anxiety (DA) may give new clinically relevant information in the assessment and management of children with DA.

Objective:  The aims of this study were to explore the relationships between BIIP and DA, and to explore to what extent the two subtypes of BIIP in combination with DA are related to self‐reported probability of avoiding dental treatment if a dental injection is needed.

Methods:  The subjects were a random sample of 1385 18‐year‐olds attending high schools in a county of Norway, and the data were collected by use of questionnaires completed in classrooms. The survey instruments applied were Dental Fear Survey, Injection Phobia Scale‐Anxiety, and Mutilation Questionnaire.

Results:  About 11% of the subjects with DA and subtypes of BIIP, respectively, reported high probability of avoiding dental treatment in a situation where a dental injection was possibly needed. In multiple regression analysis, only DA contributed to self‐reports of high probability of avoiding dental treatment.

Conclusion:  The results indicate that among adolescents, BIIP is relatively often connected with DA. Clinical implications are discussed.
Solitary median maxillary central incisor syndrome occurring together with oromandibular‐limb hypogenesis syndrome type 1: a case report of this previously unreported combination of syndromes
Authors: LERTSIRIVORAKUL JINDA , HALL ROGER K.
Published: March 2008

Background. Solitary median maxillary central incisor syndrome is a unique developmental abnormality, involving the central incisor tooth germs, occurring with and without systemic involvement. This syndrome has been recorded in association with many other midline developmental anomalies and several known syndromes. Its presence, together with oromandibular‐limb hypogenesis syndrome type 1, has not previously been reported.

Case report. A 3‐year‐old girl was presented with early childhood caries and a solitary median maxillary central incisor. She had a median submucosal cleft palate and severe micrognathia with hypoglossia. In addition, she had short stature, eating difficulty, and hearing and speech problems. Comprehensive dental treatment for severe early childhood caries was accomplished with a 3‐month follow‐up appointment to monitor the oral health. The multidisciplinary consultation important for further management has been established.

Conclusion. The results suggested that when a solitary median maxillary incisor tooth presents, a paediatrician and a geneticist should be asked to carefully examine the patient for other craniofacial malformations and especially midline systemic problems.
The meaning of caring for people with malodorous exuding ulcers
Authors: Lindahl Elisabeth , Norberg Astrid , Söderberg Anna
Published: March 2008

Title. The meaning of caring for people with malodorous exuding ulcers.

Aim. This paper is a report of a study to illuminate the meaning of caring for people with malodorous exuding ulcers.

Background. Managing ulcers is complicated and consensus on assessment and treatment difficult to reach. Nurses need knowledge and skills to provide good care. They must stay close and be exposed to contamination and suffering. They must provide care without violating patients and we need to further explore this challenge.

Method. A convenience sample of ten participants was recruited. Participants had experience of caring for people with malodorous exuding ulcers and were employed in primary health or hospital care in Sweden. Narrative interviews were conducted during late 2002 to early 2005 and interpreted using a phenomenological‐hermeneutic method.

Findings. Themes were formulated: ‘Facing the wound’ when nurses reveal what is meant to be concealed and perceive patients’ vulnerability; ‘Facing one’s own defencelessness’ when feeling invaded, helpless and ashamed; ‘Struggling to shield one’s own defencelessness’ was achieved by striving to be in control, striving to endure and seeking a way out. ‘Struggling to shield patients’ vulnerability’ was about alleviating patients’ additional suffering by striving to spare patients, pushing boundaries, making uncomfortable decisions and sharing togetherness. When failing to shield their own defencelessness and patients’ vulnerability, nurses run the risk of experiencing desolation.

Conclusion. Physical proximity and bodily suffering affect nurses. Caring for people with ulcers calls for improved interprofessional cooperation in order to provide the best treatments and care. Further education for these nurses is needed, as well as support from managements and organizations.
Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia
Authors: Jennings Natasha , O'Reilly Gerard , Lee Geraldine , Cameron Peter , Free Belinda , Bailey Michael
Published: March 2008

Aims and objectives.  The aim of this study was to evaluate the impact of the introduction of Emergency Nurse Practitioner Candidates (ENPC) on waiting times and length of stay of patients presenting to a major urban Emergency Department (ED) in Melbourne, Australia.

Background.  As part of a Victorian state funded initiative to improve patient outcomes, the role of the Emergency Nurse Practitioner has been developed. The integration and implementation of this role, is not only new to the Alfred Emergency and Trauma Centre but to EDs in Melbourne, Australia, with aims of providing holistic and comprehensive care for patients.

Design.  A retrospective case series of all patients with common ED diagnostic subgroups were included. The ENPC group (n = 572) included all patients managed by the ENPC and the Traditional Model (TM) group (n = 2584) included all patients managed by the traditional medical ED model of care. Outcome measures included waiting times and length of stay.

Results.  Statistically significant differences were evident between the two groups in waiting times and length of stay in the ED. The overall median waiting time for emergency patients to be seen by the ENPC was less than for the TM group [median (IQR): ENPC 12 (5·5–28) minutes; TM 31 (11·5–76) minutes (Wilcoxon p < 0·001)]. Length of stay in the ED was also significantly reduced in the ENPC group [median (IQR): ENPC 94 (53·5–163·5) minutes; TM 170 (100–274) minutes (Wilcoxon p < 0·001)]. The comparison of overall waiting times for ENPC shifts vs. non‐ENPC shifts revealed significant differences [median (IQR): ENPC rostered 24 (9–52) minutes; ENPC not rostered 33 (13–80·5) minutes (Wilcoxon p < 0·001)].

Conclusions.  This study has demonstrated that ENPCs implementation in Melbourne, Australia were associated with significantly reduced waiting times and length of stay for emergency patients. Emergency Nurse Practitioners should be considered as a potential long term strategy to manage increased service demands on EDs.

Relevance to clinical practice.  This study is the first in Australia with a significant sample size to vigorously compare ENPC waiting times and length of stay outcomes with the TM model of care in the ED. The study suggests that ENPCs can have a favourable impact on patient outcomes with regard to waiting times and length of stay.
Pulse dynamics and microbial processes in aridland ecosystems
Authors: Collins Scott L. , Sinsabaugh Robert L. , Crenshaw Chelsea , Green Laura , Porras‐Alfaro Andrea , Stursova Martina , Zeglin Lydia H.
Published: March 2008

Aridland ecosystems cover about one‐third of terrestrial environments globally, yet the extent to which models of carbon (C) and nitrogen (N) cycling, developed largely from studies of mesic ecosystems, apply to aridland systems remains unclear.

Within aridland ecosystems, C and N dynamics are often described by a pulse‐reserve model in which episodic precipitation events stimulate biological activity that generate reserves of biomass, propagules and organic matter that prime the ecosystem to respond rapidly to subsequent precipitation events.

 The role of microbial C and N processing within the pulse‐reserve paradigm has not received much study. We present evidence suggesting that fungi play a critical and underappreciated role in aridland soils, including efficient decomposition of recalcitrant C compounds, N‐transformations such as nitrification, and nutrient storage and translocation of C and N between plants and biotic soil crusts. While fungi may perform some of these functions in other ecosystems, this ‘fungal loop’ assumes particular importance in the N cycle in aridlands because water availability imposes even greater restrictions on bacterial activity and physicochemical processes limit accumulation of soil organic matter (SOM).

We incorporate these findings into a Threshold‐Delay Nutrient Dynamics (TDND) model for aridland ecosystems in which plant responses to pulsed precipitation events are mediated by a fungal loop that links C and N cycling, net primary production (NPP) and decomposition in aridland soils.

Synthesis. Arid ecosystems are highly sensitive to global environmental change including N deposition and altered precipitation patterns; yet, models from mesic ecosystems do not adequately apply to aridland environments. Our ‘fungal loop’ N cycle model integrates spatial structure with pulse dynamics and extends the pulse‐reserve paradigm to include the key role of microbial processes in aridland ecosystem dynamics.
Maximum size distributions in tropical forest communities: relationships with rainfall and disturbance
Authors: Poorter Lourens , Hawthorne William , Bongers Frans , Sheil Douglas
Published: March 2008

The diversity and structure of communities are partly determined by how species partition resource gradients. Plant size is an important indicator of species position along the vertical light gradient in the vegetation.

Here, we compared the size distribution of tree species in 44 Ghanaian tropical forest communities, using data from 880 one‐hectare plots and over 118 000 trees belonging to more than 210 species.

The size distribution of forest species showed a continuous normal or log‐normal distribution, with many canopy species and a few large species, and varied from community to community. Multiple regression showed that this variation is related to rainfall and to disturbance.

Size distributions in wet forests were less skewed than those in dry forests, with a smaller proportion of big species and a smaller size range. At the same time they exhibited tighter species packing, resulting in higher species richness. Communities with high disturbance have less species packing and lower species richness.

Synthesis. We conclude that the factors that constrain organism size and species coexistence in these tropical forest tree communities differ from those known to operate on a number of well‐studied animal communities.
Marital status, feeling depressed and self‐rated health in rural female primary care patients
Authors: Rohrer James E. , Bernard Matthew E. , Zhang Yan , Rasmussen Norman H. , Woroncow Halina
Published: March 2008

Objective  To determine whether marital status and self‐assessed mental health are independent risk factors for poor self‐rated overall health among female primary care patients.

Design  We conducted a cross‐sectional survey of family medicine patients treated in a clinic in rural Minnesota. Complete responses were obtained from 723 women. Self‐ratings of mental health, demographics and symptoms were used to predict self‐rated overall health.

Results  Women who were single, divorced or otherwise not married, or widowed had lower odds of good self‐rated overall health (OR = 0.39, P = 0.004) compared with married women. Women who were 65 years of age and over (OR = 0.31, P = 0.017), women who rated themselves as depressed (OR = 0.54, P = 0.029), and women who reported more physical symptoms (OR = 0.78, P = 0.000) also were less likely to have good health, compared with younger women, women who did not feel depressed, and women with fewer physical symptoms, respectively. Education was not independently related to health in this sample. Worry was related to health in the univariate analysis but not after controlling for self‐assessed depression.

Conclusions  In order to improve overall health among rural women seen in primary care settings, special attention may need to be directed at women who are single, are older, report more physical symptoms, and feel depressed. Programmes should include self‐help materials, support groups and counselling services addressing social isolation, employment and financial hardship.
Factors associated with physical activity of patients with osteoarthritis of the lower limb
Authors: Rosemann Thomas , Kuehlein Thomas , Laux Gunter , Szecsenyi Joachim
Published: March 2008

Objective  In patients with osteoarthritis (OA), moderate physical activity (PA) can reduce the progress of joint damage. PA is therefore an important target of in the non‐surgical treatment of OA. To know about factors associated with PA can increase the success of interventions aiming at increasing PA. The aim of the study was to determine predictors of PA in patients suffering from OA to the hip or to the knee.

Methods  In total, 1250 outpatients from 75 general practices were consecutively approached, 1021 returned questionnaires containing sociodemographic data, and short forms of the International Physical Activity Questionnaire (IPAQ), the Arthritis Impact Measurement Scale and the Patient Health Questionnaire to assess concomitant depression. A hierarchical stepwise multiple linear regression analysis with the IPAQ continuous score as dependent variable was performed.

Results  Comparison of our findings with General population suggests that the overall PA of OA patients is decreased. Main predictors of PA were physical limitation to the lower body (beta = −0.179; P = 0.001), social contacts (P = −0.134; P < 0.001), pain (beta =−0.120; P = 0.001), age (beta = −0.110; P = 0.004) and the body mass index (beta =−0.043; P < 0.001).

Conclusion  The findings emphasize the influence of physical as well as psychosocial factors on PA of patients with OA and should help to tailor future interventions more appropriately. Further research is needed to determine if these tailored interventions will result in better compliance and in increased PA.
Do gynaecology outpatients use the Internet to seek health information? A questionnaire survey
Authors: Neelapala Padmaja , Duvvi S. K. , Kumar G. , Kumar B. N.
Published: March 2008

Background  The Internet is a rich source of medical information and the general opinion among doctors is that the number of patients attending clinics with information from a web search is increasing. The purpose of this study was to assess the demographics of those who access the Internet and their attitudes towards the quality and usefulness of information provided by the Internet. This study also looked at the various sources of health information and the satisfaction rates.

Design  Cross‐sectional observational study. The study group consisted of a cohort of women attending the gynaecology outpatient clinic at a district general hospital in the United Kingdom. In total, 484 patients attending the gynaecology outpatient clinic completed a questionnaire which included 13 structured questions regarding access to and attitudes towards the Internet and other health sources of information.

Setting  Questionnaires were distributed to 564 women attending gynaecology outpatient clinics for 3 months from 1 June 2005.

Results  A total of 484 patients (85.6%) completed the questionnaire. Age range was 41–65 years and the median education level was completion of General Certificate of Secondary Education (GCSE). In total, 360/484 (74%) had sought health information about their condition from a variety of sources before attending the outpatient clinic. In total, 399/484 (82.4%) respondents had access to the Internet. Of 399 with access, 107 (26.8%) of the patients used the Internet to find information about their condition before their appointment. General practitioners remain as the primary source of health information, mainly to improve the knowledge of the condition. A total of 78/107 (73.3%) who had used the Internet before their appointment would like to continue using the Internet as a health information resource.

Conclusion  A significant proportion of patients had access to the Internet to find health information. The widespread availability and increased usage of medical websites by patients raises important issues regarding the need for quality control and impacts on the doctor–patient relationship.
Effects of occupational violence on Australian general practitioners’ provision of home visits and after‐hours care: a cross‐sectional study
Authors: Magin Parker J. , Adams Jon , Sibbritt David W. , Joy Elyssa , Ireland Malcolm C.
Published: March 2008

Rationale, aims and objectives  Occupational violence is increasingly recognized as a problem in general practice, and has been suggested as adversely affecting general practitioners’ (GPs) provision of services to patients. The aim of this study was to investigate the association of experiences of violence and perceptions of risk of violence with provision of after‐hours GP care and home visits.

Method  A questionnaire‐based cross‐sectional survey of GPs in three Australian Urban Divisions of General Practice was used.

Results  Five hundred and twenty‐eight GPs completed the survey (response rate 49%). Of the GPs surveyed, 63.7% were subjected to some form of violence in the previous 12 months. Risk of violence influenced 10.2% of GPs’ delivery of in‐hours home visits and 22.0% of GPs’ delivery of after‐hours home visits. A further 4.7% of GPs reported not performing after‐hours home visits at all during the previous 12 months because of safety concerns. On logistic regression, gender, location of practice and country of medical qualification were significantly associated with provision of in‐hours and after‐hours home visits. Experience of violence during the previous 12 months was not significantly associated with provision of home visits.

Conclusions  This study’s finding of GPs’ self‐reported restriction of practice and withdrawal from home visits and after‐hours calls in response to risk of violence represents a significant primary health care issue. GPs’ decision to provide after‐hours calls and home visits is complex, and the finding of lack of significant association of experiences of violence with provision of home visits and after‐hours calls is likely to be due to the cross‐sectional nature of the study.
Prevalence and type of pre‐analytical problems for inpatients samples in coagulation laboratory
Authors: Salvagno Gian L. , Lippi Giuseppe , Bassi Antonella , Poli Giovanni , Guidi Gian C.
Published: March 2008

Rationale, aims and objectives  Total quality in coagulation testing is a necessary requisite to achieve clinically reliable results. Evidence was provided that poor standardization in the extra‐analytical phases of the testing process has the greatest influence on test results, though little information is available so far on prevalence and type of pre‐analytical variability in coagulation testing.

Methods  The present study was designed to describe all pre‐analytical problems on inpatients routine and stat samples recorded in our coagulation laboratory over a 2‐year period and clustered according to their source (hospital departments).

Results  Overall, pre‐analytic problems were identified in 5.5% of the specimens. Although the highest frequency was observed for paediatric departments, in no case was the comparison of the prevalence among the different hospital departments statistically significant. The more frequent problems could be referred to samples not received in the laboratory following a doctor’s order (49.3%), haemolysis (19.5%), clotting (14.2%) and inappropriate volume (13.7%). Specimens not received prevailed in the intensive care unit, surgical and clinical departments, whereas clotted and haemolysed specimens were those most frequently recorded from paediatric and emergency departments, respectively. The present investigation demonstrates a high prevalence of pre‐analytical problems affecting samples for coagulation testing.

Conclusions  Full implementation of a total quality system, encompassing a systematic error tracking system, is a valuable tool to achieve meaningful information on the local pre‐analytic processes most susceptible to errors, enabling considerations on specific responsibilities and providing the ideal basis for an efficient feedback within the hospital departments.
Renin–angiotensin and endothelial nitric oxide synthase gene polymorphisms are not associated with the risk of incident type 2 diabetes mellitus: a prospective cohort study
Authors: Conen D. , Glynn R. J. , Buring J. E. , Ridker P. M , Zee R. Y.
Published: March 2008

Objective. The renin–angiotensin system and endothelial function have both been implicated in the pathogenesis of type 2 diabetes. The aim of this study was to assess the relationship between a set of well‐characterized genetic variants of the renin–angiotensin system and the endothelial nitric oxide synthase (NOS3) gene and the incidence of type 2 diabetes.

Design. Prospective cohort study.

Setting. Women’s Health Study, United States.

Subjects. A total of 24 309 Caucasian women free of diabetes at baseline.

Main outcome measures. Six previously characterized single nucleotide polymorphisms (NOS3 rs1800779, NOS3 rs3918226, NOS3 rs1799983, ACE rs1799752, AGT rs699 and AGTR rs5186) were genotyped. Cox proportional‐hazards models were constructed to compare the incidence of type 2 diabetes according to the different genotypes.

Results. During a median follow‐up of 10.2 years (interquartile range 9.6–10.6 years), 999 women developed type 2 diabetes. The age‐adjusted incidence rates across the six genotypes were very similar, and ranged from 3.7 to 4.8 cases/1000 person‐years of follow‐up. The multivariable adjusted hazard ratios (95% confidence intervals) for rs1800779, rs3918226, rs1799983, rs1799752, rs699, and rs5186 were 1.01 (0.92–1.10), 1.09 (0.93–1.27), 0.95 (0.86–1.05), 1.04 (0.95–1.14), 1.08 (0.98–1.18), 1.01 (0.91–1.11), confirming the lack of association between the genotypes and incident type 2 diabetes. Stratification by body mass index revealed essentially unchanged results. Finally, there was no association between NOS3‐haplotypes and incident type 2 diabetes.

Conclusion. We did not find an association between six well‐characterized genetic polymorphisms of the renin–angiotensin system or the NOS3 gene and the occurrence of type 2 diabetes.
Hypertriglyceridaemia and low plasma HDL in a patient with apolipoprotein A‐V deficiency due to a novel mutation in the APOA5 gene
Authors: Oliva C. Priore , Carubbi F. , Schaap F. G. , Bertolini S. , Calandra S.
Published: March 2008

APOA5 encodes a novel apolipoprotein (apo A‐V) which appears to be a modulator of plasma triglyceride (TG). In apoA5 knock out mice plasma TG level increases almost fourfold, whereas in human APOA5 transgenic mice it decreases by 70%. Some SNPs in the APOA5 gene have been associated with variations in plasma TG in humans. In addition, hypertriglyceridaemic (HTG) patients have been identified who carried rare nonsense mutations in the APOA5 gene (Q139X and Q148X), predicted to result in apo A‐V deficiency. In this study we report a 17‐year‐old male with high TG and low high density lipoprotein cholesterol (HDL‐C), who at the age of two had been found to have severe HTG and eruptive xanthomas suggesting a chylomicronaemia syndrome. Plasma postheparin LPL activity, however, was normal and no mutations were found in LPL and APOC2 genes. The sequence of APOA5 gene revealed that the patient was homozygous for a point mutation (c.289 C>T) in exon 4, converting glutamine codon at position 97 into a termination codon (Q97X). Apo A‐V was not detected in patient’s plasma, indicating that he had complete apo A‐V deficiency. The administration of a low‐fat and low‐oligosaccharide diet, either alone or supplemented with ω‐3 fatty acids, started early in life, reduced plasma TG to a great extent but had a negligible effect on plasma HDL‐C. Loss of function mutations of APOA5 gene may be the cause of severe HTG in patients without mutations in LPL and APOC2 genes.
Estimating contemporary early life‐history dispersal in an estuarine fish: integrating molecular and otolith elemental approaches
Authors: BRADBURY I. R. , CAMPANA S. E. , BENTZEN P.
Published: March 2008

Dispersal during the early life history of the anadromous rainbow smelt, Osmerus mordax, was examined using assignment testing and mixture analysis of multilocus genotypes and otolith elemental composition. Six spawning areas and associated estuarine nurseries were sampled throughout southeastern Newfoundland. Samples of adults and juveniles isolated by > 25 km displayed moderate genetic differentiation (FST ~ 0.05), whereas nearby (< 25 km) spawning and nursery samples displayed low differentiation (FST < 0.01). Self‐assignment and mixture analysis of adult spawning samples supported the hypothesis of independence of isolated spawning locations (> 80% self‐assignment) with nearby runs self‐assigning at rates between 50 % and 70%. Assignment and mixture analysis of juveniles using adult baselines indicated high local recruitment at several locations (70–90%). Nearby (< 25 km) estuaries at the head of St Mary's Bay showed mixtures of individuals (i.e. 20–40% assignment to adjacent spawning location). Laser ablation inductively coupled mass spectrometry transects across otoliths of spawning adults of unknown dispersal history were used to estimate dispersal among estuaries across the first year of life. Single‐element trends and multivariate discriminant function analysis (Sr:Ca and Ba:Ca) classified the majority of samples as estuarine suggesting limited movement between estuaries (< 0.5%). The mixtures of juveniles evident in the genetic data at nearby sites and a lack of evidence of straying in the otolith data support a hypothesis of selective mortality of immigrants. If indeed selective mortality of immigrants reduces the survivorship of dispersers, estimates of dispersal in marine environments that neglect survival may significantly overestimate gene flow.