bluuebunny/crossref_metadata_2025 huggingface dataset:
Harm caused by adverse events in primary care: a clinical observational study
Authors: Wetzels Raymond , Wolters Rene , Van Weel Chris , Wensing Michel
Published: March 2009

Rationale, aims and objectives  Patient safety in primary care is important, but not well studied. The aim of our study was to determine the actual and potential harm caused by adverse events in primary care.

Method  Observational study in two general practices, including the patients of five doctors. Two methods were used to identify adverse events; (1) a prospective registration of adverse events by the general practitioner and (2) a retrospective audit of medical records. Actual harm was registered and a clinical analysis was made to estimate potential harm.

Results  A total of 31 adverse events were collected and analysed. The adverse events were spread over different adverse event categories. About half of the events did not have health consequences, but a third led to worsening of symptoms and a few resulted in unplanned hospital admission. Potential negative health consequences were likely in three‐quarters of the events.

Conclusions  The identified adverse events had some impact on health outcomes, but a risk for harm existed in a majority of the events. Patient safety programmes in primary care should focus on adverse events and not just on harm.
Supplemental perioperative oxygen for reducing surgical site infection: a meta‐analysis
Authors: Al‐Niaimi Ahmed , Safdar Nasia
Published: March 2009

Objective  To assess the efficacy of supplemental perioperative oxygenation for prevention of surgical site infection (SSI).

Data sources  Computerized PUBMED and MEDLINE search supplemented by manual searches for relevant articles.

Study selection  Randomized, controlled trials evaluating efficacy of supplemental perioperative oxygenation versus standard care for prevention of SSI in patients’ undergoing colorectal surgery.

Data synthesis  Data on incidence of SSI were abstracted as dichotomous variables. Pooled estimates of the relative risk (RR) and 95% confidence interval (CI) were obtained using the DerSimonian and Laird random effects model and the Mantel‐Haenzel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I2.

Results  Four randomized controlled trials met the inclusion criteria. Supplemental perioperative oxygenation resulted in a reduced incidence of SSI [RR 0.70 (95% CI 0.52–0.94), P = 0.01], using a fixed effects model. Using the more conservative random effects model, the point estimate was similar [RR 0.74 (95% CI 0.39–1.43), P = 0.37], but the results failed to achieve statistical significance. The I2 test showed moderate heterogeneity.

Conclusions  Our analysis showed that supplemental perioperative oxygenation is beneficial in preventing SSI in patients undergoing colorectal surgery. Because of heterogeneity in study design and patient population, additional randomized trials are needed to determine whether this confers benefit in all patient populations undergoing other types of surgery. Supplemental perioperative oxygenation is a low‐cost intervention that we recommend be implemented in patients undergoing colorectal surgery pending the results of further studies. Further research is needed to determine whether or not supplemental hyperoxia may cause unanticipated adverse effects.
A specific deficit in visuospatial simultaneous working memory in Down syndrome
Authors: Lanfranchi S. , Carretti B. , Spanò G. , Cornoldi C.
Published: March 2009

Background  Recent studies have demonstrated that individuals with Down syndrome (DS) present both central and verbal working memory deficits compared with controls matched for mental age, whereas evidence on visuospatial working memory (VSWM) has remained ambiguous. The present paper uses a battery of VSWM tasks to test the hypothesis that individuals with DS can also encounter specific difficulties in VSWM.

Method  Four tasks were administered to 34 children and adolescents with DS and 34 controls matched for verbal mental age. In two of these tasks, participants had to remember a series of locations sequentially presented on a matrix (spatial‐sequential WM); in another two, they had to remember locations simultaneously presented (spatial‐simultaneous WM).

Results and Conclusions  Results showed that individuals with DS are poorer than controls in the spatial‐simultaneous tasks, but not in the spatial‐sequential tasks. These findings were not due to a difference in speed of visuospatial processing. In fact, when performances of the two groups in VSWM were compared using speed measures as covariates, differences between groups remained. It is suggested that the simultaneous VSWM deficit of individuals with DS could be due to the request for processing more than one item at a time.
Optimum beam transfer in the environmental scanning electron microscope
Authors: DANILATOS G.D.
Published: March 2009

The gas density of argon along the axis of a pressure‐limiting aperture in an environmental scanning electron microscope is found by the direct simulation Monte Carlo method. The aperture is made on a thin material plate, producing the sharpest possible transition region between the specimen chamber and the differentially pumped region downstream of the gas flow. The entire regime from free molecule to continuum flow has been studied, which covers any size of aperture diameter and any pressure from vacuum to one atmosphere. The amount of electron beam transmitted without scattering at any point along the aperture axis is found in the range of accelerating voltage between 1 and 30 kV for argon. The electron beam transmission is further computed for helium, neon, hydrogen, oxygen, nitrogen and water vapour. This study constitutes the basis for the design and construction of an environmental scanning electron microscope having an optimum electron beam transfer, which is the primary requirement for an optimum performance instrument.
Diversity despite dispersal: colonization history and phylogeography of Hawaiian crab spiders inferred from multilocus genetic data
Authors: GARB JESSICA E , GILLESPIE ROSEMARY G
Published: March 2009

The Hawaiian archipelago is often cited as the premier setting to study biological diversification, yet the evolution and phylogeography of much of its biota remain poorly understood. We investigated crab spiders (Thomisidae,Mecaphesa) that demonstrate contradictory tendencies: (i) dramatic ecological diversity within the Hawaiian Islands, and (ii) accompanying widespread distribution of many species across the archipelago. We used mitochondrial and nuclear genetic data sampled across six islands to generate phylogenetic hypotheses forMecaphesaspecies and populations, and included penalized likelihood molecular clock analyses to estimate arrival times on the different islands. We found that 17 of 18 HawaiianMecaphesaspecies were monophyletic and most closely related to thomisids from the Marquesas and Society Islands. Our results indicate that the Hawaiian species evolved from either one or two colonization events to the archipelago. Estimated divergence dates suggested that thomisids may have colonized the Hawaiian Islands as early as ~10 million years ago, but biogeographic analyses implied that the initial diversification of this group was restricted to the younger island of Oahu, followed by back‐colonizations to older islands. Within the Hawaiian radiation, our data revealed several well‐supported genetically distinct terminal clades corresponding to species previously delimited by morphological taxonomy. Many of these species are codistributed across multiple Hawaiian Islands and some exhibit genetic structure consistent with stepwise colonization of islands following their formation. These results indicate that dispersal has been sufficiently limited to allow extensive ecological diversification, yet frequent enough that interisland migration is more common than speciation.
Measurement of serum 7α‐hydroxy‐4‐cholesten‐3‐one (or 7αC4), a surrogate test for bile acid malabsorption in health, ileal disease and irritable bowel syndrome using liquid chromatography‐tandem mass spectrometry
Authors: Camilleri M. , Nadeau A. , Tremaine W. J. , Lamsam J. , Burton D. , Odunsi S. , Sweetser S. , Singh R.
Published: March 2009

Abstract  Bile acid malabsorption (BAM) is reported in up to 50% of patients with functional diarrhoea and irritable bowel syndrome with diarrhoea (IBS‐D). Serum 7α‐hydroxy‐4‐cholesten‐3‐one (7αHCO or 7αC4), an indirect measurement of hepatic bile acid synthesis, has been validated as a measurement of BAM relative to the 75SeHCAT retention test. Our aim was to develop a serum 7αC4 assay, normal values, and compare results from healthy controls, patients with ileal Crohn’s disease or resection, and patients with IBS‐D or IBS with constipation (IBS‐C). Stored serum samples were used from adult men and women in the following groups: 111 normal healthy controls, 15 IBS‐D, 15 IBS‐C, 24 with distal ileal Crohn’s disease and 20 with distal ileal resection for Crohn’s disease. We adapted a published high pressure liquid chromatography, tandem mass spectrometry (HPLC‐MS/MS) assay. The HPLC‐MS/MS assay showed good linearity in concentration range 0–200 ng mL−1, sensitivity (lowest limit of detection 0.04 ng mL−1), and high analytical recovery (average 99%, range 93–107%). The 5th to 95th percentile for 111 normal healthy controls was 6–60.7 ng mL−1. There were significant overall group differences (anovaon ranks, P < 0.001), with significantly higher values for terminal ileal disease or resection. There were significant differences between health and IBS (anova, P = 0.043) with higher mean values in IBS‐D relative to controls (rank sum test, P = 0.027). We have established a sensitive non‐isotopic assay based on HPLC‐MS/MS, determined normal 7αC4 values, and identified increased 7αC4 in IBS‐D and in distal ileal resection and disease. This assay has potential as a non‐invasive test for BAM in IBS.
Characterization of intraluminal impedance patterns associated with gas reflux in healthy volunteers
Authors: Van Wijk M. P. , Sifrim D. , Rommel N. , Benninga M. A. , Davidson G. P. , Omari T. I.
Published: March 2009

Abstract  Multichannel intraluminal impedance (MII) recording allows assessment of flow through the oesophagus and differentiation between liquid and gas contents. Existing MII criteria for recognition of gas gastro‐oesophageal reflux (GOR) have not been validated during known gas GOR in humans. Aims: (i) Characterize MII patterns of known gas GOR and optimize criteria. (ii) Clarify interrelationships between magnitude of maximal impedance change, luminal diameter and electrode‐mucosa contact. Ten healthy volunteers (six male, 21–37 years) were studied using an oesophageal MII‐manometry catheter. After catheter placement, subjects were asked to drink 600 mL of carbonated soft drink. Recordings were made for 20 min and the protocol repeated. Reported belches confirmed manometrically (triggered by transient lower oesophageal sphincter relaxations) were included for analysis. Those episodes were compared against commonly used criteria. Another five subjects (three male, 26–52 years) underwent simultaneous MII and videofluoroscopy using the same protocol. Videofluoroscopic images were analyzed for luminal diameter and the presence of electrode–mucosa contact. All analyzed gas GOR episodes (n = 88) were associated with a pattern of impedance rise which was either retrograde (62.5%), synchronous (19.3%) or antegrade (18.2%). Depending on the exact criteria used, sensitivity ranged from 33% to 75%. A multivariate regression model including luminal diameter and the presence of electrode‐mucosa contact as independent factors accounted for 53% of all variation in impedance changes. In conclusion, a significant number of gas GOR episodes does not meet criteria for their recognition. New criteria are proposed to include specific antegrade patterns of impedance rise. Luminal diameter and the extent of contact between the oesophageal mucosa and MII‐electrodes influence the magnitude and patterning of impedance change.
Molecular phylogeny of the fungus gnat family Mycetophilidae (Diptera, Mycetophiliformia)
Authors: RINDAL EIRIK , SØLI GEIR E. E. , BACHMANN LUTZ
Published: March 2009

Abstract A molecular phylogeny of the fungus gnat family Mycetophilidae based on the nuclear 18S, 28S, and the mitochondrial 16S rRNA genes is presented. The total alignment included 58 taxa and 1704 bp. The family was recovered as monophyletic in parsimony and Bayesian analyses. In the Bayesian analysis, Mycetophilinae and its two tribes, Mycetophilini and Exechiini, were monophyletic with good statistical support. The subfamily Mycomyinae was found consistently in a sister‐group relationship to Mycetophilinae. Gnoristinae was rendered paraphyletic, subtending Mycomyinae and Mycetophilinae. Within Gnoristinae, the genera Coelosia Winnertz, Boletina Staeger, Gnoriste Meigen group with Docosia Winnertz, usually considered to be a member of Leiinae. No support was found for the monophyly of the subfamilies Sciophilinae and Leiinae.
SnRK1 (SNF1‐related kinase 1) has a central role in sugar and ABA signalling in Arabidopsis thaliana
Authors: Jossier Mathieu , Bouly Jean‐Pierre , Meimoun Patrice , Arjmand Alaleh , Lessard Philippe , Hawley Simon , Grahame Hardie D. , Thomas Martine
Published: March 2009

The proteins kinases SNF1/AMPK/SnRK1 are a subfamily of serine/threonine kinases that act as metabolite sensors to constantly adapt metabolism to the supply of, and demand for, energy. In the yeast Saccharomyces cerevisiae, the SNF1 complex is a central component of the regulatory response to glucose starvation. AMP activated protein kinase (AMPK) the mammalian homologue of SNF1, plays a central role in the regulation of energy homeostasis at the cellular as well as the whole‐body levels. In Arabidopsis thaliana, SnRK1.1 and SnRK1.2 have recently been described as central integrators of a transcription network for stress and energy signalling. In this study, biochemical analysis established SnRK1.1 as the major SnRK1 isoform both in isolated cells and leaves. In order to elucidate the function of SnRK1.1 in Arabidopsis thaliana, transgenic plants over‐expressing SnRK1.1 were produced. Genetic, biochemical, physiological and molecular analyses of these plants revealed that SnRK1.1 is implicated in sugar and ABA signalling pathways. Modifications of the starch and soluble sugar content were observed in the 35S:SnRK1.1 transgenic lines. Our studies also revealed modifications of the activity of essential enzymes such as nitrate reductase or ADP‐glucose pyrophosphorylase, and of the expression of several sugar‐regulated genes, confirming the central role of the protein kinase SnRK1 in the regulation of metabolism.
A new HLA‐B*08 variant ‐ B*0838
Authors: Johnson J. , Street J. , Hammond L. , Pepperall J. , Darke C.
Published: March 2009

HLA‐B*0838 differs from B*080101 by three nucleotides resulting in an amino acid change of 63asparagine to 63glutamic acid and a synonymous substitution.
Nomenclature for factors of the SLA system, update 2008
Authors: Ho C.‐S. , Lunney J. K. , Ando A. , Rogel‐Gaillard C. , Lee J.‐H. , Schook L. B. , Smith D. M.
Published: March 2009

This report summarizes the new swine leukocyte antigen (SLA) allele sequences and haplotypes designated by the SLA Nomenclature Committee of the International Society for Animal Genetics. There have been 74 new SLA alleles, comprising 18 SLA‐1 alleles, 11 SLA‐2 alleles, six SLA‐3 alleles, two SLA‐6 alleles, one SLA‐DRA allele, 20 SLA‐DRB1 alleles, three SLA‐DQA alleles and 13 SLA‐DQB1 alleles. Twelve new SLA class I and four new class II haplotypes have also been designated. This is the first official update since the 2005 reports on the nomenclature for factors of the SLA class I and II systems. This report also summarizes recent updates to the Immunopolymorphism Database–Major Histocompatibility Complex (IPD‐MHC) website (http://www.ebi.ac.uk/ipd/mhc/sla/). All information has now been integrated to the SLA section of the IPD‐MHC database, which serves as the repository for maintaining a list of all recognized SLA genes and their allelic sequences.
Identification of six new HLA‐G alleles with non‐coding DNA base changes
Authors: Lajoie J. , Boivin A.‐A. , Jeanneau A. , Faucher M.‐C. , Roger M.
Published: March 2009

We identified six novel human leukocyte antigen‐G alleles with synonymous mutations in Caucasian and/or African populations.
Follicle Deviation in Ovulatory Follicular Waves with One or Two Dominant Follicles in Mares
Authors: Jacob JC , Gastal EL , Gastal MO , Carvalho GR , Beg MA , Ginther OJ
Published: March 2009

Contents

The follicle and hormone aspects of diameter deviation and development of one dominant (≥28 mm) follicle (1DF) vs two dominant follicles (2DF) were studied in 32 ovulatory follicular waves in mares. Follicles were ranked each day as F1 (largest) to F3. The beginning of deviation was designated day 0 and preceded the first increase in the differences in diameter between F1 and F2 in the 1DF group and between a combination of F1 and F2 vs F3 in the 2DF group. One dominant follicle and 2DF developed in 21 (66%) and 11 (34%) waves, respectively. Double ovulations occurred in only one of the waves with 2DF. In 8/11 waves with 2DF, a second deviation occurred between F1 and F2 on 2.5 ± 0.4 days after the first deviation. On day 0, 1DF and 2DF waves were similar in number of days after ovulation, number of follicles, difference in diameter between F1 and F2, and plasma concentrations of LH, estradiol and immunoreactive inhibin. The interval from maximum FSH concentration to day 0 was longer (p < 0.05) and FSH concentration was lower (p < 0.05) on days ‐1 to 4 in the 2DF group. The similarities on day 0 in the characteristics of 1DF and 2DF waves despite the differences in the declining portions of the FSH profile indicated that a specific day of the FSH decline or a specific concentration were not factors in initiating deviation. Unlike reported results in heifers, the results in mares did not indicate a hormonal basis for the development of 2DF or two deviations.
Light and Scanning Electron Microscopic Studies of Oviductal Epithelium in Thai Swamp Buffalo (Bubalus bubalis) at the Follicular and Luteal Phases
Authors: Tienthai P , Sajjarengpong K , Techakumphu M
Published: March 2009

Contents

The purpose of this study was to investigate the morphological changes in the epithelium of Thai swamp buffalo oviducts at the follicular and luteal phases by histological technique and scanning electron microscopy. The samples from the infundibulum, ampulla, isthmus and uterotubal junction (UTJ) of the oviduct were taken immediately after slaughter at the local abattoir. Noticeable cyclic changes were observed on the epithelial surface of the infundibulum and ampulla, but few changes were present in the isthmus and UTJ. At the follicular phase, the epithelium of infundibulum and ampulla were densely covered with ciliated cells whose cilia concealed the apical processes of the secretory cells. In contrast, the secretory cells dominated in the epithelium at the luteal phase and most of the ciliated cells were hidden by the bulbous processes of these cells. In the isthmus and UTJ at the follicular and luteal phases, the secretory cells were almost flat or gently rounded and covered with numerous microvilli at their apical surface. In conclusion, the histological and ultrastructural observation of Thai swamp oviduct epithelium revealed marked cyclic changes in the cellular differences associated with the main functions of segmental variations.
Endoscopic retrograde pancreatography in pancreatic trauma: Need to break the mental barrier
Authors: Bhasin Deepak K , Rana Surinder S , Rawal Pawan
Published: March 2009

Pancreatic injury has a high morbidity and mortality. The integrity of the main pancreatic duct is the most important determinant of prognosis. Serum amylase, peritoneal lavage and computed tomography of the abdomen can assist with diagnosis but endoscopic retrograde pancreatography (ERP) is the most accurate investigation for diagnosing the site and extent of ductal disruption. However, it is invasive and can be associated with significant complications. Magnetic resonance cholangiopancreatography (MRCP) and secretin‐enhanced MRCP probably parallel ERP in delineating pancreatic ductal injuries. They can also delineate the duct upstream to complete disruption, an area not visualized on ERP. In relation to therapy, endoscopic transpapillary drainage has been successfully used to heal duct disruptions in the early phase of pancreatic trauma and, in the delayed phase, to treat the complications of pancreatic duct injuries such as pseudocysts and pancreatic fistulae. Transpapillary drainage is especially effective in patients who have partial pancreatic duct disruption that can be bridged. Endoscopic transmural drainage has also been successfully used to treat post‐traumatic pancreatic pseudocysts. Further large, prospective and randomized studies are required to adjudge the efficacy and long‐term safety of pancreatic duct drainage in the treatment of post‐traumatic pancreatic duct injuries.
Inflammatory pseudotumour affecting the lung and orbit
Authors: KISHI Kazuma , FUJII Takeshi , KOHNO Tadasu , YOSHIMURA Kunihiko
Published: March 2009

This report describes a rare case of inflammatory pseudotumour arising metachronously from the orbit and lung. A 78‐year‐old man with a 7‐year history of orbital inflammatory pseudotumour developed a solitary mass in the right lung. Serological studies showed elevated levels of IgG and antinuclear antigen. Wedge resection of the lesion was performed under VATS. Histology showed that lymphoplasmacytic infiltration with dense fibrosis and flow cytometry proved these cells to be polyclonal. Immunostaining revealed numerous IgG4‐positive plasma cells diffusely infiltrating the lesion.
Dual‐energy X‐ray absorptiometry is the method of choice to assess body composition in COPD
Authors: MILLER Alistair , STRAUSS Boyd J. , MOL Stijn , KYOONG Andrew , HOLMES Peter H. , FINLAY Paul , BARDIN Philip G. , GUY Paul
Published: March 2009

Background and objective: Mortality and morbidity in COPD have been related to reduced FEV1as well as indices of body composition. Different techniques used to evaluate body composition may vary in accuracy, particularly in conditions with altered fluid balance such as COPD. We hypothesized that direct measurement of fat‐free mass index (FFMI) by dual‐energy X‐ray absorptiometry (DEXA) would provide superior assessment of body composition in COPD.

Methods: We measured body composition in 31 patients with COPD randomly selected from a teaching hospital clinic. To estimate total body water (TBW) and FFMI, skin‐fold anthropometry, bioelectrical impedance analysis (BIA) with Schols and Lukaski equations as well as DEXA, total body potassium by whole‐body γ‐counting (TBK) andin vivoneutron activation analysis were used. Combined body composition methods providing precise estimations of TBW were used for comparisons. Bland–Altman analyses, ANOVA and χ2‐testing were used to examine data.

Results: Mean BMI was 27.6 ± 5.34 kg/m2(mean ± SD). Estimations of TBW were similar using Schols BIA or by using combined body composition methods. FFMI did not vary significantly between grades of COPD severity but was significantly different when assessed using DEXA and other methods. Calculated FFM hydration was significantly different from the fixed hydration factor used to calculate FFMI from BIA TBW (P < 0.05).

Conclusion: The Schols BIA method incorporates a fixed hydration factor that may lead to an erroneous estimation of FFMI with ensuing clinical implications. DEXA can be used to obtain accurate and comprehensive assessments of body composition and should be the preferred investigation in COPD.
Six principal symptoms and coronary artery sequelae in Kawasaki disease
Authors: Nakamura Yosikazu , Yashiro Mayumi , Sadakane Atsuko , Aoyama Yasuko , Oki Izumi , Uehara Ritei , Yanagawa Hiroshi
Published: March 2009

Background:  The relationship between coronary artery sequelae due to Kawasaki disease and the six principal symptoms associated with the latter are still unknown.

Methods:  Among the 16 952 patients reported in the 17th nationwide survey on Kawasaki disease, 14 068 were found to have definite and typical cases with five or six principal symptoms. The proportions of coronary artery aneurysms including dilatation of the artery were compared between the patient group with six symptoms and that with five.

Results:  Percentages for those with all six symptoms (7223) were 4.7% for coronary dilatations (i.e. small aneurysms), 1.7% for coronary aneurysms (i.e. middle‐sized aneurysms), and 0.42% for giant coronary aneurysms (i.e. large aneurysms) 1 month after onset, whereas for those with five symptoms (6845), the corresponding percentages were 4.1%, 1.4%, and 0.22%, respectively. For overall observation, the odds ratios were 1.44, 1.28, and 1.70 for the three types of aneurysm, respectively. For male patients, all the odds ratios were >1.0, and some were significant. In contrast, odds ratios <1.0 were observed among those with six symptoms in some subgroups among female patients despite the lack of significance.

Conclusions:  Because odds ratios were elevated – especially for male patients with Kawasaki disease – with all six principal symptoms, patients with the six symptoms are more problematic for coronary sequelae among the definite cases, although there was not a specific symptom for the sequelae.
Predictive validity of Bayley scale in language development of children at 6–36 months
Authors: Lung For‐Wey , Shu Bih‐Ching , Chiang Tung‐Liang , Chen Po‐Fei , Lin Li‐Ling
Published: March 2009

Background:  The aim of the present study was to investigate the prediction of development among 6‐, 18‐, and 36‐month‐old infants on the Bayley Scale of Infant Development (BSID).

Methods:  One hundred infants were assessed using the BSID at 6 months; of these, 70 completed the 18 and 36 month assessment at follow up.

Results:  Multivariate regression and structural equation modeling were used to determine predictive validity in the mental and psychomotor developmental scales. Structural equation analysis also confirmed the conceptual scheme of the stability of development from 6 to 36 months for boys. Boys had a steadier overall developmental trajectory compared to girls.

Conclusions:  The validity of BSID was consistent with previous studies. The language spurt in girls, however, from 6 to 18 months affected the stability of the BSID. Thus, the gender difference in language development should be considered in clinical assessment.
Multidisciplinary approach in cystic hygroma: Prenatal diagnosis, outcome, and postnatal follow up
Authors: Gedikbasi Ali , Oztarhan Kazim , Aslan Gulseren , Demirali Oyhan , Akyol Alpaslan , Sargin Akif , Ceylan Yavuz
Published: March 2009

Background:  The aim of the present study was to determine prenatal follow up and clinical outcome in fetuses born with cystic hygroma.

Methods:  A series of 64 cystic hygroma patients, who were diagnosed in the first and the second trimester of pregnancy, was enrolled. Associated structural abnormalities, karyotype analysis and pregnancy outcome were studied. Survivors were followed for their fetal outcome and prognosis.

Results:  There were 64 new cases of cystic hygroma in 8524 subjects screened (0.75%). Thirty‐nine (60.9%) were of non‐septated and 25 (39.1%) were of septated cystic hygroma. Chromosomal abnormalities were present in 25 (39.1%). The most common abnormality in non‐septated cystic hygroma was trisomy 21 (10, 27.8%), and that in septated cystic hygroma was Turner syndrome (5, 23.8%). Associated structural malformations are common in cystic hygroma and overall survival was poor. Nine of the present infants were live‐born and were subsequently followed up. Two had cardiac pathology and died after cardiac operation, two others were diagnosed with axillary cystic hygroma, had an excellent prognosis and responded well to treatment, and another two had cranial findings with mild neurological sequel. Only three cases had, at birth and in the follow‐up period, no complications.

Conclusion:  Cystic hygroma is highly correlated with adverse perinatal outcome. Prenatal diagnosis and invasive procedures are vital for counselling with close follow‐up after delivery for appropriate medical support. A multidisciplinary approach is strictly recommended in live‐born children.
Susceptible bacteria increased with limited usage of antibiotics: Data with emphasis on defined daily doses
Authors: Takeuchi Hajime
Published: March 2009

Background:  Resistant bacteria Haemophilus influenzae and Streptococcus pneumoniae are the primary causative organisms of bacterial respiratory tract infections and meningitis in children.

Methods:  This study was carried out over 4 years. Specimens from the pharynges and sputum of children were collected. H. influenzae and S. pneumoniae were cultured, and the sensitivity to antibiotics were measured. The dosages of major antibiotics for children were calculated.

Results:  A total of 920 samples of H. influenzae and 128 samples of S. pneumoniae collected from the specimens from the pharynges and sputum were cultured. The level of non‐sensitive H. influenzae for cefaclor decreased from 62.1% to 50.3% (P= 0.0398). The level of non‐sensitive S. pneumoniae for amoxicillin decreased sharply from 31.6% to 0.0%. Finally, the total amount of antibiotics was reduced to 40.5% of the first period.

Conclusion:  It is possible to reduce the levels of non‐susceptible bacteria by limited usage of antibiotics for daily treatment.
The importance of international consensus statements in surgery*
Authors: Canter Richard J
Published: March 2009

The article is a summary of some of the pertinent literature on professionalism, highlighting the difference between how physicians understand professionalism and how other groups e.g. politicians, nurses and hospital managers might view the professionalism of doctors. It partly explains why surgeons have become increasingly ‘managerialised’ and lost autonomy since the 1970s. I speculate what might be the logical conclusion of this process if surgeons continue to be seen as technicians. The choice facing the surgical profession appears to be between retrenching, by this is meant resisting the challenges to traditional notions of professionalism, or reforming, i.e. to develop new workable models that better serve society and the profession. Some of this might make uncomfortable reading for physicians and surgeons; it is meant to.
Laying the foundation of surgical skills for trainees (Residents)
Authors: Perry Richard E.
Published: March 2009

The role of the surgical skills laboratory is becoming increasingly important as surgical service needs evolve and educational processes seek to become more robust. The skills laboratory offers an opportunity to better prepare residents for their clinical rotations and to accelerate their clinical effectiveness. The Royal Australasian College of Surgeons has developed and introduced a new standardised basic surgical skills curriculum that can be delivered sustainably in centres throughout Australia and New Zealand. A technical skill set required by all surgical disciplines was compiled, and each skill was deconstructed into cognitive steps. Models were devised to simulate an application of each skill, and standardized demonstrations were created and recorded to ensure uniform teaching. Extensive resource material supports the course programme, with information for tutors, technicians, course directors and participants. Currently, clinical rotations offer inconsistent opportunities for trainees to practise their skills after the course. Recruitment and retention of tutors remains a key challenge.
E‐Learning in surgical education and training
Authors: Larvin Mike
Published: March 2009

For most surgeons and surgical educators, e‐learning is relatively new and confusing. This article attempts to explain the key concepts behind e‐learning, as well as its benefits and risks. E‐learning has become a fixed feature within Higher and Professional Education and has been prioritized by Universities around the world, as well as all six Surgical Royal Colleges. Trainees have grown up with virtual learning environments and expect similar provision for their postgraduate studies, but have a greater need for basic science learning. Dispersal of trainees across duty rotas and geographically makes e‐learning more attractive, but preserving peer and trainer communication is as important as content. Recent changes in surgical education and training have also made electronic and distance learning more attractive than previously. Initial work by the Colleges is now being evaluated and important lessons have emerged. The UK Department of Health has made medical e‐learning a priority and it is now the largest e‐learning provider in Europe. Changes in the World Wide Web, with a shift to more social‐networking activity in education and to web‐based delivery to small, ubiquitous portable devices will increase opportunities for surgical e‐learning.
The annual scientific conference: what does the future hold?
Authors: Hollands Michael , Miles Campbell
Published: March 2009

It is now expected that medical practitioners around the world will engage in ongoing professional development. Many Colleges, medical associations and societies have made completion of appropriate continuing professional development (CPD) mandatory and medical registration in some jurisdictions is predicated on participation in a CPD programme. This commits doctors to a programme of lifelong learning.
Assessment of tubal disorder as a risk factor for repeat ectopic pregnancy after laparoscopic surgery for tubal pregnancy
Authors: Kuroda Keiji , Takeuchi Hiroyuki , Kitade Mari , Kikuchi Iwaho , Shimanuki Hiroto , Kumakiri Jun , Kobayashi Yuko , Kuroda Masako , Takeda Satoru
Published: March 2009

Heading Aims:  We evaluated tubal disorders, including peritubal adhesions, as risk factors for repeat ectopic pregnancy (REP) after laparoscopic linear salpingotomy (LS) or salpingectomy for tubal pregnancy.

Methods:  This was a retrospective clinical study in a university hospital.

Results:  Of 43 women monitored for at least 6 months after LS, 28 (65%) subsequently conceived. In 24 (86%) of these women the pregnancy was intrauterine, and four (14%) had REP. Of 40 women with a unilateral tube monitored for at least 6 months after salpingectomy, 24 (60%) conceived. In 17 (71%) of these women the pregnancy was intrauterine, and seven (29%) had REP. There was no significant difference between groups in postoperative pregnancy or REP rates. There was no significant difference in the mean adhesion score by revised American Fertility Society stage points (re‐AFS) at operation and the site of subsequent pregnancy in either the LS or the salpingectomy group, although the mean re‐AFS score was significantly higher in women who had REP (3.1) than in those whose subsequent pregnancy was intrauterine (0.4).

Conclusions:  There was no significant difference in postoperative pregnancy or REP rates following previous LS or salpingectomy. The re‐AFS score appeared to be an accurate predictor of the prognosis of subsequent pregnancies.
Treatment of ureteric lithiasis with retrograde ureteroscopy and holmium:YAG laser lithotripsy vs extracorporeal lithotripsy
Authors: Arrabal‐Polo Miguel A. , Arrabal‐Martín Miguel , Miján‐Ortiz José L. , Valle‐Díaz Francisco , López‐León Víctor , Merino‐Salas Sergio , Zuluaga‐Gómez Armando
Published: March 2009

OBJECTIVE

To analyse the efficiency of extracorporeal shockwave lithotripsy (ESWL) vs retrograde ureteroscopy and holmium:YAG laser lithotripsy, as ESWL is successful in 67–90% of cases but endoscopic lithotripsy with pneumatic lithotrites or lasers is successful in 90–96% of distal ureteric calculi, and holmium:YAG lithotripsy is effective in proximal ureteric calculi.

PATIENTS AND METHODS

From April 2006 to April 2008 we assessed 164 patients undergoing ureteric lithiasis in two homogeneous groups: group A included 83 treated with retrograde ureteroscopy and holmium:YAG endoscopic lithotripsy, and group B, 81 treated by ESWL. For laser lithotripsy we used 2071 mJ pulses at 3–6 Hz, with a mean of 1105 pulses and 2.5 kJ of total energy. ESWL was carried out using 37.5–87.5 mJ shock waves, a mean of 3650 shock waves and 187.6 J, with a radioscopy time of 1–4 min. The results were assessed after 3 weeks with plain films and ultrasonography, or urography. The efficiency of each procedure was assessed by calculating the relative risk, and results compared using the chi‐square or Student’s t‐test. The efficiency quotient (EQ) was determined for both procedures, and the focal applied energy quotient (FAEQ) used to assess ESWL.

RESULTS

The overall success rate for retrograde ureteroscopy and laser lithotripsy was 96.4% (80/83 patients), with an EQ of 0.52; a JJ catheter was placed in 67 patients. The success rate for the first ESWL session was 48%, and after repeat ESWL was 64% (52/81 patients), giving an EQ of 0.39. For successful treatments the FAEQ was 9.22, vs 6.47 for the failures (P < 0.005). There was a significant difference (P < 0.001) favouring laser lithotripsy, with an absolute benefit of 46% (95% confidence interval 33.8–57.9%), and number needed to treat of 2 (2–3), but no significant differences for lumbar ureteric calculi.

CONCLUSIONS

Endoscopic lithotripsy with the holmium laser is more effective than ESWL, but for lumbar ureteric calculi ESWL is therapeutically recommended as it is less invasive.
The Present of the Past: Dialogues With Memory Over Time
Authors: Josselson Ruthellen
Published: March 2009

ABSTRACT
This study analyzes the self‐constructing meanings of an autobiographical episode in the life of one woman told at repeated intervals over 35 years. It demonstrates the ways in which the present constructs the past and shows how autobiographical memory may be used dialogically to create and contrast with current self‐constructions, to disavow intolerable aspects of self, and to preserve disused but valued self‐representations. Memories, in this sense, operate as texts whose meaning changes as the dialogue within self changes. The meanings of past memories, rather than their contents, are reshaped to hold aspects of a layered, multiple self.
Gender Differences in Gratitude: Examining Appraisals, Narratives, the Willingness to Express Emotions, and Changes in Psychological Needs
Authors: Kashdan Todd B. , Mishra Anjali , Breen William E. , Froh Jeffrey J.
Published: March 2009

ABSTRACTPrevious work suggests women might possess an advantage over men in experiencing and benefiting from gratitude. We examined whether women perceive and react to gratitude differently than men. InStudy 1, women, compared with men, evaluated gratitude expression to be less complex, uncertain, conflicting, and more interesting and exciting. InStudy 2, college students and older adults described and evaluated a recent episode when they received a gift. Women, compared with men, reported less burden and obligation and greater gratitude. Upon gift receipt, older men reported the least positive affect when their benefactors were men. In Studies 2 and 3, women endorsed higher trait gratitude compared with men. In Study 3, over 3 months, women with greater gratitude were more likely to satisfy needs to belong and feel autonomous; gratitude had the opposite effect in men. The willingness to openly express emotions partially mediated gender differences, and effects could not be attributed to global trait affect. Results demonstrated that men were less likely to feel and express gratitude, made more critical evaluations of gratitude, and derived fewer benefits. Implications for the study and therapeutic enhancement of gratitude are discussed.
Optimal Fiscal Policy in a Multisector Model: The Price Consequences of Government Spending
Authors: CASSOU STEVEN P. , GOROSTIAGA ARANTZA
Published: March 2009

This paper investigates optimal fiscal policy in a static multisector model. A Ramsey type planner chooses tax rates on each good type as well as spending levels on each good type subject to an exogenous total expenditure constraint. It is shown that, like taxes, government spending policy has price effects and that these price effects have significant implications for optimal policy. These price effects imply a U shape to the government's objective function and this U shape results in boundary values for the choice of the spending allocation. In particular, it is shown that the optimal allocation of government spending tends to be concentrated on one good rather than spread among many goods.
The Salient Issue of Issue Salience
Authors: DELLIS ARNAUD
Published: March 2009

This paper proposes a model where the set of issues that are decisive in an election (i.e., the set of salient issues) is endogenous. The model takes into account a key feature of the policy‐making process, namely, that the decision‐maker faces time and budget constraints that prevent him from addressing all of the issues that are on the agenda. We show that this feature creates a rationale for a policy‐motivated decision‐maker to manipulate his policy choice in order to influence which issues will be salient in the next election. We identify three motivations for the decision‐maker to manipulate his policy choice for salience purposes. One is to make salient an issue on which he has an electoral advantage. A second motivation is to defuse the salience of an issue on which he is electorally weak, which is accomplished by either implicitly committing to a policy outcome or triggering a change of salient issue for the challenger. A third motivation is to induce the opposition party to nominate a candidate who, if elected, will implement a policy that the incumbent decision maker finds more palatable.
On the Strategic Use of Representative Democracy in International Agreements
Authors: GRAZIOSI GRÉGOIRE ROTA
Published: March 2009

We consider as endogenous the choice of the delegation rule in an international agreement between two countries. We study three potential types of delegation: strong, weak or no delegation, the latter case corresponding to direct democracy. We show that populations decide to bind themselves by delegating the national policy decision‐making to a “powerful conservative representative,” in order to improve their bargaining position. These noncooperative behaviors of countries when they decide on their delegation rule induce negative political externalities between countries, which cancel the gains achieved by the internalization of economic externalities in the case of political integration. We then examine the consequences of ratification by referendum. We conclude that a Pareto improvement of the international agreement would be to incorporate an ex post referendum.
Flexibility in young second‐language learners: examining the language specificity of orthographic processing
Authors: Deacon S. Hélène , Wade‐Woolley Lesly , Kirby John R.
Published: March 2009

This study examines whether orthographic processing transfers across languages to reading when the writing systems under acquisition are sufficiently related. We conducted a study with 76 7‐year‐old English‐first‐language children in French immersion. Measures of English and French orthographic processing (orthographic choice tasks) and standardised measures of English and French word reading (Woodcock and FIAT) were taken, in addition to verbal and nonverbal ability, and phonological and morphological awareness. Analyses reveal significant contributions of orthographic processing to reading both within and across the two languages, despite the inclusion of control variables. Findings of the transfer of orthographic processing skills to reading across languages suggest that orthographic processing may not be as language specific as previously hypothesised. We discuss the several similarities between English and French, such as a shared alphabet and cognates, that may drive transfer across languages in the context of current theories of second‐language reading development.
Progress in International Reading Literacy Study 2006 (PIRLS): pedagogical correlates of fourth‐grade students in Hong Kong
Authors: Cheung Wai Ming , Tse Shek Kam , Lam Joseph W.I. , Ka Yee Loh Elizabeth
Published: March 2009

Reading literacy of fourth‐grade students in Hong Kong showed a remarkable improvement from 2001 to 2006 as shown by international PIRLS studies. This study identified various aspects of the teacher factor contributing to the significant improvement among students. A total of 4,712 students and 144 teachers from 144 schools were randomly selected using probability proportional‐to‐size technique to receive the Reading Assessment Test and complete the Teacher's Questionnaire, respectively. A number of items pertaining to teachers' instructional strategies and activities, opportunities for students to read various types of materials, practices on assessment, and professional preparation and perception, were found to be significantly correlated with the outcome of students' reading literacy. Stepwise regression procedure revealed four significant predictors for students' overall reading achievement. The most powerful predictor was the use of materials from other subjects as reading resources. Suggestions to improve quality of teaching of reading and further studies are made.
Socialist Antimilitarist Manlinesses: Visual Representations and Normativity in Norway circa 1914
Authors: Kollhøj Jens Petter
Published: March 2009

This essay aims at developing the research on antimilitarist men from gender perspectives to acquire more nuanced and precise understandings. The focus is on pictures. I interpret images and texts as elements in cultural communication and in relation to their historical contexts, and look at how socialist antimilitarist ideals and norms coincided with and differed from dominant notions of what men should be. The essay includes discussions of concepts of masculinity, manliness, and unmanliness. I argue that socialist antimilitarist manlinesses contested military values in various degrees and forms, and find four different but overlapping sets of ideals and norms. The first three are revolutionary, muscular, and pacifist socialist manliness, and the fourth is related to visions of a new humanity. I also argue that to better understand men taking the risk to be culturally marginalized, we need more research with a focus on the perspectives of the men themselves.
Genetic structure, relatedness and helping behaviour in the yellow mongoose in a farmland and a natural habitat
Authors: Vidya T. N. C. , Balmforth Z. , Le Roux A. , Cherry M. I.
Published: March 2009

The yellow mongoose Cynictis penicillata is a facultatively social species and provides an opportunity to study the evolution of social behaviour. We examined genetic structure, relatedness and helping behaviour in the yellow mongoose in natural habitat in the Kalahari Desert, where the species lives in small family groups of up to four individuals and shows no cooperative breeding; and in farmland in the Western Cape Province of South Africa, where they live in larger groups of up to 13 individuals, engage in numerous social interactions and show cooperative breeding. The farmland population showed significant inbreeding, and lower genetic variability than the desert population, but there was no evidence of a recent population bottleneck. The genetic relatedness between individuals within social groups and that between future potential helpers and pups were higher in the farmland population than in the desert population. However, based on a limited sample, helping effort (in the farmland population) was not preferentially directed towards kin. Thus, the origin of helping in the farmland population is consistent with kin selection, but in the absence of kin discrimination, future research should investigate whether long‐term breeding opportunities or group augmentation contribute to maintaining cooperative breeding in this population.