bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathological replication in cells lacking RecG DNA translocase
Authors: Rudolph Christian J. , Upton Amy L. , Harris Lynda , Lloyd Robert G.
Published: June 2009

Little is known about what happens when forks meet to complete DNA replication in any organism. In this study we present data suggesting that the collision of replication forks is a potential threat to genomic stability. We demonstrate that Escherichia coli cells lacking RecG helicase suffer major defects in chromosome replication following UV irradiation, and that this is associated with high levels of DNA synthesis initiated independently of the initiator protein DnaA. This UV‐induced stable DNA replication is dependent on PriA helicase and continues long after UV‐induced lesions have been excised. We suggest UV irradiation triggers the assembly of new replication forks, leading to multiple fork collisions outside the terminus area. Such collisions may generate branched DNAs that serve to establish further new forks, resulting in uncontrolled DNA amplification. We propose that RecG reduces the likelihood of this pathological cascade being set in motion by reducing initiation of replication at D‐ and R‐loops, and other structures generated as a result of fork collisions. Our results shed light on why replication initiation in bacteria is limited to a single origin and why termination is carefully orchestrated to a single event within a restricted area each cell cycle.
Assemblage level variation in springtail lower lethal temperature: the role of invasive species on sub‐Antarctic Marion Island
Authors: JANION CHARLENE , WORLAND M. ROGER , CHOWN STEVEN L.
Published: June 2009

Abstract. It is widely held both in the physiological literature, and more generally, that the average characteristics of species within an assemblage differ among sites. Such generalizations should be based on investigations of whole assemblages at sites, but this is rarely done. Here, such a study is undertaken for virtually the full assemblage of springtails found at sub‐Antarctic Marion Island, by investigating supercooling points (SCPs) of 12 of the 16 species that occur there. Assemblage level variation tends to be less than that documented for assemblages across northern hemisphere sites but similar to that found at some Antarctic locations. Across this set of species, the mean SCPs of the indigenous species (mean ± SE =−17.2 ± 0.4 °C) do not differ significantly from that of the invasive species (−16.3 ± 0.7 °C). Overall, the introduction of several species to the island does not appear to have led to functional homogenization (for this trait). By combining the assemblage‐level SCP data with information on the abundances of the species in each of four major habitats, it is also shown that severe but uncommon low temperature events could substantially alter species relative abundances. By resetting assemblage trajectories, such events could play an important role in the terrestrial system at the island.
Toll‐Like Receptor Expression and Function in Subsets of Human γδ T Lymphocytes
Authors: Pietschmann K. , Beetz S. , Welte S. , Martens I. , Gruen J. , Oberg H.‐H. , Wesch D. , Kabelitz D.
Published: June 2009

Two subsets of human γδ T cells can be identified by T cell receptor (TCR) V gene usage. Vδ2Vγ9 T cells dominate in peripheral blood and recognize microbe‐ or tumour‐derived phosphoantigens. Vδ1 T cells are abundant in mucosal tissue and recognize stress‐induced MHC‐related molecules. Toll‐like receptors (TLRs) are known to co‐stimulate interferon‐γ (IFN‐γ) production in peripheral blood γδ T cells and in Vδ2Vγ9 T cell lines. By microarray analysis, we have identified a range of genes differentially regulated in freshly isolated γδ T cells by TCR versus TCR plus TLR3 stimulation. Furthermore, we have investigated TLR expression in freshly isolated Vδ1 and Vδ2 subsets and cytokine/chemokine production in response to TLR1/2/6, 3 and 5 ligands. TLR1,2,6,7 RNA was abundantly expressed in both subsets, whereas TLR3 RNA was present at low levels, and TLR5 and 8 RNA only marginally in both subsets. Despite abundant RNA expression, TLR1 was rarely detectable by flow cytometry. In contrast, TLR2 and TLR6 proteins were detected in purified Vδ1 and Vδ2 T cells, and TLR3 protein was detected intracellularly in both subsets. TLR1/2/6, 3 and 5 ligands co‐stimulated the IFN‐γ and chemokine secretion in TCR‐activated Vδ1 and Vδ2 subsets, although the levels of IFN‐γ secreted by Vδ1 T cells were much lower than those produced by Vδ2 T cells. Our results reveal comparable expression of TLRs and functional responses to TLR ligands in freshly isolated Vδ1 and Vδ2 T cells and underscore the intrinsically different capacity for IFN‐γ secretion of Vδ1 versus Vδ2 T cells.
A rice tryptophan deficient dwarf mutant, tdd1, contains a reduced level of indole acetic acid and develops abnormal flowers and organless embryos
Authors: Sazuka Takashi , Kamiya Noriko , Nishimura Takeshi , Ohmae Kozue , Sato Yutaka , Imamura Kohei , Nagato Yasuo , Koshiba Tomokazu , Nagamura Yoshiaki , Ashikari Motoyuki , Kitano Hidemi , Matsuoka Makoto
Published: June 2009

Indole‐3‐acetic acid (IAA) plays a critical role in many aspects of plant growth and development; however, complete pathways of biosynthesis, localization and many aspects of functions of IAA in rice remain unclear. Here, we report the analysis of a rice tryptophan‐ (Trp‐) and IAA‐deficient mutant, tryptophan deficient dwarf1 (tdd1), which is embryonic lethal because of a failure to develop most organs during embryogenesis. Regenerated tdd1 plants showed pleiotropic phenotypes: dwarfing, narrow leaves, short roots and abnormal flowers. TDD1 encodes a protein homologous to anthranilate synthase β‐subunit, which catalyses the first step of the Trp biosynthesis pathway and functions upstream of Trp‐dependent IAA biosynthesis. TDD1‐uidA and DR5‐uidA expression overlapped at many sites in WT plants but was lacking in tdd1, indicating that TDD1 is involved in auxin biosynthesis. Both Trp and IAA levels in flowers and embryos were much lower in tdd1 than in wild type (WT). Trp feeding completely rescued the mutant phenotypes and moderate expression of OsYUCCA1, which encodes a key enzyme in Trp‐dependent IAA biosynthesis, also rescued plant height and root length, indicating that the abnormal phenotypes of tdd1 are caused predominantly by Trp and IAA deficiency. In tdd1 embryos, the expression patterns of OSH1 and OsSCR, which mark the presumptive apical region and the L2 layer, respectively, are identical to those in WT, suggesting a possibility either that different IAA levels are required for basic pattern formation than for organ formation or that an orthologous gene compensates for TDD1 deficiency during pattern formation.
Epidemiological studies of the non‐specific effects of vaccines: II – methodological issues in the design and analysis of cohort studies
Authors: Farrington C. P. , Firth M. J. , Moulton L. H. , Ravn H. , Andersen P. K. , Evans S. ,   on behalf of the Working Group on Non‐specific Effects of Vaccines
Published: June 2009

We review sources of bias which can affect non‐randomized cohort studies of non‐specific effects of vaccines on child mortality. Using examples from the literature on non‐specific effects, we describe different sources of selection and information bias, and, where possible, outline analysis strategies to mitigate or eliminate such biases.
Epidemiology and clinical and pathologic characteristics of cutaneous malignant melanoma in Abruzzo (Italy)
Authors: Amerio Paolo , Manzoli Lamberto , Auriemma Matteo , Carbone Angelo , Proietto Gianluca , Angelucci Domenico , Tulli Antonello
Published: June 2009

Background  Malignant melanoma incidence has increased worldwide in recent decades. Cancer registry‐derived epidemiologic data on malignant melanoma in Italy are available only in some northern regions of the country.

Aim  To report the number and characteristics of incident cases of cutaneous malignant melanoma in Abruzzo, a central‐southern Italian region.

Methods  Screening of the archives of the pathology departments of regional hospitals from 2002 to 2005 was performed. For each patient, clinical and pathologic data were collected. Cases of metastatic, multiple, or relapsing melanoma were excluded.

Results  Six hundred and seventy‐two cases of primary melanoma were recorded, with an incidence rate of 14.1 per 100,000 inhabitants per year. Differences related to gender (41.1% males and 58.9% females) and age (35% in the 50–70‐year age group) were found. The trunk (30.7%) and lower limbs (25.94%) were the most frequent sites observed. The superficial spreading histiotype and thin melanoma (≤ 1.00 mm) were more often recorded (44.8% and 62%, respectively).

Conclusions  Despite the bias present in this study, linked to the nature and source of the data, we believe that the figures found in this report are comparable with those obtained in the international literature from other Mediterranean countries.
Efficacy of glucantime in the treatment of Old World cutaneous leishmaniasis
Authors: Firdous Rukhsana , Yasinzai Masoom , Ranja Khalid
Published: June 2009

Background  Leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania. Depending on the parasite species and host response, the disease presents itself in different clinical forms. The cutaneous form of the disease is most common in the Old World. Pentavalent antimonials in the form of an injection represent the most widely used therapy for all clinical forms of the disease. As a result of reports on the development of resistance from various parts of the world, we thought it pertinent to determine its response in our region.

Methods  Two hundred and seven military personnel with cutaneous leishmaniasis, caused by Leishmania major, were treated with glucantime according to the World Health Organization (WHO) recommended protocol. All patients were nonindigenous to the area and had moved from a nonendemic area to a highly endemic area.

Results  Thirty‐seven per cent of patients were cured within 15 days. The cure percentage reached 81% when 20 mg/kg/day was continued to 20 days. Twenty‐five patients who failed to respond were subjected to a further course of glucantime injection. Sixteen responded by the 10th day of treatment, and the remaining nine were cured by completion of the second course, i.e. within 40 days. The drug was administered intramuscularly. The common side‐effects noted were vertigo, headache, anorexia, temperature, and joint pain.

Conclusion  Glucantime is still effective against Old World cutaneous leishmaniasis when used in the doses recommended by WHO.
A novel HLA‐DRB1 allele, DRB*090202, is identified in a Taiwanese family
Authors: Chu C.‐C. , Lee H.‐L. , Lin M.
Published: June 2009

Human leukocyte antigen‐DRB1*090202 has two synonymous nucleotide substitutions with DRB1*090201 at codons 57 and 58, which may be the result of a gene conversion.
Variation in the time‐mortality responses of laboratory and field populations of Helicoverpa armigera infected with nucleopolyhedrovirus
Authors: Grant M. , Bouwer G.
Published: June 2009

The virulence of Helicoverpa armigera nucleopolyhedrovirus (HearNPV) to South African laboratory and field populations of Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) was evaluated. After determining the volume imbibed by each population, bioassays were performed using the droplet feeding method and gradient‐purified HearNPV occlusion bodies. Evaluation of dose‐ and time‐mortality data showed that the median lethal doses (LD50s) did not differ significantly between the populations but that the median lethal time (LT50) of the laboratory population was significantly shorter than the LT50s of the field populations. The study shows the importance of considering both the dose‐ and time‐mortality responses when comparing the response variability of populations to a nucleopolyhedrovirus infection.
Randomized study of school‐based intensive interpersonal psychotherapy for depressed adolescents with suicidal risk and parasuicide behaviors
Authors: Tang Tze‐Chun , Jou Shaw‐Hwa , Ko Chih‐Hung , Huang Shih‐Yin , Yen Cheng‐Fang
Published: June 2009

Aim:  The aim of the present study was to examine the intervention effects of intensive interpersonal psychotherapy for depressed adolescents with suicidal risk (IPT‐A‐IN) by comparison with treatment as usual (TAU) at schools.

Methods:  A total of 347 students from one‐fifth of the classes of a high school in southern Taiwan completed the Beck Depression Inventory‐II, the Beck Scale for Suicide Ideation, the Beck Anxiety Inventory and the Beck Hopelessness Scale for screening for suicidal risk. Of them, 73 depressed students who had suicidal risk on screening were randomly assigned to the IPT‐A‐IN or TAU group. Analysis of covariance (ANCOVA) was performed to examine the effect of IPT‐A‐IN on reducing the severity of depression, suicidal ideation, anxiety and hopelessness.

Results:  Using the pre‐intervention scores as covariates, the IPT‐A‐IN group had lower post‐intervention severity of depression, suicidal ideation, anxiety and hopelessness than the TAU group.

Conclusion:  Intensive school‐based IPT‐A‐IN is effective in reducing the severity of depression, suicidal ideation, anxiety and hopelessness in depressed adolescents with suicidal risk.
There's more to transient ischaemic attack than ABCD
Authors: Blacker D. J.
Published: June 2009

Several important studies have contributed to recent changes in clinical thinking regarding transient ischaemic attack (TIA). The use of risk stratification scores and urgent clinics has become popular and incorporated into recent guidelines, but there may be some pitfalls with this approach. This commentary stresses the need for careful individual patient assessment focussed on prompt determination of the underlying pathogenic mechanism for the TIA. Suggestions on how to incorporate assessment of TIA patients into the current duties of stroke units are made.
Systematic prevention of overweight and obesity in adults: a qualitative and quantitative literature analysis
Authors: Kremers S. , Reubsaet A. , Martens M. , Gerards S. , Jonkers R. , Candel M. , De Weerdt I. , De Vries N.
Published: June 2009

To date, most interventions aimed at preventing obesity have underemphasized the application of systematic intervention development, implementation and evaluation. The present review provides a thorough insight in factors promoting implementation and/or effectiveness in interventions aimed at preventing overweight/obesity among adults. A total of 46 studies evaluating interventions aimed at preventing obesity were reviewed, followed by both qualitative and quantitative analyses. The Intervention Mapping protocol and the Environmental Research framework for weight Gain prevention (EnRG) were applied to analyse and classify the included studies. The interventions were categorized by setting (workplace, community, health care) and target group (ethnic minorities, pregnant women, [pre]menopausal women, smokers, people with intellectual disabilities). Generally, interventions were found to have potential in changing energy balance‐related behaviours and anthropometric outcomes. Effect sizes for changes in body mass index ranged between −0.09 and 0.45. When the programme goal specifically aimed at weight management, the intervention was found to be more successful than interventions with programme goals that were aimed at preventing cardiovascular disease or improving general health status. Although a considerable part of studies included motivational interventions, only some actually assessed the effects on potential cognitive mediators. A general lack of reporting underlying theoretical models for behaviour change was observed as well as the inclusion of linkage groups and strategies to promote empowerment.
Victoria's Unique Approach to Road Safety: A History of Government Regulation*
Authors: Jessop Glenn
Published: June 2009

The Australian state of Victoria has a record of proactive and determined legislative action addressing road safety. Its processes and deliberations concerning the introduction of road safety laws serve as a noteworthy case study of political rationality and public policy development. Victoria has taken a unique and pioneering approach to traffic regulation. Using the seatbelt and handheld phone laws as examples, this article examines the political dynamics involved in, and the forms of political reasoning underpinning, the road safety policy decisions taken by Victorian governments. I argue that the different approaches taken by governments are partly due to the interaction of the political imperatives of state institutions imposing regulations for the public good and the protection of individual liberties.
The 2007 Presidential and Parliamentary Elections in Timor‐Leste
Authors: Leach Michael
Published: June 2009

In the wake of the 2006 “east‐west” crisis in Timor‐Leste, the 2007 Presidential and Parliamentary elections were widely heralded as a key test of political development in the newly independent nation. This article analyses the pre‐election situation, significant electoral law changes, the emergence of new political parties, campaign incidents, poll results, and postelection negotiations over a coalition government. It concludes by reflecting on some of the wider implications for political stability in Timor‐Leste, and related developments through 2008.1
Does international openness affect the productivity of local firms?
Authors: Damijan Jože P. , De Sousa José , Lamotte Olivier
Published: June 2009

This paper examines how international openness can change firm productivity in south‐eastern Europe (SEE), a crucial question for middle‐income countries. Using firm‐level data for six transition economies over the 1995–2002 period, we identify whether foreign ownership and propensity to trade with more advanced countries can bring about higher learning effects. We find that: (i) foreign ownership has helped restructure and enhance the productivity of local firms in four out of six countries; (ii) exporting to advanced markets has a larger impact on productivity growth in four countries, especially when the firm's absorptive capacity is taken into account; (iii) in contrast, exporting to the less competitive markets of the former Yugoslavia seems to negatively affect productivity growth in three countries; and (iv) learning effects from importing are similar to those from exporting. Our results suggest that trade liberalization is not uniformly beneficial. Regional composition of trade flows and absorptive capacity of local firms matter. Thus, trade liberalization within the SEE region may not provide a substitute for a general trade liberalization which includes access to the more competitive markets of countries belonging to the Organization for Economic Co‐operation and Development.
Option Expensing and Managerial Equity Incentives
Authors: Feng Yi , Tian Yisong S.
Published: June 2009

We examine the impact of mandatory option expensing on managerial equity incentives. Though effective only after June 15, 2005, there is evidence that U.S. firms begin preparing for option expensing as early as 2002 by making changes to their equity incentive plans. We find that (1) CEO option incentives exhibit a sharp reversal during the period 1993‐2005, with the median CEO option incentives increasing 25% a year before 2002 but declining 17% a year after 2001; (2) the reduction in option incentives after 2001 is larger for firms that use excessive levels of equity incentives prior to 2002; (3) firms make similar reductions to options granted to CEOs, other top executives and lower‐level employees; (4) CEO stock incentives increase throughout the entire 13‐year period, rising at an even greater rate after 2001; and (5) the increase in stock incentives after 2001 is far from offsetting the corresponding decrease in option incentives. These findings are robust to controls for firm and CEO characteristics and for concurrent regulatory, business and market events such as the Sarbanes‐Oxley Act of 2002, the option backdating scandal, and the 2000 stock market crash. We also provide a theoretical explanation for the documented changes in option incentives.
Carrier frequency of SMA by quantitative analysis of the SMN1 deletion in the Iranian population
Authors: Hasanzad M. , Azad M. , Kahrizi K. , Saffar B. S. , Nafisi S. , Keyhanidoust Z. , Azimian M. , Refah A. A. , Also E. , Urtizberea J. A. , Tizzano E. F. , Najmabadi H.
Published: June 2009

Background and purpose:  Spinal muscular atrophy (SMA) is a common autosomal recessive neuromuscular disorder. Carrier frequency studies of SMA have been reported for various populations. Although no large‐scale population‐based studies of SMA have been performed in Iran, previous estimates have indicated that the incidence of autosomal recessive disorder partly because of the high prevalence of consanguineous marriage is much higher in the Iranian population than in other populations.

Methods:  In this study, we used a reliable and highly sensitive quantitative real‐time PCR assay with SYBR green I dye to detect the copy number of the SMN1 gene to determine the carrier frequency of SMA in 200 healthy unrelated, non‐consanguineous couples from different part of Iran.

Results:  To validate the method in our samples, we determined the relative quantification (RQ) of patients with homozygous deletion (0.00) and hemyzygous carriers (0.29–0.55). The RQ in 10 of 200 normal individuals were within the carrier range of 0.31–0.57, estimating a carrier frequency of 5% in the Iranian population.

Conclusions:  Our data show that the SMA carrier frequency in Iran is higher than in the European population and that further programs of population carrier detection and prenatal testing should be implemented.
Screening for LRRK2 R1441 mutations in a cohort of PSP patients from Germany
Authors: Madžar D. , Schulte C. , Gasser T.
Published: June 2009

Background and purpose:  Mutations in the leucine‐rich repeat kinase gene (LRRK2) have been shown to be the most common genetic cause of both familial and sporadic Parkinson’s disease. Patients harboring LRRK2 mutations develop late onset PD that in most cases cannot be clinically distinguished from idiopathic PD. Furthermore, LRRK2 mutations have been reported to result in a broad spectrum of neuropathological alterations including progressive supranuclear palsy (PSP)‐like Tau pathology.

Methods:  We screened a cohort of 88 clinically confirmed PSP patients for mutations in exon 31.

Results:  We did not find any of the known mutations or any new variants.

Conclusions:  Thus, there is no evidence that mutations in exon 31 of LRRK2 are a major risk factor for PSP. Our study, however, cannot rule out that other genetic variations in LRRK2 may be associated with PSP.
Cognitive function in early Parkinson’s disease: a population‐based study
Authors: Elgh E. , Domellöf M. , Linder J. , Edström M. , Stenlund H. , Forsgren L.
Published: June 2009

Background and purpose:  The study aims to describe the frequency, pattern and determinants of cognitive function in patients with newly diagnosed Parkinson’s disease (PD); to compare patients with impaired cognition to patients with intact cognition; and to compare to matched healthy controls.

Methods:  Patients were identified in a longitudinal population based study of idiopathic non‐drug induced parkinsonism. Eighty‐eight newly diagnosed patients with PD and no dementia were included during a four year period. The patients and 30 age‐ and sex‐matched healthy control subjects underwent a comprehensive neuropsychological assessment.

Results:  Patients performed significantly worse than healthy controls in a majority of neuropsychological tests. Test results in attention, psychomotor function, episodic memory (free recall), executive function and category fluency were significantly lower in the patient group. Comparison with normative data revealed that 30% of the patients had deficits in ≥1 cognitive domain (episodic memory, executive function and verbal function). Seventy per cent of the patients had normal performance. Unified Parkinson's Disease Rating Scale (UPDRS) III sub scores; speech, facial expression, rigidity and bradykinesia were significantly higher, and disease duration shorter amongst the cognitively impaired than amongst the cognitively intact patients. Tremor showed no difference. Education level was an independent predictor of dysfunction in patients with ≥2 cognitive domains affected.

Conclusion:  Cognitive dysfunction is common in untreated patients in early PD, affecting attention, psychomotor function, episodic memory, executive function and category fluency. Education level was an independent predictor of severe cognitive dysfunction.
Histamine‐N‐methyl transferase polymorphism and risk for multiple sclerosis
Authors: García‐Martín E. , Martínez C. , Benito‐León J. , Calleja P. , Díaz‐Sánchez M. , Pisa D. , Alonso‐Navarro H. , Ayuso‐Peralta L. , Torrecilla D. , Agúndez J. A. G. , Jiménez‐Jiménez F. J.
Published: June 2009

Background:  Histamine N‐methyltransferase (HNMT) is the main metabolizing enzyme of histamine (a mediator of inflammation implicated in the pathogenesis of multiple sclerosis‐MS) in the CNS. We have investigated the possible association between a single nucleotide polymorphism of the HNMT (chromosome 2q22.1), that causes the amino acid substitution Thr105Ile (decreasing enzyme activity) and the risk for MS.

Methods:  We studied the frequency of the HNMT genotypes and allelic variants in 228 MS patients and 295 healthy controls using a PCR‐RLFP method.

Results:  The frequencies of the HNMT genotypes and allelic variants did not differ significantly between MS patients and controls, and were unrelated with the age of onset of MS, gender, and course of MS.

Conclusion:  The HNMT polymorphism is not related with the risk for MS.
Psychometric Properties of the ASPeCT‐DD: Measuring Positive Traits in Persons with Developmental Disabilities
Authors: Woodard Cooper
Published: June 2009

Background The Assessment Scale for Positive Character Traits‐Developmental Disabilities (ASPeCT‐DD) was designed to measure the presence and strength of selected positive or strength‐based traits in persons with developmental disabilities. These traits may help to determine level of happiness or value associated with the more commonly measured external indicators of quality of life.

Method The present study examines the psychometric properties of this scale by exploring the factor structure, test‐retest and split‐half reliability, and inter‐rater reliability measures. Also presented is an analysis of descriminant and convergent validity.

Results Results indicate a four‐factor solution, with poor to moderate correlation among the factors. Test‐retest reliability and measures of internal consistency were in the fair to excellent range, and inter‐rater reliability measures were good. Initial evaluation of validation is encouraging.

Discussion Limitations of this study are discussed, as are related opportunities for future research endeavours.
Weight Status of Persons with Intellectual Disabilities
Authors: Maaskant Marian A. , Van Knijff‐Raeven Ankie G. M. , Van Schrojenstein Lantman‐de Valk Henny M. J. , Veenstra Marja Y.
Published: June 2009

Background  The aim was to study the weight and weight status of the study group in 2002 and 2007, and to study the differences in weight and weight status between 2002 and 2007 and the risk groups for (becoming) overweight/obese.

Materials and Methods  The Body Mass Index (BMI) of 336 clients of a Dutch service provider for persons with intellectual disabilities was calculated in 2002 and 2007.

Results  The mean increase in BMI between 2002 and 2007 was 0.8 (2.2 kg). In 2002, 36% of the study group was overweight/obese; this was higher in 2007: 45%. The expected relationship between increase in BMI and the change in living circumstances could not be confirmed.

Conclusions  Further research into health‐control programmes, weight status, food‐intake and physical exercise is recommended.
Practices for prevention, diagnosis and management of postpartum haemorrhage: impact of a regional multifaceted intervention
Authors: Audureau E , Deneux‐Tharaux C , Lefèvre P , Brucato S , Morello R , Dreyfus M , Bouvier‐Colle M‐H
Published: June 2009

Objective  To evaluate the effectiveness of a multifaceted intervention on practices for prevention, diagnosis and management of postpartum haemorrhage (PPH) and on the prevalence of major PPH in a French perinatal network.

Design  Quasi‐experimental before‐and‐after survey.

Setting  All maternity units (n = 19) of a French administrative region, operating as a perinatal network.

Sample  One representative sample of all women delivering in the network, one representative sample of women with PPH deliveries and an exhaustive sample of women with major PPH.

Methods  The multifaceted intervention took place between February 2003 and March 2004. Information was retrospectively collected for two periods, 2002 (before the intervention) and 2005 (after).

Main outcome measures  Practices for prevention, diagnosis and management of PPH and prevalence of major PPH.

Results  After the intervention, the pharmacological prevention of PPH increased from 58.8% to 75.9% of vaginal deliveries (P < 10−4), and the use of blood collecting bags from 3.9% to 76.3% (P < 10−4), but initial PPH management did not change significantly. However, the median delay for second‐line pharmacological treatment was significantly shortened [from 80 min (35–130) in 2002 to 32.5 min (20–75) in 2005]. An increase was observed in the use of surgery for PPH (0.06% versus 0.12% of deliveries; P = 0.03) and in blood transfusions (0.18% versus 0.33%; P = 0.01). The prevalence of major PPH did not change (0.80% versus 0.86% of deliveries; P = 0.62).

Conclusions  The intervention was effective at improving PPH‐related preventive and diagnostic practices in a perinatal network. Improving management practices and reducing the prevalence of major PPH might require a different intervention design.
Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort
Authors: Laursen M , Johansen C , Hedegaard M
Published: June 2009

Objectives  To examine the associations between fear of childbirth and emergency caesarean section and between fear of childbirth and dystocia or protracted labour and fetal distress.

Design  Prospective cohort study.

Setting  Danish National Birth Cohort.

Population  A total of 25 297 healthy nulliparous women in spontaneous labour with a single fetus in cephalic presentation at term following an uncomplicated pregnancy.

Methods  Data were collected during 1997–2003 from computer‐assisted telephone interviews twice in pregnancy linked with national health registers.

Main outcome measures  Risk for emergency caesarean section of women who feared childbirth; risk for dystocia/protracted labour or fetal distress of women who feared childbirth.

Results  Fear of childbirth in early (16 weeks, 6 ± 29 days) and late (31 weeks, 4 ± 21 days) pregnancy was associated with emergency caesarean section: OR, 1.23 (1.05–1.47) and 1.32 (1.13–1.55), respectively. When fear of childbirth was expressed at both interviews, the OR was 1.43 (1.13–1.80). Women who feared childbirth had an increased risk for dystocia or protracted labour (OR, 1.33; 1.15–1.54), but not for fetal distress (OR, 0.94; 0.72–1.23).

Conclusions  Fear of childbirth during pregnancy was associated with dystocia and emergency caesarean section but not with fetal distress.
Weaning from ventilation – current state of the science and art
Authors: Crocker Cheryl
Published: June 2009

Weaning from mechanical ventilation has attracted a growing interest recently in the medical and nursing press. Attempts have been made to determine a patient’s readiness to wean, define criteria for successful weaning and enhance the weaning process through the developments of protocols.

Key to this work is the role of the critical care nurse. Transferring the role and the responsibility of weaning from the traditional perspective of the intensivist to the nurse is not without challenges. Inherent is the need for skill and expertise and the willingness to accept this level of responsibility, not questioned in the medical role, but worthy of consideration when transferred to nurses.

Key to successful weaning and weaning is redefined for the purposes of this paper, is continuity of care, knowing the patient and the development of patient‐centred, individualized weaning plans. Critical care nurses have an important role to play. This is particularly so when the patient experience is to be understood. There is relatively little research conducted in this area, yet this is an important consideration if we are to fully understand and embrace the role of patients in their weaning.

Weaning in the context of critical care can be challenging. To wean the difficult‐to‐wean or the long‐term‐weaning patient requires great skill and expertise. Expertise in this context has not been fully explored, yet research suggests that these patients are not allocated expert nurses to care for them because they are not seen as critically ill. It may be that this group of patients would benefit from a transfer to a weaning centre as suggested by the Modernisation Agency in 2002. This would greatly challenge the way we, as critical care nurses, perceive weaning in critical care.
Heparin versus citrate for anticoagulation in critically ill patients treated with continuous renal replacement therapy
Authors: Tillman Joanne
Published: June 2009

Background:  Continuous renal replacement therapy (CRRT) is commonly used in the care of critically ill patients (Gabutti et al., 2002). Critical illness increases the likelihood to both coagulation and bleeding, making anticoagulation for CRRT problematic.

Aims:  This mini‐review aims to examine the evidence that compares the use of systemic heparin and regional citrate as forms of anticoagulation for CRRT in critically ill patients. The primary outcome of interest was haemofilter circuit survival, and the secondary outcome was reduced risk of bleeding.

Search strategy:  A systematic literature search was undertaken to identify all studies comparing these drugs. The Cochrane Library, Medline and Embase databases were searched. Eighty‐nine articles were found. Included studies were randomized controlled trials (RCTs), which used a target population of critically ill adults. Studies were excluded if they had not been written in English and if they were not available through King’s College London. After applying the inclusion and exclusion criteria, three RCTs comparing the use of systemic heparin and regional citrate were included in the review.

Results:  Two studies showed significant differences in circuit survival time, with citrate prolonging survival time. All studies showed an increased risk of bleeding in the heparin group, resulting in a higher rate of transfusion while heparin was being used.

Conclusions:  The studies examined lacked reference to the power of the studies and strength in the presentation of the results. Because of the lack of reliability in the studies, it would be suggested that further research is needed on this topic in order to produce rigorous high‐quality reviews with limited bias. The use of citrate, as with all treatments in clinical practice, should be used with caution and assessed on an individual patient basis. Reviewing this evidence helps to gain an insight into different treatment options available, identifying some of the risks and benefits.
Commentary: Ulger F et al. (2009). Are we aware how contaminated our mobile phones with nosocomial pathogens?
Authors: Gould Dinah
Published: June 2009

Background:  The objective of this study was to determine the contamination rate of the health care workers’ (HCWs) mobile phones and hands in operating room and intensive care unit (ICU). Micro‐organisms from HCWs hands could be transferred to the surfaces of the mobile phones during their use.

Methods:  Two hundred HCWs were screened; samples from the hands of 200 participants and 200 mobile phones were cultured.

Results:  In total, 94·5% of phones demonstrated evidence of bacterial contamination with different types of bacteria. The Gram‐negative strains isolated from mobile phones were 31·3%, and the ceftazidime‐resistant strains from the hands were 39·5%. Staphylococcus aureus strains isolated from mobile phones of 52% and those strains isolated from hands of 37·7% were methicillin resistant. Distributions of the isolated micro‐organisms from mobile phones were similar to those from hands isolates. Some mobile phones were contaminated with nosocomial important pathogens.

Conclusion:  These results showed that HCWs hands and their mobile phones were contaminated with various types of micro‐organisms. Mobile phones used by HCWs in daily practice may be a source of nosocomial infections in hospitals.

Abstract reprinted from Annals of Clinical Microbiology and Antimicrobials, volume 8, Ulger F et al., ‘Are we aware how contaminated our mobile phones with nosocomial pathogens?’, doi:10.1186/1476‐0711‐8‐7. © 2009, reproduced with permission from BioMed Central Ltd.
Is routine cervical dilatation necessary during elective caesarean section? A randomised controlled trial
Authors: GÜNGÖRDÜK Kemal , YILDIRIM Gokhan , ARK Cemal
Published: June 2009

Objective: The purpose of this prospective randomised study was to determine the effect of routine cervical dilatation during elective caesarean section on maternal morbidity.

Methods: Participants with indication for elective caesarean section were randomly allocated to two groups. Group A (n = 200) women with intraoperative cervical dilatation; group B (n = 200) women with no intraoperative cervical dilatation.

Results: No demographic differences were observed between groups. There was no significant difference between groups in infectious morbidity (P = 0.87) (relative risk (RR) 1.11, 95% confidence interval (CI) 0.58–2.11), endometritis (P = 0.72) (RR 1.68, 95% CI 0.39–7.14), febrile morbidity (P = 0.66) (RR 1.21, 95% CI 0.51–2.87), wound infection (P = 0.82) (RR 1.11, 95% CI 0.44–2.81), endometritis (P = 0.72) (RR 1.68, 95% CI 0.39–7.14) or urinary tract infection (P = 1.00) (RR 1.00, 95% CI 0.28–3.50), and estimated blood loss (P = 0.2). However, group A had longer operative times compared with the group B (P = 0.01).

Conclusion: Intraoperative digital cervical dilatation during elective caesarean section did not reduce blood loss and postoperative infectious morbidity. The routine digital cervical dilatation during elective caesarean section is not recommended.
Neonatal hyperinsulinaemic hypoglycaemia and monogenic diabetes due to a heterozygous mutation of the HNF4A gene
Authors: CONN Jennifer J. , SIMM Peter J. , OATS Jeremy J. N. , NANKERVIS Alison J. , JACOBS Susan E. , ELLARD Sian , HATTERSLEY Andrew T.
Published: June 2009

Recent research has demonstrated that mutations of the hepatocyte nuclear factor 4‐alpha (HNF4A) gene are associated with neonatal hyperinsulinaemic hypoglycaemia. Mutations of this gene also cause one of the subtypes of monogenic diabetes, a form of diabetes formerly known as maturity‐onset diabetes of the young. This article describes a family discovered to have a novel frame‐shift mutation of the HNF4A gene in the setting of early‐onset maternal diabetes and severe neonatal hyperinsulinaemic hypoglycaemia. The implications of a diagnosis of HNF4A gene mutation for obstetric and paediatric practice are discussed.
Effects of Prescribed Fires on Young Valley Oak Trees at a Research Restoration Site in the Central Valley of California
Authors: Holmes Katherine A. , Veblen Kari E. , Berry Alison M. , Young Truman P.
Published: June 2009

Woodland restoration sites planted with Quercus lobata (valley oak) often have serious invasions of nonnative annual grasses and thistles. Although prescribed fire can effectively control these exotics, restoration managers may be reluctant to use fire if it causes substantial mortality of recently planted saplings. We studied the effects of prescribed fires on the survival and subsequent growth of 5‐ and 6‐year‐old valley oak saplings at a research field near Davis, California. One set of blocks was burned in summer 2003 at a time that would control yellow star thistle, a second set of blocks was burned in spring 2004 at a time that would control annual grasses, and a third set was left unburned. Very few oaks died as a result of either fire (3–4%). Although a large proportion was top‐killed (66–72%), virtually all these were coppiced and most saplings over 300 cm tall escaped top‐kill. Tree height, fire temperature, and understory biomass were all predictive of the severity of sapling response to fire. Although the mean sapling height was initially reduced by the fires, the growth rates of burned saplings significantly exceeded the growth rates of unburned control trees for 2 years following the fires. By 2–3 years after the fires, the mean height of spring‐ and summer‐burned saplings was similar to that of the unburned control saplings. The presence of valley oak saplings does not appear to preclude the use of a single prescribed burn to control understory invasives, particularly if saplings are over 300 cm tall.
Giant Sequoia (Sequoiadendron giganteum) Regeneration in Experimental Canopy Gaps
Authors: York Robert A. , Battles John J. , Eschtruth Anne K. , Schurr Frieder G.
Published: June 2009

Restoration of giant sequoia populations is a high priority for managers, but few experimental studies have examined the efficacy of restoration treatments. To inform giant sequoia restoration treatment options, we assessed the response of giant sequoia regeneration (germination, mortality, and growth) to experimental gaps within a native giant sequoia grove. We created experimental gaps, ranging in size from 0.05 to 0.4 ha. Following gap creation, we sowed seeds and planted seedlings along north‐south transects across gaps. Transects were planted on paired burned and unburned substrates. The seed‐sowing treatment did not result in a cohort of established seedlings, although the amount of seeds sowed was far short of the potential amount released during intense fires. Mortality of planted seedlings did not vary with gap size (average 25% mortality). However, there was a distinct relationship between gap size and second year seedling growth. The relationship was best modeled with an asymptotic curve for both burned and unburned substrates. Relative seedling growth more than doubled as gap size increased from 0.05 to 0.2 ha, then increases in growth diminished. Growth rates of giant sequoia seedlings saturated above 70% light availability while increasing linearly with belowground resource availability. Long‐lived pioneer species such as giant sequoia require restoration treatments that involve relatively severe disturbances to facilitate cohort establishment and recruitment.
Distribution of hepatitis C virus genotype in Iranian multiply transfused patients with thalassemia
Authors: Alavian Seyed‐Moayed , Miri Seyyed Mohammad , Keshvari Maryam , Elizee Pegah Karimi , Behnava Bita , Tabatabaei Seyed‐Vahid , Lankarani Kamran Bagheri
Published: June 2009

BACKGROUND: Hepatitis C virus (HCV) infection is the most common transfusion‐transmitted disease in multiply transfused patients worldwide. In this study, the aim was to investigate distribution of HCV genotypes in Iranian patients with thalassemia.

STUDY DESIGN AND METHODS: Blood samples were received from 280 multiply transfused patients with thalassemia with chronic hepatitis C who were referred to us to start pegylated interferon‐α plus ribavirin for duration of 48 weeks. HCV RNA viral load was detected using Amplicor test (Version 2, Roche Molecular Systems). Genotyping was performed by genotype‐specific primers.

RESULTS: HCV genotype distribution was 1 in 57%, 3 in 35%, 2 in 1%, and mixed in 4% (1 + 3 in 2.8%, 3 + 4 in 0.4%, mixed subtypes in 0.8%) cases. A total of 2.5% of isolates were nontypable. Genotype 1 was associated with higher rate of splenectomy and greater serum ferritin.

CONCLUSION: Genotype 1 is the most frequently detected HCV genotype in Iranian patients with thalassemia and might cause more need for splenectomy and more severe iron overloading. Higher HCV viral load could be regarded as another risk factor for greater iron overloading.
Differential Left Atrial Remodeling in LV Diastolic Dysfunction and Mitral Regurgitation
Authors: Maiello Maria , Sharma Rakesh K. , Matteo Ciccone M. , Reddy Humananth K. , Palmiero Pasquale
Published: June 2009

Objective: Chronic pressure and volume overload may cause different type of left atrial (LA) remodeling in left atrial enlargement (LAE) leading to different cardiovascular outcomes. These two different patterns of LA remodeling can be discriminated by LA eccentricity index (LAEi). The goal of our study was to evaluate an association between LAEi, LV diastolic dysfunction (LVDD), and mitral regurgitation (MR). Method: LAEi was calculated from 3D of left atrium (LA): anteroposterior (D1), superoinferior (D2), mediolateral (D3), and LAEi = D2×2/ (D1+D3). LAE was described as elongated left atrium (EA) if LAEi ≥ 1.27, and spherical left atrium (SA) if LAEi < 1.27. Results: A group of 501 patients (10.4%) with LAE were categorized into two subgroups; 232 (46.3%) with EA and 269 (53.7%) with SA based on LAEi. Among 108 patients (21.6%) with LVDD without MR, 102 had EA and only 6 had SA (P < 0.0001). The cohort of 155(30.1%) patients with MR without LVDD, only 8 had EA and143 had SA (P < 0.0001). Of the total group of 501 patients, 59 had persistent AF and in this subgroup only 10 patients had EA and 49 patients had SA (P < 0.0001). There was a statistically significant difference for AF rate between EA‐patients with LVDD without MR and SA‐patients with MR without LVDD (P < 0.001). Conclusions: LVDD may contribute to pressure overload LA remodeling in a way quite different from volume overload LA remodeling by MR. LAEi can discriminate two different LA morphologies with significantly different potential outcomes. It may identify patients associated with a higher rate of AF with a higher cardiovascular risk.
Safety and Feasibility of Real Time Adenosine Myocardial Contrast Echocardiography with Emphasis on Induction of Arrhythmias: A Study in Healthy Volunteers and Patients with Stable Coronary Artery Disease
Authors: Dijkmans P. A. , Juffermans L. J. M. , Van Dijk J. , Musters R. J. P. , Spreeuwenberg  , Kamp O.
Published: June 2009

Introduction: Some studies reported an increased incidence of premature ventricular complexes (PVCs) during triggered myocardial contrast echocardiography (MCE) using high‐intensity ultrasound destruction. Whether PVCs are also induced by real time MCE using low emission power, is unknown. The aim of the study was to assess the occurrence of arrhythmias during real time adenosine MCE in healthy volunteers and patients with stable coronary artery disease (CAD). Methods: Fifty healthy volunteers and 26 patients with stable CAD underwent real time MCE using Sonovue and power pulse inversion (ATL 5000) at rest and during adenosine stress. The occurrence of premature atrial complexes (PAC) and PVCs was analyzed before and during MCE using ECG‐tracings from videotapes. Results: In healthy subjects, the occurrence of PVCs at baseline (0.04 ± 0.23 PVCs/min) was similar at rest (0.04 ± 0.23 PVCs/min, P = NS), and adenosine stress (0.03 ± 0.14, P = NS). In CAD patients, the occurrence of PVCs at baseline was 0.30 ± 0.76 PVC/min, compared to 0.29 ± 0.74 at rest (P = NS), and 0.34 ± 0.74 during adenosine stress (P = NS). The number of subjects demonstrating PVCs did not increase during MCE. The occurrence of PACs during MCE was not increased compared to baseline. Conclusion: Real time MCE using low emission power does not increase the occurrence of premature complexes in healthy volunteers or CAD patients.