bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing waiting time for radiotherapy: A single machine unit experience
Authors: Martin J , Bowden P , Stephens R , Andrews J , Bishop M
Published: November 2005

Waiting time (WT) for radiotherapy (RT) is a significant clinical problem. This paper examines various strategies for managing WT for patients treated with radical and palliative intent in the new setting of a rural single machine unit in Australia. Cohorts of patients undergoing both radical and palliative RT in Bendigo had their WT prospectively recorded. Matched cohorts from the hub centre (Peter MacCallum Cancer Centre, Melbourne) treated with palliative intent were also collated. Strategies implemented included a devoted priority meeting, palliative points system, and reallocation of appointment times. The audit was to continue until best practice guidelines were bettered. Three cohorts of patients were compared. There is a significant trend for increasing numbers of patients treated per month since the centre opened (P < 0.0001). The ratio of palliative to radical intent patients remained stable between 46 and 52%. Mean WT for palliative RT reduced from 25 days in the first cohort to 7 days in the final cohort (P < 0.0005). Waiting time for palliative RT was initially longer at Bendigo than the hub centre (P < 0.0005), but by the final cohort there was a non‐significant difference favouring the Bendigo cohort (P = 0.26). Waiting time for radical treatment also improved throughout the three cohorts in Bendigo (P < 0.0005). A number of new strategies have successfully resulted in the abolition of lengthy WT for RT in Bendigo despite the increasing demand for the RT service.
Carcinoma of the tonsil with bilateral breast metastasis: A rare presentation
Authors: Munshi A , Sharma R , Iyer VK , Chander B , Rath GK
Published: November 2005

With increasing local regional control and survival rates, the incidence of distant metastasis is increasing. Head and neck malignancies traditionally metastasize to the lung, liver and bone. We present a case of an elderly woman who was loco‐regionally controlled after radiotherapy for carcinoma of the tonsil, but later presented with breast metastasis. To our knowledge, this metastatic pattern has never been reported in published literature. We also discuss the management of breast metastasis and the need to avoid unnecessary mastectomies in such patients.
Glomus tumour in a child
Authors: Lim KAS , Borg MF , Schultz M , Rice M , Potter AE
Published: November 2005

Glomus tumours are uncommon neoplasms. Very rarely do they present in the paediatric age group. We describe a case of bilateral glomus tumours in a 13‐year‐old girl that were successfully treated with radiotherapy. The patient remains well 8 years after completion of treatment.
Endovascular treatment of arterial mesenteric ischaemia: A retrospective review
Authors: Lim RP , Dowling RJ , Mitchell PJ , Vrazas JI , Thomson KR , Tress BM
Published: November 2005

Mesenteric ischaemia is a condition that has traditionally been managed surgically. It poses a challenging diagnostic and therapeutic problem, particularly in the acute setting. We review a small series of eight patients managed with endovascular techniques for either acute or chronic mesenteric ischaemia at The Royal Melbourne Hospital, from 1997 to 2002. We describe our results and relate these to the recent published literature regarding endovascular and surgical management of mesenteric ischaemia. Our experience confirms the valuable contribution of angioplasty and stenting in chronic mesenteric ischaemia, which compares favourably with surgery with regards to complication rates and mortality. We suggest the need for further studies to compare the long‐term efficacy of endovascular techniques compared with surgery in the management of chronic mesenteric ischaemia. Furthermore, we demonstrate a role for endovascular management in acute mesenteric ischaemia, in the appropriate clinical setting.
Ultrasound characteristics of histologically proven grade 3 invasive ductal breast carcinoma
Authors: Rotstein AH , Neerhut PK
Published: November 2005

High‐grade invasive ductal carcinoma (IDC) may paradoxically display features similar to benign breast masses. This study analysed the ultrasound features of histologically proven cases of grade 3 IDC. At North Western BreastScreen Victoria, from 4 February 1993 to 30 September 2002, 181 cases of grade 3 IDC that had ultrasound evaluation were available for retrospective analysis. For each tumour, four features were assessed: margin, attenuation characteristics, echotexture and depth versus width ratio. Eighty‐seven per cent of tumours had an aggressive margin with an echogenic rind, microlobulation or angular margins. However, 11% had a well‐defined smooth margin. The classic sonographic malignant feature of posterior shadowing was present in only 30%, whereas the tissues posterior to the lesion remained isoechoic in 48% and showed posterior enhancement in 11%. Six per cent of the tumours were isoechoic and difficult to appreciate on ultrasound. The best feature to characterize lesions as malignant was the margin of the lesion. To ensure that malignant lesions are correctly categorized, it is important that interfaces between the tumour and adjacent breast parenchyma are meticulously evaluated in a real‐time fashion rather than viewed as a single still image.
The biology of Dasineura dielsi Rübsaamen (Diptera: Cecidomyiidae) in relation to the biological control of Acacia cyclops (Mimosaceae) in South Africa
Authors: Adair Robin J
Published: November 2005

Abstract  Acacia cyclops is an invasive Australian tree in South Africa and a target for biological control using seed‐reducing agents. In southern Australia, two gall‐forming Cecidomyiidae, Dasineura dielsi (Small Fluted Galler) and Asphondylia sp., develop on the flowers and seeds of A. cyclops, respectively. The larvae of D. dielsi form woody fluted galls on the ovaries of flowers and prevent the development of fruit. Immature Asphondylia sp. develop in the loculi of green fruit and destroy developing seeds. Dasineura dielsi was selected as a biological control candidate for A. cyclops in South Africa and was approved for official release after host specificity evaluation and consideration of potential conflicts of interest. Dasineura dielsi naturalised in South Africa in 2001 and after 3 years dispersed up to 450 km from a single population at Stellenbosch, Western Cape. At sites where D. dielsi has been present longest, high gall densities occur on A. cyclops during the peak flower season in summer. Four hymenopterans, ?Synopeas sp., Mesopolobus sp., Torymus sp. and an unidentified Platygastridae, were reared from D. dielsi galls and are suspected parasitoids of the cecidomyiid, with incidence levels less than 10%. Monitoring is required to evaluate trends in the population status of D. dielsi, its parasitoids and seed production of A. cyclops. Importantly, field monitoring should determine the extent and nature of possible competitive interactions between D. dielsi and an introduced seed‐feeding weevil, Melanterius servulus.
Ecology of Leptocoris Hahn (Hemiptera: Rhopalidae) soapberry bugs in Australia
Authors: Carroll Scott P , Loye Jenella E , Dingle Hugh , Mathieson Michael , Zalucki Myron P
Published: November 2005

Abstract  Soapberry bugs are worldwide seed predators of plants in the family Sapindaceae. Australian sapinds are diverse and widespread, consisting of about 200 native trees and shrubs. This flora also includes two introduced environmental weeds, plus cultivated lychee (Litchi chinensis Sonn.), longan (Dimocarpus longan Lour.) and rambutan (Nephelium lappaceum L.). Accordingly, Australian soapberry bugs may be significant in ecology, conservation and agriculture. Here we provide the first account of their ecology. We find five species of Leptocoris Hahn in Australia, and list sapinds that do and do not serve as reproductive hosts. From museum and field records we map the continental distributions of the insects and primary hosts. Frequency of occupation varies among host species, and the number of hosts varies among the insects. In addition, differences in body size and beak length are related to host use. For example, the long‐beaked Leptocoris tagalicus Burmeister is highly polyphagous in eastern rainforests, where it occurs on at least 10 native and non‐native hosts. It aggregates on hosts with immature fruit and commences feeding before fruits dehisce. Most of its continental range, however, matches that of a single dryland tree, Atalaya hemiglauca F. Muell., which has comparatively unprotected seeds. The taxon includes a smaller and shorter‐beaked form that is closely associated with Atalaya, and appears to be taxonomically distinct. The other widespread soapberry bug is the endemic Leptocoris mitellatus Bergroth. It too is short‐beaked, and colonises hosts phenologically later than L. tagalicus, as seeds become more accessible in open capsules. Continentally its distribution is more southerly and corresponds mainly to that of Alectryon oleifolius Desf. Among all host species, the non‐native environmental weeds Cardiospermum L. and Koelreuteria Laxm. are most consistently attacked, principally by L. tagalicus. These recent host shifts have biocontrol implications. In contrast, the sapinds planted as fruit crops appear to be less frequently used at present and mainly by the longer‐beaked species.
The Thrips orientalis group from South‐east Asia and Australia: some species identities and relationships (Thysanoptera, Thripidae)
Authors: Mound Laurence A
Published: November 2005

Abstract  A thrips associated in Thailand with the flowers of Paederia foetida, a rubiaceous weed in Florida that is a threat to Australia, is here recognised as Thrips morindae Priesner, a species previously considered a synonym of T. javanicus Priesner. Systematic relationships of these species with others in South‐east Asia and the Australasian region are discussed. Two new species‐groups are designated: the T. obscuratus group of six species from New Zealand and New Caledonia, and the T. orientalis group of 12 South‐east Asian species that are associated with scented white flowers such as Gardenia. Four species of this second group are recorded from tropical Australia.
Egg production across a 40‐week period in the phasmid Sipyloidea sp. (Diapheromeridae) from a tropical rain forest, north Queensland, Australia
Authors: Edwards Will , Seymour Jamie , Pritchard Katie , Brock Paul
Published: November 2005

Abstract  In this study we report the results from the first long‐term (40 weeks) study of stick‐insect fecundity and distribution under natural conditions of which we are aware. We used the number of eggs falling into 72 × 0.5 m2 traps to ask: ‘Was egg production in Sipyloidea sp. uniform across the sample period’? and ‘Was there evidence of host plant species preference or avoidance’? We collected a total of 213 Sipyloidea sp. eggs. The number of eggs caught per week was not uniform and an exponential decay model was the best‐fit relationship between egg production and time, indicative of a steep decline from high to low (but continuous) egg production across the study period. Continuous egg production differs from other insect species in tropical areas that often show distinct seasonal differences between wet and dry seasons, timed to leaf production in host plants. The distribution of eggs within traps was aggregated, and more traps than expected from Poisson probabilities received no eggs, or six or more eggs. The concentration of eggs within particular traps was not related to the identity of canopy plant species, however. We suggest that continuous egg production in Sipyloidea sp. may be related to the wider range of plant species available as food resources for the polyphagous Sipyloidea, compared with other tropical insect species.
Decreased total antioxidant capacity and increased oxidative stress in passive smoker infants and their mothers
Authors: Aycicek Ali , Erel Ozcan , Kocyigit Abdurrahim
Published: November 2005

Abstract
Background
: Smoking has many adverse health effects in infants and adults. The purpose of the study was to study the effect of passive cigarette smoking on oxidative and antioxidative status of plasma in passive smoker infants and their mothers and to compare with those of non‐smokers.

Methods
: Subjects were randomly chosen from infants aged 8–26 weeks and their mothers aged 20–34 years. Passive smoker infants (n = 29) and their mothers (n = 29) were defined as having other family members who smoked six or more cigarettes per day continually for at least 8 weeks. Non‐smokers were defined as infants (n = 30) and their mothers (n = 24) who had never been exposed to passive smoking. The antioxidative status of plasma were perused by measuring the total antioxidant capacity. Oxidative status was evaluated by predicating total peroxide level, oxidative stress index, protein oxidation and lipid peroxidation.

Results
: Plasma concentrations of total antioxidant capacity were significantly lower in passive smoker infants and their mothers than non‐passive smoker infants and their mothers. However, lipid peroxidation and oxidative stress index were remarkably higher in passive smoker infants and their mothers than those of non‐passive smoker infants and their mothers. There were significant correlations between the oxidative and antioxidative parameters of the passive smoker infants and their mothers.

Conclusions
: Oxidants are increased and antioxidants are decreased in passive smoker infants and their mothers than those of non‐smokers. Passive smoker infants and their mothers are exposed to potent oxidative stress.
Familial cases of Henoch‐Schönlein purpura in eight families
Authors: Motoyama Osamu , Iitaka Kikuo
Published: November 2005

Abstract
Background
: Familial cases of Henoch‐Schönlein purpura (HSP) have rarely been reported.

Methods
: Familial cases of HSP were reviewed by medical records of 418 children with HSP.

Results
: Two members developed HSP in eight families. HSP occurred in a mother and her daughter in one family and in siblings, including one pair of twin sisters, in seven other families. Four pairs of patients developed HSP at the same age. Three pairs presented HSP within 1 month of each other and the other pairs presented HSP between 9 months and 5 years. Seven patients had a history of allergic diseases. The clinical courses of 12 patients were reviewed. Upper respiratory tract infection preceded HSP in 10 patients, two of whom had elevated antistreptolysin‐O titers. No pairs of patients in a family received the same drugs before the onset of HSP. Abdominal pain was noted in eight patients, arthralgia in six and nephritis in four. Severity of skin lesions, presence of abdominal pain and nephritis, and serum IgA levels at the acute stage varied among family members of HSP.

Conclusions
: The incidence of HSP in family members of children with HSP seems to be high. Onset at the same age and onset of HSP within 1 month in siblings have not previously been reported. There were no characteristic or similar findings between two patients of the same family. No trigger or genetic factor causing HSP was identified.
Clinical course of congenital nephrotic syndrome and Denys‐Drash syndrome in Japan
Authors: Motoyama Osamu , Arai Kenji , Kawamura Takeshi , Aikawa Atsushi , Ohara Takehiro , Iitaka Kikuo , Hasegawa Akira
Published: November 2005

Abstract
Background
: The prognosis of Japanese patients with congenital nephrotic syndrome (CNS) and Denys‐Drash syndrome (DDS) is not clear.

Methods
: Five patients with CNS and four patients with DDS, which causes secondary CNS, were studied retrospectively.

Results
: Seven patients were sporadic and two DDS patients were identical twins. Five CNS patients presented with edema within 3 months of birth. In four DDS patients, edema was not noted and end‐stage renal disease developed between 7 months and 6 years of age. Of these five CNS patients, one patient had cerebral thrombosis and cytomegalovirus pneumonia at the onset and another patient died during dialysis. Frequent intravenous albumin administration required, growth and development during infancy were varied. Of the nine patients with CNS and DDS, seven received renal transplantation and were alive with functioning grafts at the last follow up. Catch‐up growth was observed in five patients after transplantation. Five school‐aged patients attended school and received adequate grades and two adults worked full‐time. Of the DDS patients, dysuria due to hypospadias persisted in one patient and treatment for hypogonadism was needed in one patient.

Conclusions
: CNS and DDS were diagnosed early after onset and adequate treatment was started. Growth and development after renal transplantation were relatively good. Thrombotic episodes or severe infection in CNS patients was difficult to manage and complications resulting from DDS affected the quality of life.
Familial Mediterranean fever in a childhood population in eastern Turkey
Authors: Ertekin Vildan , SelimoĞlu M. AySe , Pirim Ibrahim
Published: November 2005

Abstract
Background
: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent attacks of inflammation of serosal membranes. Amyloidosis is the most severe complication of the disease The aim of this study was to explore the magnitude of the FMF problem and to describe clinical phenotypic and genotypic profile in the childhood population in Eastern Turkey.

Methods
: In this study, 52 patients who were diagnosed as FMF between January 2000 and January 2003 in Department of Pediatrics, Ataturk University Hospital, were included. The diagnosis of FMF was based on typical clinical and laboratory features. The 12 FMF mutations were investigated in the patients.

Results
: Of the 52 patients, 30 (57.7%) were girls, 22 (42.3%) were boys, and the age ranged from 9 months to 15 years (8.5 ± 3.2 years). A positive family history for FMF was noted in 33 (63.5%) patients. The mean onset age was 6 ± 3.4 (from 8 months to 14 years). Nineteen children (36.5%) were symptomatic below the age of 5 years. Abdominal pain was observed in 50 (96.2%), fever in 42 (80.8%), arthralgia in 29 (55.8%), arthritis in 18 (34.6%), splenomegaly in 11 (21.2), hepatomegaly in 15 (28.8%), myalgia in 11 (26.2%), erysipelas‐like erythema in 10 (19.2%), thoracic pain in four (7.7%), protracted febrile myalgia in three (5.8%), and seizures in two (3.8%). The most frequent mutation was the M694V/M694V. Clinical presentation of the patients was not different in respect with genotypes (P > 0.05). Two patients had chronic renal disease suggestive of amyloidosis.

Conclusion
: It was noted that the FMF patients in this study had a broad spectrum of mutation combination, which might reflect the intercultural interactions of ancient ethnic groups that lived in Anatolia, and these mutations were not significantly different in respect to clinical presentations.
Effects of montelukast on symptoms and eNO in children with mild to moderate asthma
Authors: Lee Ming‐Yung , Lai Yuan‐Sheng , Yang Kuender D. , Chen Chun‐Jung , Hung Chih‐Hsing
Published: November 2005

Abstract 
Background
: Asthma is a chronic inflammatory airway disease. Exhaled nitric oxide (eNO) is a marker reflecting airway inflammation. This study was conducted to investigate whether montelukast, a leukotriene receptor antagonist, could be used for the management of asthma and how fast the montelukast sodium decreased airway inflammation as demonstrated by eNO levels.

Methods
: Twenty children aged 6–14 years (mean age: 9.2 ± 2.4 years; mean weight 30 ± 4.6 kg) with mild to moderate asthma were recruited for the study. They received montelukast plus an inhaled short‐acting beta2 agonist as open and uncontrolled therapy. Asthma score (AS) and peak expiratory flow rate (PEFR) and eNO concentrations were measured at pretreatment (0 week) and post‐treatment (1 and 2 weeks) as well as 2 weeks after withdrawal of therapy.

Results
: In one week, the eNO levels (33.3 ± 15.5 p.p.b. vs 14.8 ± 8.6 p.p.b.; P < 0.05), and AS (4.2 ± 1.3 vs 1.8 ± 1.3; P < 0.05) decreased rapidly, and PEFR (206.9 ± 69.7 L/min vs 236.2 ± 69.8 L/min; P < 0.05) increased. Concurrent beta2 agonist use decreased from a mean ± SD of 2.2 ± 0.4–1.3 ± 0.3 puffs per weeks (P < 0.05). After the withdrawal of treatment for 2 weeks, the eNO levels (29.2 ± 16.1 p.p.b) rebounded again, although the improvements in AS (1.1 ± 1.3) and PEFR (245.0 ± 91.3 L/min) persisted.

Conclusion
: Oral montelukast sodium treatment of these children with mild to moderate asthma effectively improved asthmatic symptoms and suppressed airway inflammation in 1 week, suggesting that this leukotriene antagonist combined with short‐acting beta2 agonists may provide effective treatment option in mild to moderate childhood asthma. Larger, controlled, and double‐blinded studies are needed to confirm these preliminary open uncontrolled observations.
Different patterns of cytokines, ECP and immunoglobulin profiles at two adverse drug reactions in a patient
Authors: Aihara Yukoh , Ito Shuichi , Aihara Michiko , Kobayashi Yoshinori , Yokota Shumpei
Published: November 2005

Abstract
Objectives
: Drug‐induced hypersensitivity syndrome (HS) is a rare but life‐threatening disease. We experienced carbamazepine‐induced HS in a 14‐year‐old boy, who had cefaclor‐induced cutaneous eruptions 15 months later. To clarify the mechanisms of HS and the differences between two diseases we studied this case in detail.

Methods
: We investigated the associated viral agents by polymerase chain reaction and the specific antibodies. We also studied the mechanism of diseases by measuring chemical mediators including cytokines, ECP and immunoglobulins.

Results
: The patient was diagnosed as having carbamazepine‐induced HS associated with reactivation of human herpesvirus 6 based on the clinical course and laboratory data including drug‐induced lymphocyte stimulation tests. Similarly, the diagnosis of cefaclor‐induced eruption without any viral reactivation was made. Serum levels of IFN‐γ, IL‐6, TNF‐α, IL‐5 and ECP were increased significantly at HS but mildly at cefaclor‐induced eruptions. Furthermore, we detected transient hypogammaglobulinemia only at HS.

Conclusions
: This is the first report of anticonvulsant‐induced HS followed by antibiotic‐induced eruptions in a patient. In addition, we demonstrated difference in serum levels of inflammatory cytokines, immunoglobulins, activated eosinophils and viral reactivation between these diseases. This case would contribute to the understanding of the pathophysiology of adverse drug reactions including HS.
Diurnal variation of height in children
Authors: Siklar Zeynep , Sanli Efgan , Dallar Yildiz , Tanyer Gülten
Published: November 2005

Abstract 
Background
: Diurnal variation of height is largely ignored in the assessment of growth in children. Diurnal decrease in stature may effect the reliability of height measurement. In this study, the degree of differences in daily height measurement were evaluated.

Methods
: A total of 478 children, aged 3–15 years (mean age 9.9 ± 2.3 years) were enrolled in the study. The height of children were measured twice in a day. The first measurements were taken between 09:00 and 10:00 h and the second measurements between 15:00 and 16:00 h.

Results
: Children's height measurements differences were +1.8 to –2.7 cm, and a mean of 0.47 ± 0.05 cm decrease was determined.

Conclusions
: Little differences of height measurement could be very important in evaluating the short child. When the result of height measurement is recorded, recording the time of day is offered.
Primary malignant skin tumors in children: Etiology, treatment and prognosis
Authors: Varan Alİ , Gököz Aytaç , Akyüz Canan , Kutluk Tezer , YalçIn Bİlgehan , Köksal Yavuz , Büyükpamukçu Münevver
Published: November 2005

Abstract
Objective
: The aim of the study was to evaluate the etiology, treatment and prognosis of the malignant skin tumors in children.

Methods
: Twenty‐one patients who had been diagnosed with malignant skin tumors between 1972 and 2003 were retrospectively analyzed. Age range was 0.5–20 years (median 9), and the male/female ratio was 12/9. We had nine (42.9%) patients with malignant melanoma, five (23.8%) with primary skin non‐Hodgkin lymphoma, three (14.3%) with Kaposi sarcoma (KS), two (9.5%) with basal cell carcinoma (BCC), and two (9.5%) with squamous cell carcinoma (SCC).

Results
: We could define the etiologic factors in only nine (42.9%) patients. Two KS cases were associated with renal transplantation, two cases of malignant melanoma occurred within the area of giant hairy cell nevus, one melanoma patient previously had bone marrow transplantation due to Gricelli syndrome, one patient with BCC had xeroderma pigmentosum and the other BCC had got radiotherapy due to previous diagnosis of medulloblastoma. One SCC patient also had xeroderma pigmentosum and the other had previous skin burn. Overall survival rate was 77%. Melanoma patients were treated successfully with high‐dose interferon.

Conclusion
: Although malignant skin tumors are rare in childhood, the prognosis is relatively better than it is for adults. Malignant melanoma was the most frequent tumor. Forty‐three per cent of our patients had an underlying defect in their immune barriers which is thought to be responsible for the development of their malignancies.
Sodium cromoglycate therapy in wheezing infants: preliminary evidence of beneficial outcome at early school age
Authors: Kotaniemi‐Syrjänen Anne , Reijonen Tiina M. , Korhonen Kaj , Korppi Matti
Published: November 2005

Abstract
Background
: In order to affect the natural course of childhood wheezing and asthma, anti‐inflammatory therapy is often prescribed for young wheezing children, but there is lack of long‐term follow‐up data.

Methods
: Eighty‐two of the original 100 children, hospitalized for wheezing under the age of 2 years in 1992–1993, were re‐examined at school age in 1999. The children had participated in an open, randomized, parallel‐group trial including a 4‐month intervention with inhaled sodium cromoglycate (SCG) or budesonide (BUD). The baseline data, including data on atopy, eosinophilia and viral etiology, were prospectively collected on admission.

Results
: At early school age (median 7.2 years), asthma was present in 33 (40%) children. There was less asthma in the original SCG (21%) than in the control group (54%) (OR 0.23; 95% CI 0.07–0.77). The figure was 46% in the BUD group. When the analyses were performed separately for atopic and non‐atopic infants, the difference was significant only among atopics. The lowered risk for asthma in the SCG group remained significant in the multivariate logistic regression analysis when adjusted for age, sex and atopy, and further when adjusted for earlier episodes of wheezing and respiratory syncytial virus identification. However, after adjustment for blood eosinophilia, the significance was lost, albeit the risk for asthma remained low (OR 0.21; 95% CI 0.04–1.12). A sensitivity analysis, which was done by including the six drop‐outs of the SCG group as unfavorable and the 12 drop‐outs of other groups as favorable outcomes in the model, did not change the direction of the result (OR 0.70; 95% CI 0.26–1.89).

Conclusions
: An early SCG intervention in infants hospitalized for wheezing was associated with a lowered risk for early school‐age asthma, especially in infants with evidence of atopy.
Pharmacological profile of a novel, non‐TZD PPARγ agonist
Authors: Chen X. , Osborne M. C. , Rybczynski P. J. , Zeck R. , Yang M. , Xu J. , Zhou L. , Cryan E. , Tang Y. , Demarest K. T.
Published: November 2005

Aim: The purpose of this study was to characterize a novel, non‐thiazolidinedione (TZD) peroxisome proliferator‐activated receptor (PPAR)γ agonist, RWJ‐348260, via bothin vitroandin vivoapproaches.

Methods: Thein vitroPPARγ activities of RWJ‐348260 were assessed in PPARγ‐GAL4 co‐transfection assay, PPARγ receptor binding assay, aP2 gene induction assay and preadipocyte differentiation assay. Thein vivoefficacy of the compound was determined in rodent genetic diabetes models [ob/obmouse,db/dbmouse and Zucker diabetic fatty (ZDF) rat] following multiple days of oral administration.

Results: RWJ‐348260 selectively activated PPARγin vitro.In vivo, RWJ‐348260 produced significant decreases in plasma glucose, HbA1c, insulin and triglyceride levels. RWJ‐348260 also dose‐dependently improved oral glucose tolerance. Indb/dbmice, the compound up‐regulated PPARγ target genes in white adipose tissues. RWJ‐348260 produced a lower extent of hepatocyte lipid deposition and a smaller increase in liver weight compared to rosiglitazone indb/dbmice. While RWJ‐348260 effectively normalized hyperglycaemia and dyslipidaemia, it did not change haematocrit, transaminase, alkaline phosphatase, total bilirubin levels or liver weights in ZDF rats.

Conclusions: RWJ‐348260 is a potent PPARγ agonist with efficacious antidiabetic activity in diabetic animal models. The compound has an improved side‐effect profile compared to rosiglitazone.
Diabetes mellitus as a contributory factor in oral candidosis
Authors: Soysa N. S. , Samaranayake L. P. , Ellepola A. N. B.
Published: November 2005

It has been reported that poor glycaemic control predisposes to oral candidal infection in diabetic patients. For instance, the carriage of Candida species and the density of candidal growth in the oral cavity is frequently claimed to be increased in patients with diabetes mellitus. However, the validity of these observations remains controversial. Hence, we review and discuss here the clinical data in the literature on the relationship between diabetes and oral candidal carriage and infection, and possible mechanisms associated with its pathogenicity.
Association analysis of genes in the renin‐angiotensin system with subclinical cardiovascular disease in families with Type 2 diabetes mellitus: The Diabetes Heart Study
Authors: Burdon K. P. , Langefeld C. D. , Wagenknecht L. E. , Carr J. J. , Freedman B. I. , Herrington D. , Bowden D. W.
Published: November 2005

Aims  Cardiovascular disease (CVD) is a major complication of Type 2 diabetes mellitus. The renin‐angiotensin system (RAS) and nitric oxide production are both important regulators of vascular function and blood pressure. Genes encoding proteins involved in these pathways are candidates for a contribution to CVD in diabetic patients. We have investigated variants of the angiotensinogen (AGT), angiotensin converting enzyme (ACE), angiotensin type 1 receptor (AT1R) and endothelial nitric oxide synthase (NOS3) genes for association with subclinical measures of CVD in families with Type 2 diabetes mellitus (T2DM).

Methods  Atherosclerosis was measured by carotid intima‐media thickness and calcification of the carotid and coronary arteries in 620 European Americans and 117 African Americans in the Diabetes Heart Study. Because of the role of these systems in blood pressure regulation, blood pressure was also investigated.

Results  Compelling evidence of association was not detected with any of the SNPs with any outcome measures after adjustments for covariates despite sufficient power to detect relatively small differences in traits for specific genotype combinations.

Conclusions  Genetic variation of the RAS and NOS3 genes do not appear to strongly influence subclinical cardiovascular disease or blood pressure in this diabetic population.
Measuring beliefs about taking hypoglycaemic medication among people with Type 2 diabetes
Authors: Farmer A. , Kinmonth A.‐L. , Sutton S.
Published: November 2005

Aims  Identifying patients’ beliefs about taking medication can inform interventions to support medication taking, and their evaluation. We set out to establish the range of these beliefs, and measure the frequency of commonly held beliefs and their correlation with intention to take medication and self‐reported medication adherence.

Methods  An exploratory survey among Type 2 diabetic patients aged 40 years or older, registered in general practice, used a questionnaire measuring a range of plausible beliefs about taking and intention to take medication developed from interviews where belief elicitation was guided by the Theory of Planned Behaviour. The Medication Adherence Report Schedule was used as a self‐report adherence measure.

Results  Questionnaires were returned by 121 (61.7%) people. The majority strongly agreed with statements about the benefits of taking medication. Negative beliefs that taking medication would ‘cause unpleasant side effects’ and ‘lead to weight gain’ were held by 24.1 and 13.9% of people, respectively. Beliefs about benefit were strongly associated with intention to take medication regularly. Two beliefs were associated with reduced medication adherence: ‘changes to my daily routine would make it more difficult to take my diabetes medicines regularly’ (P < 0.001), and ‘if I were to take my diabetes medicines regularly this would lead to my gaining weight’ (P < 0.05).

Conclusions  Use of a theoretical model to elicit and identify common beliefs about taking medication regularly underscores the importance of exploring weight‐gain concerns and how to keep taking tablets when routines change. Beliefs associated with intention and taking medication will inform intervention development, implementation and evaluation in randomized controlled studies.
Diabetes—prevalence and cost of illness in Germany: a study evaluating data from the statutory health insurance in Germany
Authors: Stock S. A. K. , Redaelli M. , Wendland G. , Civello D. , Lauterbach K. W.
Published: November 2005

Objective  This population‐based study assesses the prevalence and cost of illness as a result of diabetes mellitus in Germany by retrospectively analysing routine health insurance data. Prevalence and costs were analysed from statutory health insurance (GKV) and societal perspectives.

Research design and methods  The analysis comprises data of all insured persons of six large sickness funds. The insured with diabetes were identified via ICD‐9 diagnosis and Anatomical Therapeutic Chemical Classification System (ATC) code for regular medication prescriptions. Costs for inpatient stay, medication and sickness benefits were taken from claims data. Costs for rehabilitation, premature death and early retirement were calculated using the human capital approach and data from national statistics.

Results  Overall diabetes prevalence in this age and sex standardized census of six large sickness funds was 6.45%. The cost of illness for sickness funds including hospital cost, medication and sickness benefits, and excluding ambulatory doctor care, were €3.69bn. The total cost of diabetes from a societal perspective was calculated at €5.71bn for the year 1999.

Conclusion  In accordance with the results of recent studies using routinely collected health insurance data, our study suggests that the prevalence of diabetes mellitus has increased steadily in the past years. The prevalence in our population of 14.7 million insured was 6.45%. Total costs of diabetes mellitus amounted to €5.71bn.
What do we mean by adherence to treatment and advice for living with diabetes? A review of the literature on definitions and measurements
Authors: Hearnshaw H. , Lindenmeyer A.
Published: November 2005

Aims  In order to measure the effectiveness of interventions claiming to improve adherence in diabetes, valid measurement of adherence is necessary. Any measurement must first be based on a definition. This study aimed to identify and categorize definitions and measurements of adherence in living with diabetes, from a review of the literature.

Methods  Publications were identified from the medline database. Adherence, compliance and concordance were used as terms in the search algorithm, along with diabetes, diabetes mellitus and treatment. Two hundred and ninety‐three papers were identified. Abstracts of these papers were read by two researchers independently. Two hundred and thirty‐nine papers did not contain definitions or measures of adherence and were discarded. Of the remaining 54 papers, 26 included definitions and 46 described measurements of adherence.

Results  Definitions and measurements fell into five categories: coincidence of behaviour with professional advice, relationship as part of the process of care, outcome and process targets, taking the medication as prescribed and others. No single definition of adherence emerged. Many authors did not provide definitions of adherence. Glycated haemoglobin was the most common measurement of adherence, although this can raise problems.

Conclusion  Research which claims to show an intervention has, or has not, improved adherence must be interpreted cautiously. Interventions which appear to fail may actually succeed in aspects of adherence which were not defined or measured in the study. Clinicians and researchers could use clear definitions and measurements, such as the ones presented in this review.
Incorporating partial credit in computer‐aided assessment of Mathematics in secondary education
Authors: Ashton Helen S. , Beevers Cliff E. , Korabinski Athol A. , Youngson Martin A.
Published: November 2005

In a mathematical examination on paper, partial credit is normally awarded for an answer that is not correct, but, nevertheless, contains some of the correct working. Assessment on computer normally marks an incorrect answer wrong and awards no marks. This can lead to discrepancies between marks awarded for the same examination given in the two different media. The current paper presents possible solutions to this problem and the results of experiments designed to test how successful these solutions are in practice. In light of the findings, developments to the assessment engine have been made and some questions redesigned for use in real automated examinations. The results were obtained as part of the Project for Assessments in Scotland using Information Technology (PASS‐IT): a major collaborative programme involving the leading educational agencies in Scotland (see http://www.pass‐it.org.uk for more details).

PASS‐IT has demonstrated that the computer can help measure lower order student skill profiles provided the computer assessment package is sophisticated enough. Optional steps are required to mimic partial credit; randomisation of parameters is needed for practice and the avoidance of copying; the ability to capture and mark automatically mathematical expressions and short free text responses; and the delivery in a number of feedback modes are all vital ingredients of an automatic assessment system. PASS‐IT has shown how to ensure that education drives technology and not vice versa. Finally, collaboration has been paramount within PASS‐IT and should continue. No single group has all the keys to unlock the future of computer‐aided assessment. Scotland is well placed to move forward and e‐assess where its students e‐learn in a large range of subjects such as those delivered via the SCHOLAR Programme (see http://scholar.hw.ac.uk). It should be done too by ensuring that teachers remain central to the learning cycle by supporting the demanding work they do through the supply of suitably filtered data on student performance. Special educational needs can also be addressed more effectively by the use of technology.
Evaluation parameters for computer‐adaptive testing
Authors: Georgiadou Elisabeth , Triantafillou Evangelos , Economides Anastasios A.
Published: November 2005

With the proliferation of computers in test delivery today, adaptive testing has become quite popular, especially when examinees must be classified into two categories (pass/fail, master/nonmaster). Several well‐established organisations have provided standards and guidelines for the design and evaluation of educational and psychological testing. The purpose of this paper was not to repeat the guidelines and standards that exist in the literature but to identify and discuss the main evaluation parameters for a computer‐adaptive test (CAT). A number of parameters should be taken into account when evaluating CAT. Key parameters include utility, validity, reliability, satisfaction, usability, reporting, administration, security, and thoseassociated with adaptivity, item pool, and psychometric theory. These parameters are presented and discussed below and form a proposed evaluation model, Evaluation Model of Computer‐Adaptive Testing.
Non‐parametric Estimation of Tail Dependence
Authors: SCHMIDT RAFAEL , STADTMÜLLER ULRICH
Published: November 2005

Abstract.  Dependencies between extreme events (extremal dependencies) are attracting an increasing attention in modern risk management. In practice, the concept of tail dependence represents the current standard to describe the amount of extremal dependence. In theory, multi‐variate extreme‐value theory turns out to be the natural choice to model the latter dependencies. The present paper embeds tail dependence into the concept of tail copulae which describes the dependence structure in the tail of multivariate distributions but works more generally. Various non‐parametric estimators for tail copulae and tail dependence are discussed, and weak convergence, asymptotic normality, and strong consistency of these estimators are shown by means of a functional delta method. Further, weak convergence of a general upper‐order rank‐statistics for extreme events is investigated and the relationship to tail dependence is provided. A simulation study compares the introduced estimators and two financial data sets were analysed by our methods.
Hypotheses Testing: Poisson Versus Self‐exciting
Authors: DACHIAN SERGUEÏ , KUTOYANTS YURY A.
Published: November 2005

Abstract.  We consider the problem of hypotheses testing with the basic simple hypothesis: observed sequence of points corresponds to the stationary Poisson process with known intensity. The alternatives are stationary self‐exciting point processes. We consider one‐sided parametric and one‐sided non‐parametric composite alternatives and construct locally asymptotically uniformly most powerful tests. The results of numerical simulations of the tests are presented.
A recent increase in AIDS at Lyon University Hospitals: patient characteristics and comparisons with previous years
Authors: Baratin D , Marceillac E , Trepo C , Cotte L , Peyramond D , Chidiac C , Touraine JL , Livrozet JM , Fabry J , Vanhems P
Published: November 2005

Background

A 36% increase in the incidence of AIDS was observed in 2002/2003 compared with 2000/2001 at Lyon University Hospitals.

Objectives

We compared the characteristics of these patients with the characteristics of those diagnosed previously with AIDS.

Methods

Data for all patients with AIDS diagnosed at Lyon University Hospitals were analyzed. The data were collected prospectively. Multiple logistic regression was used for analysis.

Results

The variables independently associated with an AIDS diagnosis in 2002/2003 compared with the 1985–1989 period were: homosexual exposure [odds ratio (OR) 0.4; 95% confidence interval (CI) 0.2–0.8]; heterosexual exposure in an endemic area (OR 22.5; 95% CI 6.8–74.8), compared with other exposure to HIV; lymphoma as initial AIDS event (OR 10.3; 95% CI 2.7–39.1) compared with Pneumocystis carinii pneumonia; and age at first AIDS event aged 34–38 years (OR 2.5; 95% CI 1.0–6.4), aged 39–46 years (OR 5.1; 95% CI 2.2–11.8), and aged 47–84 years (OR 10.6; 95% CI 4.5–25.1) compared with aged <30 years. The variables independently associated with an AIDS diagnosis in 2002/2003 compared with the 1997/2001 period were age at first AIDS event aged 34–38 years (OR 0.4; 95% CI 0.2–0.9) compared with aged <30 years.

Conclusion

Recently diagnosed AIDS patients differed from those diagnosed previously, showing an epidemic switch in different populations. The characteristics of the AIDS population in 2002/2003 might reflect public health messages disseminated around 10 years ago or more for the prevention of HIV transmission. Anticipation of populations affected by the AIDS epidemic is difficult.
Effects of highly active antiretroviral therapy on paediatric metabolite levels
Authors: Rhoads MP , Smith CJ , Tudor‐Williams G , Kyd P , Walters S , Sabin CA , Lyall EGH
Published: November 2005

Objectives

Highly active antiretroviral therapy (HAART) has extended survival of HIV‐infected children into adulthood, raising concerns about long‐term metabolic changes in childhood.

Methods

A longitudinal study of metabolite levels in paediatric HIV‐infected patients before and after starting HAART (January 2000 to June 2003). The effects of HAART on nonfasting blood levels of total (TC), high‐density lipoprotein (HDL), and low‐density lipoprotein (LDL) cholesterol, cholesterol ratio and lactate were analysed using mixed‐effects regression.

Results

A total of 146 children attended 1208 appointments (median 6.7/child). Of these, 99 (68%) were African. At baseline, 75 (51%) were on HAART and had higher TC (4.19 vs 3.49 mmol/L, P<0.0001), HDL (1.03 vs 0.82 mmol/L, P<0.0001), and LDL (2.54 vs 2.11 mmol/L, P=0.0003) than those not on HAART. Metabolites increased with time on HAART exposure and then stabilized. At 2 years, TC had increased by 0.93 mmol/L (P<0.0001), with 29 children (20%) having repeated TC levels above the 95th centile. LDL and HDL had increased by 0.69 and 0.31 mmol/L at 2 years, respectively (both P<0.0001). Lactates declined with increasing age (−0.06 mmol/L/year, P=0.0001).

Conclusions

This is the first cohort study to demonstrate significant elevations of HDL as well as LDL in children on HAART. This rise in cardio‐protective HDL may represent a positive effect of treatment.
Repetitive and stereotyped behaviours in pervasive developmental disorders
Authors: Carcani‐Rathwell Iris , Rabe‐Hasketh Sophia , Santosh Paramala J.
Published: November 2005

Background: Repetitive and stereotyped behaviours are a heterogeneous group of behaviours present in many neuropsychiatric disorders. Despite their core significance in PDD, it is not clear whether there are distinct groups of these behaviours with different specificity to autism.

Methods: A two‐factor model of the repetitive behaviours, namely sensory/motor (lower‐order) and cognitive rigidity (higher‐order), was conceptualised. The model's goodness of fit to the data was examined in a clinic population of children with PDD, with and without mental retardation, and of those with only mental retardation (MR).

Results: Subjects with PDD had higher rates of all repetitive behaviours compared to those with MR only. The existence of two independent ‘lower‐order’ and ‘higher‐order’ sub‐groups of the repetitive behaviours was confirmed only in the MR group. The lower‐order behaviours appear to be associated more with global developmental problems, whereas the higher‐order behaviours were significantly associated with ruminations in the PDD group.

Conclusions: This study suggests that there may be two distinct sub‐groups of repetitive behaviours whereby the sensory and motor repetitive behaviours are generally associated with lower developmental age and less specific to the autistic syndrome whereas the ‘higher‐order’ behaviours may be a more ‘autism specific’ feature. The co‐occurrence of the lower‐ and higher‐order behaviours in PDD might reflect the end result of diffuse altered neural networks in these disorders thus being a specific feature of PDD. There is a need for more systematic studies of these behaviours not only in autistic disorders but also in other neuropsychiatric disorders.