bluuebunny/crossref_metadata_2025 huggingface dataset:
Access to and use of NHS Patient Advice and Liaison Service (PALS): the views of children, young people, parents and PALS staff
Authors: Heaton J. , Sloper P. , Clarke S.
Published: March 2007

Background  The English National Health Service Patient Advice and Liaison Service (PALS) was set up to provide patients and their relatives with a way of obtaining information or expressing concerns about their health care. This study examined children's, young people's and parents' access to and use of PALS, and how this could be improved.

Methods  Qualitative and quantitative methods were used to obtain the views of children, young people, parents and PALS staff, on the inclusiveness of the service. These methods included discussion groups and interviews with 30 young people and 16 parents; a postal survey of PALS users, to which 171 (21%) parents responded; and telephone interviews with 14 PALS staff. The data were analysed using qualitative and quantitative methods, and the views of participants on key topics were examined.

Results  Children and young people were found to be low users of PALS, but thought that the service was potentially useful. They and parents and PALS staff all highlighted ways in which access to and use of the service could be improved. Participants' views on the following topics are reported: awareness of PALS existence and role; access to and use of PALS; effectiveness of and satisfaction with PALS; and training of staff.

Conclusions and recommendations  Patient Advice and Liaison Service has not been designed and developed in ways that are fully inclusive of children, young people and parents. Based on their views and experiences, and the suggestions of PALS staff, the authors recommend that access to and use of the service could be improved, increasing awareness of PALS, facilitating access to and use of the service, providing training for PALS staff on dealing with young people and their issues, and developing links between PALS and other organizations that deal with young people and parents.
Plant diversity and land use under organic and conventional agriculture: a whole‐farm approach
Authors: GIBSON R. H. , PEARCE S. , MORRIS R. J. , SYMONDSON W. O. C. , MEMMOTT J.
Published: March 2007

Organic farming is thought to lead to increased biodiversity and greater sustainability than higher‐yielding conventional farming systems. It is usually assumed that organic farms have both larger and higher quality areas of semi‐natural habitats, although this assumption has not been unequivocally tested.

Here we test the hypothesis that in comparison to conventional farms, organic farms have larger areas of semi‐natural and boundary vegetation, and organic farms support higher levels of plant abundance, richness and diversity within cropped and semi‐natural areas.

Our study compared whole‐farms: 10 organic farms were paired with 10 conventional farms in a complex landscape in the south‐west of England. On average, organic farms were 7·3 years post conversion. Plant abundance, species richness and diversity were measured in all crop and non‐crop landscape elements on each farm.

Organic farms had greater total areas of semi‐natural habitat (woodland, field margins and hedgerows combined). Woodland area on it's own was also significantly greater. Organic farms had more continuous blocks of woodland (with simpler perimeters than similarly sized patches on conventional farms), whereas woodland on conventional farms often consisted of more linear patches.

Semi‐natural habitats on organic farms did not have higher plant abundance, richness or diversity than their conventional counterparts. The only landscape element that showed a significant increase in plant abundance, richness or diversity was arable fields.

Synthesis and applications. Even within a complex agricultural landscape differences do exist between organic and conventional farms, these differences being larger areas of semi‐natural habitats on organic farms. However, with the exception of arable fields, no habitats on organic farms were yet of a better quality than their conventional counterparts in terms of plant abundance and diversity. Conventional farmers may be able to achieve an increase in plant diversity within arable fields by adopting some organic management practices at the field scale (e.g. exclusion of synthetic herbicides), and whole‐farm conversion to organic practice might not be required. However, further work is needed to determine any biodiversity benefits of larger areas of semi‐natural habitat on conventional farmland.
Forecasting suitable breeding conditions for the red‐billed quelea Quelea quelea in southern Africa
Authors: CHEKE ROBERT A. , VENN JON F. , JONES PETER J.
Published: March 2007

Red‐billed queleas Quelea quelea are major pests of small‐grain crops throughout sub‐Saharan Africa. When conditions permit, birds breed in vast colonies which are targets for control operations. Queleas are intra‐African long‐distance migrants whose complex movements vary annually according to variations in rainfall patterns. An ability to forecast where and when colonies could be established will greatly improve the efficiency of control measures. We describe such a forecasting model for the southern African subspecies Q. q. lathamii.

The model is based on and provides a partial test of the conjectured rainfall–migration model of Ward (1971), whereby quelea movements are determined by rainfall patterns and grass seed availability. We consider that a threshold quantity of rainfall (shown here to be c. 60 mm) within any 2 weeks at the start of the wet season is necessary to cause annual grass seeds to germinate, forcing queleas to emigrate. Only if rainfall exceeds another threshold (240 mm within a 6‐week span and at least 6 weeks elapsed after the 60‐mm threshold had been exceeded), allowing production of fresh seed, can queleas return and commence breeding. Birds may breed again in the same season by undertaking further long‐distance ‘breeding migrations’ to areas where sufficient rain had fallen even later.

Using only estimates of rainfall derived from satellite data, we describe a simple spatio‐temporal model for southern Africa to show at weekly intervals those areas where (a) the wet season has not yet started; (b) the early rains migration threshold has been exceeded; (c) the threshold to permit breeding has been exceeded; and (d) conditions are no longer suitable for new colonies to be established.

Synthesis and applications. The model was run for three seasons and performed well compared to an expected null distribution of breeding colonies among quarter‐degree grid squares. In 2002/2003 and 2004/2005, but not in 2003/2004, quelea colonies were reported significantly more often in grid squares where the model had predicted breeding to be possible. However, in a more refined analysis of a smaller subset of colonies for which precise dates of their establishment were known, their spatio‐temporal distribution matched predictions in 95%, 85% and 99% of grid squares, respectively, over the three breeding seasons. These success rates show that predictions from the model, the first of its kind for any African bird, can aid the planning of quelea control strategies.
Landscape ecology of house mouse outbreaks in south‐eastern Australia
Authors: SINGLETON GRANT R. , TANN COLIN R. , KREBS CHARLES J.
Published: March 2007

House mouse Mus domesticus outbreaks in the grain‐growing areas of south‐eastern Australia occur irregularly and may be local or widespread, covering thousands of square kilometres. All natural and agricultural habitats are occupied when house mouse numbers are high, and the question we addressed was whether we can distinguish source and sink habitats within these agricultural landscapes so that management practices can be better targeted.

Live‐trapping on replicated grids in 15 habitats, including eucalypt woodland, cypress pine woodland, areas of permanent water and crop habitats, was carried out from 1983 to 1988 at 9‐week intervals.

Agricultural cropland (including crops, fallow and pastures), farm buildings, seepage areas and natural woodland could be source habitats. Farm buildings, seepage areas and saltbush areas all had high mouse densities entering the 1983–84 outbreak and were refuge habitats for mice.

Cropland habitats quickly became the source area in spring 1983, and woodlands were initially sinks that lagged 2–4 months behind the population growth shown in crops.

Adult female mice in cropland habitats were more often in breeding condition compared with mice in natural woodland. Mice also had higher indices of residency in cropland than in natural woodland.

Synthesis and applications. In non‐irrigated cereal production areas of south‐eastern Australia, house mice move from refuge habitats in seepage areas and farm buildings into crops, build up in numbers in cropland habitats, and then invade woodland habitats, which by themselves cannot generate outbreaks of this pest species. Monitoring for incipient outbreaks should concentrate on refuges in seepage areas and crops and their associated fence lines as source habitat indicators. Population control in these habitats in spring would reduce the likelihood of population outbreaks in autumn, leading to reduced rodenticide use and a concomitant reduction in environmental hazards.
Managing heterogeneity in elephant distribution: interactions between elephant population density and surface‐water availability
Authors: CHAMAILLÉ‐JAMMES SIMON , VALEIX MARION , FRITZ HERVÉ
Published: March 2007

Concerns over the ecological impacts of high African elephantLoxodonta africanadensities suggest that it may be necessary to control their numbers locally, although the best management approach is still widely debated. Artificial water supply is believed to be a major cause of local overabundance, and could be used as a potential tool to regulate elephant distribution and impact across landscapes, but its effect on elephants at the population scale has never been studied.

We assessed how dry‐season surface‐water availability constrained the distribution of an entire elephant population, using aerial and waterhole census data from Hwange National Park, Zimbabwe. The study was initiated in 1986, when the population was released from culling. We studied how artificial waterholes, holding water throughout the dry season, and vegetation production, estimated from a normalized difference vegetation index (NDVI), influenced the long‐term distribution of elephant densities. We also investigated how the elephant distribution responded to changes in population density and annual rainfall, a driver of surface‐water availability.

Long‐term dry‐season elephant densities across the park tended to increase with vegetation production, and increased asymptotically with the density of artificial waterholes.

Since the culling stopped, dry‐season elephant densities have increased in most areas of the park, except in areas of low vegetation production and low water availability. Interannual fluctuations in elephant distribution are linked to rainfall variability through its effect on surface‐water availability. During dry years elephants concentrated in areas where artificial pumping maintained surface‐water availability during the dry season.

During dry years elephant numbers at waterholes increased because of reduced surface‐water availability, and elephants were distributed more evenly across waterholes, although active waterholes were unevenly distributed across the park.

Synthesis and applications. Surface‐water availability drives the distribution and abundance of elephants within Hwange National Park, and therefore appears to be at the heart of the trade‐off between elephant conservation and the extent of their impact on ecosystems. Artificial manipulation of surface water is one of the tools available for the management of elephant populations and should not be overlooked when considering options for controlling elephant numbers in places where they are considered to be overabundant.
Peripheral immune responses in pregnant cattle following Neospora caninum infection
Authors: ROSBOTTOM A. , GUY C. S. , GIBNEY E. H. , SMITH R. F. , VALARCHER J. F. , TAYLOR G. , WILLIAMS D. J. L.
Published: March 2007

Experimental infection of cattle with Neospora caninum in early gestation causes foetal death, but the foetus survives infection in late gestation. An immunological mechanism of abortion has been suggested; therefore changes in the maternal immune response during pregnancy could account for these differences. We have investigated the peripheral immune responses of pregnant cattle following an intravenous inoculation with 107 N. caninum tachyzoites in early and late gestation. Percentages of CD2+ and CD4+ T‐cells in peripheral blood mononuclear cells (PBMC) increased 1–2 weeks after infection in both early (day 70) and late (day 210) gestation, and percentages of CD8+ T‐cells increased 1–2 weeks after infection at day 70. Interleukin‐4 (IL‐4) and interferon‐γ (IFN‐γ) mRNA expression in PBMC increased 1–2 weeks after infection at day 210 and IL‐4 increased 1–2 weeks after infection at day 70. Immunomagnetic isolation of CD4+ cells from PBMC showed that they were a major source of IL‐4 and IFN‐γ, and expression of both cytokines increased in CD4+ cells after infection in early and late gestation. These results suggest that CD4+ cells proliferate and express IL‐4 and IFN‐γ in response to N. caninum irrespective of the stage of gestation when infection occurs.
Nomenclature of prominin‐1 (CD133) splice variants – an update
Authors: Fargeas C. A. , Huttner W. B. , Corbeil D.
Published: March 2007

Prominin‐1 (CD133), a pentaspan membrane glycoprotein that constitutes an important cell surface marker of various, either normal or cancerous, stem cell populations is widely used to isolate or characterize such cells in different systems. Occurring throughout the metazoan evolution with a remarkably conserved genomic organization, it may be expressed as different splice variants with distinctive characteristics. A rational nomenclature has been proposed earlier for their consistent designation across species. Although generally accepted, it seems to be misunderstood in view of the recent report of novel prominin‐1 complementary DNAs in rhesus monkey and humans with improper naming. As this may lead to confusion, we have reexamined the genomic organization of prominin‐1 in various primates to provide an update that should further clarify the rationale of the nomenclature for prominin‐1 gene products. This report comprises (i) the determination of the genomic organization of prominin‐1 gene in two non‐human primates, i.e. Macaca mulatta and Pan troglodytes, commonly used in research, (ii) the mapping of a new exon that creates an alternative cytoplasmic C‐terminal end of prominin‐1, (iii) the identification of various potential PDZ‐binding domains generated by alternative cytoplasmic C‐terminal tails, suggesting that different prominin‐1 splice variants might interact with distinct protein partners, and (iv) a summing up of the different prominin‐1 splice variants.
Ketamine, an NMDA‐antagonist, increases the oscillatory frequencies of α‐peaks on the electroencephalographic power spectrum
Authors: Tsuda N. , Hayashi K. , Hagihira S. , Sawa T.
Published: March 2007

Background:  Ketamine, an N‐methyl‐D‐aspartate (NMDA) antagonist, is known to activate the electroencephalogram (EEG), despite its sedative effects. Spindle oscillations are known to be related to the sedative actions of the reticular thalamic nucleus with links to thalamocortical neurons. This study was designed to examine the effect of ketamine on the spindle oscillations to understand the simultaneous sedative effect and EEG activation that occurs with ketamine, by comparing the EEG in emergence.

Methods:  Anesthesia was induced with propofol using a target‐controlled infusion (TCI) system (3.5 μg/ml). Seventeen patients, scheduled for non‐cranial surgery under general anesthesia combined with epidural anesthesia, were randomly divided into two groups: (i) anesthesia was maintained with TCI‐propofol alone (n= 8) and (ii) anesthesia was maintained with TCI‐propofol and intravenously administered ketamine (n= 9). The EEG was continuously monitored and EEG indices and power spectra were determined.

Results:  Propofol alone caused the α‐peaks of the power spectra to occur at an average frequency of 10.4 ± 0.9 Hz; the addition of ketamine shifted the peaks to higher frequencies of 15.1 ± 1.4 Hz (P < 0.05). On the other hand, when the EEG was activated by discontinuation of propofol, the corresponding α‐peaks disappeared.

Conclusions:  Ketamine increased the frequencies of α‐spindle waves induced by propofol, but did not block their formations. The phenomena have the possibility to underlie the cooperative effect between propofol and ketamine concerning sedation and anesthesia.
Family presence and environmental factors at the time of a patient’s death in an ICU
Authors: Fridh I. , Forsberg A. , Bergbom I.
Published: March 2007

Background:  In an intensive care unit (ICU), privacy and proximity are reported to be important needs of dying patients and their family members. It is assumed that good communication between the ICU team and families about end‐of‐life decisions improves the possibilities of meeting families’ needs, thus guaranteeing a dignified and peaceful death in accordance with end‐of‐life care guidelines. The aim of this study was to explore the circumstances under which patients die in Swedish ICUs by reporting on the presence of family and whether patients die in private or shared rooms. An additional aim was to investigate the frequency of end‐of‐life decisions and whether nurses and family members were informed about such decisions.

Methods:  A questionnaire based on the research questions was completed when a patient died in the 10 ICUs included in the study. Data were collected on 192 deaths.

Results:  Forty per cent of the patients died without a next of kin at the bedside and 46% of deaths occurred in a shared room. This number decreased to 37% if a family member was present. Patients without a family member at their bedside received less analgesics and sedatives. There was a significant relationship between family presence, expected death and end‐of‐life decisions.

Conclusions:  The results indicate the necessity of improving the ICU environment to promote the need for proximity and privacy for dying patients and their families. The study also highlights the risk of underestimating the needs of patients without a next of kin at their bedside at the time of death.
Sustained intravascular exposure to propofol does not prolong pain at the site of injection
Authors: Liljeroth E. , Karlsson A. , Lagerkranser M. , ÅKeson J.
Published: March 2007

Background:  Pain at the site of intravenous injection of propofol is a common clinical finding. This double‐blind, randomized cross‐over study was designed to evaluate whether venous occlusion applied during injection of a low dose of propofol reduces the intensity of pain at the site of injection compared with no occlusion.

Methods:  Bilateral 0.5‐ml injections of an emulsion containing 10 mg/ml of propofol were given over 30 s in 75 adult surgical patients. Each patient was given one injection with and one without 60‐s occlusion of the cannulated vein with a 10‐min interval, and asked to score the maximal pain intensity on a visual analogue scale (VAS).

Results:  The maximal pain intensity [median (25th percentile; 75th percentile), range] at the site of injection was 0.5 (0; 3.5), 0–8.0 VAS units with venous occlusion and 0.5 (0; 1.4), 0–6.0 VAS units without occlusion (P= 0.042). Pain was first reported within 20 s regardless of the study regimen and was not prolonged by local venous occlusion.

Conclusion:  Venous occlusion augments pain intensity at the site of propofol injection without prolonging pain, implying that propofol‐induced pain is determined more by the blood concentration than by the duration of intravascular exposure. The low intensity of pain induced by low‐dose propofol and the fading of pain despite sustained exposure suggest that initial low‐dose administration of propofol should be evaluated for the attenuation of local pain induced by higher intravenous doses of propofol.
Does a positive end‐expiratory pressure‐induced reduction in stroke volume indicate preload responsiveness? An experimental study
Authors: Lambert P. , Sloth E. , Smith B. , Hansen L. K. , Koefoed‐Nielsen J. , Tønnesen E. , Larsson A.
Published: March 2007

Background:  Increases in positive end‐expiratory pressure (PEEP) are often associated with cardiovascular depression, responding to fluid loading. Therefore, we hypothesized that if stroke volume (SV) is reduced by an increase in PEEP this reduction is an indicator of hypovolemia or preload responsiveness, i.e. that SV would increase by fluid administration at zero end‐expiratory pressure (ZEEP). The relationship between the cardiovascular response to different PEEP levels and fluid load as well as the relation between change in SV as a result of change in preload (Frank–Starling relationship) were evaluated in a porcine model. In addition, other measures of fluid status were assessed.

Methods:  Eight, 20–22 kg, anesthetized, mechanically ventilated pigs were subjected to 0, 10, and 20 cm H2O PEEP at 10% (of estimated blood volume) hypovolemia, normo‐ and 10% hypervolemia, and to ZEEP at 20% hypervolemia. SV, cardiac output, intrathoracic blood volume and airway, esophageal, vascular pressures, stroke volume variations, left ventricular end‐diastolic and end‐systolic areas and respiratory variations in the diameter of the inferior vena cava were obtained.

Results:  At hypovolemia and normovolemia, 10 cm H2O PEEP induced a significant decrease in SV, while no change occurred at 10% hypervolemia. SV measured at ZEEP increased from hypovolemia to normovolemia and 10% hypervolemia, while no change was found between 10% and 20% hypervolemia. The sensitivity and specificity decrease in SV by PEEP indicating an increase in SV by fluids was 60–88% and 67%, respectively, depending on the volemic (preload) levels.

Conclusion:  Although the overall results suggest that a change in SV by PEEP might predict preload responsiveness, the individual response of SV by 10 cm H2O PEEP and of the successive fluid administration seemed to be dependent on where on the Frank–Starling curve the heart function was located.
Pre‐occlusion ischaemia, not sevoflurane, successfully preconditions the myocardium against further damage in porcine in vivo hearts
Authors: Larsen J. R. , Aagaard S. R. , Hasenkam J. M. , Sloth E.
Published: March 2007

Background:  Sevoflurane is proposed to possess important tissue protective effects based on experimental ischaemia‐reperfusion studies from models with collateral coronary flow, unlike that of the normal human or the porcine heart. The objective was to evaluate the infarct‐reducing capability of pre‐ischaemic sevoflurane inhalation on myocardial infarct size in a porcine model.

Methods and materials:  The study comprised 33 pigs under pentobarbital anaesthesia. Animals were divided into three groups: control (CON), sevoflurane intervention (SEVO) and ischaemic preconditioning (IP). The distal left anterior descending coronary artery was occluded for 40 min with a percutaneous coronary intervention catheter. Before occlusion, group IP underwent two 5‐min ischaemia cycles, whereas SEVO received two 5‐min sevoflurane 4%v/v inhalation cycles. Animals were reperfused for 150 min. We then measured risk area (AAR) and infarct size (IS) after tetrazolium staining. The [IS/AAR‐ratio] was calculated. Haemodynamics and transthoracic tissue‐Doppler echocardiography were monitored.

Results:  Control animals developed a myocardial infarction in 46.4 (± 6.2)% (mean ± SEM) of the AAR. Both SEVO and IP groups had infarction mitigated, to 34.4 (5.7)% and 23.1 (5.3)%, respectively; however, only in the IP group was this significant. No significant differences between groups with respect to AAR, haemodynamics or echocardiographic variables were found.

Conclusion:  Pre‐ischaemic sevoflurane was found to reduce the extent of myocardial necrosis, but the change was not significant, whereas IP reduced IS by 50% (P= 0.038). Cardioprotection is species related and no previous results from porcine models have found sevoflurane to reduce IS. Anaesthetic washout, insufficient exposure or collateral coronary blood supply, dissimilar to human, may account for positive results in rodent models.
Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post‐operative analgesic requirements: a prospective, randomized, double‐blind, controlled trial in patients undergoing major orthopedic surgery
Authors: Arcioni R. , Palmisani S. , Tigano S. , Santorsola C. , Sauli V. , Romanò S. , Mercieri M. , Masciangelo R. , De Blasi R. A. , Pinto G.
Published: March 2007

Background:  New ways of decreasing post‐operative analgesic drug requirements are of special interest after major surgery. Magnesium sulfate (MgSO4) alters pain processing and reduces the induction and maintenance of central sensitization by blocking the N‐methyl‐d‐aspartate (NMDA) receptor in the spinal cord. We investigated whether supplementation of spinal anesthesia with combined intrathecally and epidurally infused MgSO4 reduced patients’ post‐operative analgesia requirements.

Methods:  In a randomized, prospective, double‐blind, placebo‐controlled trial, we enrolled 120 consecutive patients undergoing orthopedic surgery during spinal anesthesia (levobupivacaine and sufentanil). Patients were randomly assigned to receive intrathecal MgSO4 (94.5 mg, 6.3%), epidural MgSO4 (2%, 100 mg/h), intrathecal and epidural MgSO4 combined or spinal anesthesia alone (controls). Post‐operative morphine consumption was assessed in all groups by patient‐controlled analgesia (PCA).

Results:  Of the 120 patients enrolled, 103 (86%) completed the study. Morphine consumption at 36 h after surgery was 38% lower in patients receiving spinal anesthesia plus epidural MgSO4 [– 14.963 mg; 95% confidence interval (CI), – 1.44 to – 28.49 mg], 49% lower in those receiving spinal anesthesia plus intrathecal MgSO4 (– 18.963 mg; 95% CI, – 5.27 to – 32.65 mg) and 69% lower in the intrathecal–epidural combined group (– 26.963 mg; 95% CI, – 13.73 to – 40.19 mg) relative to control patients receiving spinal anesthesia alone. No complications developed during the post‐operative course or at 1 month after surgery.

Conclusion:  In patients undergoing orthopedic surgery, supplementation of spinal anesthesia with combined intrathecal and epidural MgSO4 significantly reduces patients’ post‐operative analgesic requirements.
Intrathecal betamethasone pain relief in cancer patients with vertebral metastasis: a pilot study*
Authors: Inada T. , Kushida A. , Sakamoto S. , Taguchi H. , Shingu K.
Published: March 2007

Background:  We have reported previously the usefulness of intrathecal betamethasone for pain relief in cancer patients who suffer from intractable pain caused by vertebral metastasis. The mechanism by which betamethasone relieves pain may be related to alterations in cerebrospinal fluid (CSF) concentrations of pro‐inflammatory cytokines and prostanoids.

Methods:  Thirteen cancer patients with intractable pain caused by vertebral metastasis received 2–3 mg betamethasone in the lumbar subarachnoid space. CSF concentrations of tumor necrosis factor‐α (TNF‐α), interleukin‐1β (IL‐1β), IL‐6, IL‐8 and prostaglandin E2 (PGE2) were measured with an enzyme‐linked immunosorbent assay (ELISA) and a chemiluminescence enzyme immunoassay. Pain was measured using a numerical pain score (range, 0–10; 0, no pain; 10, worst pain imaginable).

Results:  Intrathecal betamethasone was associated with a significant decrease in the pain score in six patients. In these cases, the pain score decreased from 6.7 ± 0.5 (mean ± standard error of the mean) to 3.3 ± 0.3 (P < 0.05), and the CSF concentrations of IL‐8 and PGE2 decreased significantly compared with pre‐treatment levels (IL‐8, 183.3 ± 21.2 to 116.5 ± 10.6 pg/ml; PGE2, 43.8 ± 10.3 to 14.7 ± 3.0 pg/ml). There were no significant changes in the CSF concentrations of cytokines and PGE2 in the remaining seven patients.

Conclusion:  Pain relief with intrathecal betamethasone is related to decreases in the CSF concentration of IL‐8 and PGE2.
Neurogenic pulmonary edema
Authors: Baumann A. , Audibert G. , McDonnell J. , Mertes P. M.
Published: March 2007

Neurogenic pulmonary edema (NPE) is usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. It has been reported regularly for a long time in numerous and various injuries of the central nervous system in both adults and children, but remains poorly understood because of the complexity of its pathophysiologic mechanisms involving hemodynamic and inflammatory aspects.

NPE seems to be under‐diagnosed in acute neurologic injuries, partly because the prevention and detection of non‐neurologic complications of acute cerebral insults are not at the forefront of the strategy of physicians. The presence of NPE should be high on the list of diagnoses when patients with central neurologic injury suddenly become dyspneic or present with a decreased Pao2/Fio2 ratio.

The associated mortality rate is high, but recovery is usually rapid with early and appropriate management.

The treatment of NPE should aim to meet the oxygenation needs without impairing cerebral hemodynamics, to avoid pulmonary worsening and to treat possible associated myocardial dysfunction.

During brain death, NPE may worsen myocardial dysfunction, preventing heart harvesting.
Real‐time multiplex allele‐specific polymerase chain reaction for genotyping of the Duffy antigen, the Plasmodium vivax invasion receptor
Authors: Sousa T. N. , Sanchez B. A. M. , Cerávolo I. P. , Carvalho L. H. , Brito C. F. A.
Published: March 2007

Background and Objectives  Duffy blood group is of major interest in clinical medicine as it is not only involved in blood‐transfusion risks and occasionally in neonatal haemolytic disease, but it is also the receptor for the human malaria parasite Plasmodium vivax in the erythrocyte invasion. The aim of this study was to develop a rapid and inexpensive approach for high‐throughput Duffy genotyping.

Materials and methods  This paper reported the development of a Duffy genotyping assay based on multiplex real‐time polymerase chain reaction (PCR) using SYBR Green I fluorescent dye.

Results  By using this approach for Duffy genotyping we obtained the same results as that for the conventional allele‐specific PCR, however, in a high‐throughput assay. The Duffy genotyping of field samples demonstrated that P. vivax‐infected individuals showed a significantly higher prevalence of two functional alleles than Plasmodium falciparum‐infected and non‐infected individuals. This finding corroborates the hypothesis that the presence of two functional alleles increases the risk of P. vivax infection.

Conclusion  This methodology may be suitable for epidemiological studies, particularly for exploring the relationship between Duffy alleles and malaria susceptibility, and also for identification of transfusional incompatibility in blood banks.
Growth and parameters of microflora in intestinal and faecal samples of piglets due to application of a phytogenic feed additive
Authors: Muhl A. , Liebert F.
Published: March 2007

A commercial phytogenic feed additive (PFA), containing the fructopolysaccharide inulin, an essential oil mix (carvacrol, thymol), chestnut meal (tannins) and cellulose powder as carrier substance, was examined for effects on growth and faecal and intestinal microflora of piglets. Two experiments (35 days) were conducted, each with 40 male castrated weaned piglets. In experiment 1, graded levels of the PFA were supplied (A1: control; B1: 0.05% PFA; C1: 0.1% PFA; D1: 0.15% PFA) in diets based on wheat, barley, soybean meal and fish meal with lysine as the limiting amino acid. In experiment 2, a similar diet with 0.1% of the PFA (A2: control; B2: 0.1% PFA; C2: +0.35% lysine; D2: 0.1% PFA + 0.35% lysine) and lysine supplementation was utilized. During experiment 1, no significant effect of the PFA on growth, feed intake and feed conversion rate was observed (p > 0.05). Lysine supplementation in experiment 2 improved growth performance significantly, but no significant effect of the PFA was detected. Microbial counts in faeces (aerobes, Gram negatives, anaerobes and lactobacilli) during the first and fifth week did not indicate any significant PFA effect (p > 0.05). In addition, microflora in intestinal samples was not significantly modified by supplementing the PFA (p > 0.05). Lysine supplementation indicated lysine as limiting amino acid in the basal diet, but did not influence the microbial counts in faeces and small intestine respectively.
In vitro fermentation of different starches by mixed micro‐organisms from the sheep rumen
Authors: Ataşoğlu C. , Yurtman ı. Y.
Published: March 2007

Fermentation characteristics of wheat, rye, maize and triticale starches by mixed micro‐organisms from the sheep rumen were determined in an in vitro experiment. Starch was incubated with ruminal fluid for 2, 4, 6, 8, 10 and 12 h and various fermentation variables were determined. The rates of fermentation of the starches were not different (p > 0.05) from each other except for 2 and 4 h of incubation. Likewise, net ammonia production, sugar utilization, microbial biomass and the efficiency of microbial protein synthesis did not differ between the starches (p > 0.05). The proportions of sugar utilized were similar between the starches and approximately 75% of the starches were fermented during the 12‐h incubation. The 12‐h net concentrations of individual and total volatile fatty acids (VFA) were affected (p < 0.05) by the type of starch. The concentrations of acetate, propionate and butyrate and that of total VFA from wheat, maize and triticale incubations were higher (p < 0.05) than those from rye incubation. The results suggest that the type of starch subject to investigation had no measurable effects on fermentation variables determined in this study except for individual and total VFA concentrations.
Effects of rosuvastatin on lipids, lipoproteins and apolipoproteins in the dyslipidaemia of diabetes
Authors: Betteridge D. J. , Gibson J. M.
Published: March 2007

Aims  To compare the effects of rosuvastatin and atorvastatin 10 and 20 mg on plasma lipid and lipoprotein profiles in patients with Type 2 diabetes mellitus and triglycerides ≤ 6.0 mmol/l.

Methods  A double‐blind, randomized, multicentre study to assess the effect of rosuvastatin and atorvastatin, at 10 mg/day for 8 weeks followed by 20 mg/day for a further 8 weeks, on low‐density lipoprotein cholesterol (LDL‐C), together with a range of secondary lipid and lipoprotein end points.

Results  Rosuvastatin reduced mean LDL‐C levels from baseline over 16 weeks by 57.4%, while atorvastatin reduced mean LDL‐C levels by 46.0% over the same period. The difference in LDL‐C reduction between treatments was statistically significant (P < 0.001). Rosuvastatin also produced statistically significantly greater mean reductions from baseline in levels of total cholesterol, non‐high‐density lipoprotein cholesterol, apolipoprotein B and lipid ratios. More patients achieved European LDL‐C (< 2.5 mmol/l) and total cholesterol (< 4.5 mmol/l) goals with rosuvastatin than with atorvastatin. Rosuvastatin was associated with a significantly (P < 0.049) greater mean percentage increase in glycated haemoglobin (HbA1c) from baseline compared with atorvastatin; however, patients in both treatment groups maintained good glycaemic control. Both rosuvastatin and atorvastatin were well tolerated.

Conclusions  Greater reductions in LDL‐C were achieved with rosuvastatin compared with equal doses of atorvastatin, enabling more patients with Type 2 diabetes to achieve European LDL‐C goals.
Type 1 diabetes and prolonged fasting
Authors: Reiter J. , Wexler I. D. , Shehadeh N. , Tzur A. , Zangen D.
Published: March 2007

Aims  Fasting is common in several religions. The aims of this study were to determine if prolonged fasting (> 25 h) is safe for individuals with Type 1 diabetes and to identify factors associated with success.

Methods  Patients intending to fast were instructed on insulin dose adjustments, frequent glucose monitoring and when to terminate the fast using a standard protocol. Clinical and epidemiological factors were recorded and a comparison was made between successful and unsuccessful fasters.

Results  Of 56 subjects who intended to fast, 37 (65%) were successful. Individuals terminated their fast in the presence of either hypoglycaemia or hyperglycaemia and adherence to the protocol was high. There were no serious side‐effects of fasting. Successful fasters had greater reductions in insulin dosage and higher HbA1c. There were no differences between individuals taking intermittent insulin injections and those with continuous infusion pumps.

Conclusions  Persons with Type 1 diabetes can participate safely in prolonged fasts provided they reduce their usual insulin dose significantly and adhere to guidelines regarding glucose monitoring and indications for terminating fasting.
Persistent social disparities in the risk of hospital admission of paediatric diabetic patients in Germany—prospective data from 1277 diabetic children and adolescents
Authors: Icks A. , Rosenbauer J. , Strassburger K. , Grabert M. , Giani G. , Holl R. W.
Published: March 2007

Background  Reduction of social inequality in health care is a major target in many countries. The risk of hospital admission is thought to be higher in diabetic children from socially deprived families but actual data are lacking.

Methods  Based on a nationwide prospective computer‐based documentation program (DPV), we determined the association between three social parameters (parental professional education, one‐parent family vs. complete family, migration background) and the risk for post‐onset hospital admission, as well as the number of hospital admission days in children and adolescents < 20 years of age with diabetes onset in 2002–2005 [n = 1277, 56% male, mean age at onset 8.5 (4.1) years]. We estimated relative risks with 95% confidence intervals, adjusting for age, sex, and diabetes centre (cluster), using random effect models.

Results  Forty‐two per cent of the study subjects were admitted to hospital at least once during follow‐up. The incidence of hospital admissions was 0.46 (0.43–0.49) per person year, and there were 2.72 (2.65–2.80) hospital days per person year. Hospital admissions and hospital days were higher in girls than in boys (significant for hospital days, P < 0.05), and significantly lower in adolescents aged 15–19 compared with children aged 0–4 years (P < 0.05 in all models). Hospital admission rates were significantly higher in children from lower‐educated parents, single‐parent families, and families with a migration background (all P < 0.05).

Discussion  We found post‐onset hospital admission rates to be higher in diabetic children and adolescents from socially deprived families. In comparison with an analysis in the 1990s, no decrease in social disparity in hospital admission risk was found.
HbA1c as a screening tool for detection of Type 2 diabetes: a systematic review
Authors: Bennett C. M. , Guo M. , Dharmage S. C.
Published: March 2007

Aim  To assess the validity of glycated haemoglobin A1c (HbA1c) as a screening tool for early detection of Type 2 diabetes.

Methods  Systematic review of primary cross‐sectional studies of the accuracy of HbA1c for the detection of Type 2 diabetes using the oral glucose tolerance test as the reference standard and fasting plasma glucose as a comparison.

Results  Nine studies met the inclusion criteria. At certain cut‐off points, HbA1c has slightly lower sensitivity than fasting plasma glucose (FPG) in detecting diabetes, but slightly higher specificity. For HbA1c at a Diabetes Control and Complications Trial and UK Prospective Diabetes Study comparable cut‐off point of ≥ 6.1%, the sensitivity ranged from 78 to 81% and specificity 79 to 84%. For FPG at a cut‐off point of ≥ 6.1 mmol/l, the sensitivity ranged from 48 to 64% and specificity from 94 to 98%. Both HbA1c and FPG have low sensitivity for the detection of impaired glucose tolerance (around 50%).

Conclusions  HbA1c and FPG are equally effective screening tools for the detection of Type 2 diabetes. The HbA1c cut‐off point of > 6.1% was the recommended optimum cut‐off point for HbA1c in most reviewed studies; however, there is an argument for population‐specific cut‐off points as optimum cut‐offs vary by ethnic group, age, gender and population prevalence of diabetes. Previous studies have demonstrated that HbA1c has less intra‐individual variation and better predicts both micro‐ and macrovascular complications. Although the current cost of HbA1c is higher than FPG, the additional benefits in predicting costly preventable clinical complications may make this a cost‐effective choice.
Introducing estimated glomerular filtration rate (eGFR) into clinical practice in the UK: implications for the use of metformin
Authors: Warren R. E. , Strachan M. W. J. , Wild S. , McKnight J. A.
Published: March 2007

Aims  The reporting of estimated glomerular filtration rate (eGFR) will identify people with diabetes who have previously undiagnosed renal impairment. Our current guideline recommends discontinuation of metformin when serum creatinine > 150 µmol/l. We examined the implications of replacing this with a criterion based on eGFR.

Methods  The Lothian diabetes register was used to identify patients with Type 2 diabetes for whom age, sex and creatinine measurements within the last 15 months were available. eGFR was calculated using the abbreviated Modification of Diet in Renal Disease (MDRD) equation.

Results  Of 19 981 patients with Type 2 diabetes, 11 297 were taking metformin in accordance with our current guideline. Of these, 9259 (82.0%) had at least stage 2 renal impairment (eGFR < 90 ml/min per 1.73 m2) and 2880 (25.5%) had at least stage 3 renal impairment (eGFR < 60 ml/min per 1.73 m2). Changing to an eGFR threshold of 36 ml/min per 1.73 m2 would have a neutral effect on the number of patients eligible for metformin therapy and would permit its use in patients with creatinine concentrations as high as 179 µmol/l. An eGFR threshold of 40 ml/min per 1.73 m2 would result in 312 (2.8%) patients discontinuing metformin and would permit metformin to be used with creatinine concentrations as high as 163 µmol/l.

Conclusions  The introduction of eGFR reporting could have a major effect on prescription of metformin. A threshold eGFR of 36–40 ml/min per 1.73 m2 is approximately consistent with our current practice. If our current practice is considered safe, this would be a useful recommendation.
High‐level expression of secreted complex glycosylated recombinant human erythropoietin in the Physcomitrella Δ‐fuc‐t Δ‐xyl‐t mutant
Authors: Weise Andreas , Altmann Friedrich , Rodriguez‐Franco Marta , Sjoberg Eric R. , Bäumer Wolfgang , Launhardt Heike , Kietzmann Manfred , Gorr Gilbert
Published: March 2007

The highly glycosylated peptide hormone erythropoietin (EPO) plays a key role in the regulation of erythrocyte maturation. Currently, marketed EPO is produced by recombinant technology in mammalian cell cultures. The complementary DNA (cDNA) for human EPO (hEPO) was transiently and stably expressed in the moss Physcomitrella patens wild‐type and Δ‐fuc‐t Δ‐xyl‐t mutant, the latter containing N‐glycans lacking the plant‐specific, core‐bound α1,3‐fucose and β1,2‐xylose. New expression vectors were designed based on a Physcomitrella ubiquitin gene‐derived promoter for the expression of hEPO cDNA. Transient expression in protoplasts was much stronger at 10 than at 20 °C. In Western blot analysis, the molecular size of moss‐produced recombinant human EPO (rhEPO) was identified to be 30 kDa, and it accumulated in the medium of transiently transformed protoplasts to high levels around 0.5 µg/mL. Transgenic Physcomitrella Δ‐fuc‐t Δ‐xyl‐t mutant lines expressing EPO cDNA showed secretion of rhEPO through the cell wall to the culture medium. In 5‐ and 10‐L photobioreactor cultures, secreted rhEPO accumulated to high levels above 250 µg/g dry weight of moss material after 6 days. Silver staining of rhEPO on sodium dodecylsulphate‐polyacrylamide gel electrophoresis (SDS‐PAGE) taken from the bioreactor culture demonstrated a high purity of the over‐expressed secreted rhEPO, with a very low background of endogenous moss proteins. Peptide mapping of rhEPO produced by the Physcomitrella Δ‐fuc‐t Δ‐xyl‐t mutant indicated correct processing of the plant‐derived signal peptide. All three N‐glycosylation sites of rhEPO were occupied by complex‐type N‐glycans completely devoid of the plant‐specific core sugar residues fucose and xylose.
Minority Expropriation and Shareholder Activism Following Olivetti’s Hostile Takeover of Telecom Italia
Authors: Kruse Timothy A.
Published: March 2007

I examine the treatment of minority shareholders and shareholder activism following Olivetti’s successful hostile acquisition of a majority stake in Telecom Italia in 1999. Overall, the evidence is mixed. While Olivetti pursued several operations perceived to be detrimental to Telecom Italia’s minority shareholders, they were atypically vigorous in fighting back. In several cases, Olivetti was forced to abandon or improve the terms of the operations. While Telecom Italia was vulnerable to a hostile takeover attack following its privatisation, the concentration of ownership of listed companies ensures that hostile takeovers will remain rare. Moreover, low participation rates at annual meetings among small investors serves to enhance the power of the controlling blocks.
Corporate Governance in ASEAN Financial Corporations: reality or illusion?
Authors: Chuanrommanee Wiparat , Swierczek Fredric William
Published: March 2007

According to Credit Lyonnais Securities Asia, Singapore has the best corporate governance practices in Asia. Malaysia has had the biggest improvements in governance overtime. Thailand lags behind both in achieving appropriate governance. This paper considers recent developments in corporate governance through the analysis of the corporate websites of financial corporations in these countries. The study finds that the corporate governance practices of Thai, Malaysian and Singaporean financial corporations are consistent with international best practices. Corporate governance as presented in company documents probably does not actually reflect real corporate governance practices. These practices do not have an impact on company performance. The level of corporate governance reported is also not consistent with the ratings from international financial institutions such as Credit Lyonnais Securities Asia and Standard & Poor’s. These findings suggest that corporate governance in ASEAN is more illusion than fact.
Risk and Control Developments in Corporate Governance: changing the role of the external auditor?
Authors: Holm Claus , Laursen Peter Birkholm
Published: March 2007

Are the risk and control developments in corporate governance changing the role of the external auditor? This paper examines how the concepts of risk and control are incorporated in current corporate governance promulgations and analyses the implications for the role of the external auditor. It is suggested that up till now the corporate governance debate has strengthened the position or role of the internal auditor in the advantage of the role of the external auditor. The promulgations have influenced the internal control mechanisms, and the control responsibilities have become more explicit. Dominant determinants for the future role of the external auditor seem to be in conflict, namely the value adding function of the audit with an alignment of risk oriented efforts by the auditor and the company versus the notion of “back to basics”. The external auditors ought to recognise that they must be perceived as the experts regarding internal control and risk management and that this must be engrained as part of the service rendered, i.e. part of the value adding nature of an audit. At the same time they must improve the transparency of the audit standards and the communication processes of audit reporting.