bluuebunny/crossref_metadata_2025 huggingface dataset:
Making sense of scoring systems in community acquired pneumonia
Authors: NIEDERMAN Michael S.
Published: March 2009

The site of care decision is one of the most important in the management of patients with community‐acquired pneumonia (CAP). Several scoring systems have been developed to predict mortality risk in CAP, and these have been applied to guide physicians about whether patients should be admitted to the hospital or to the intensive care unit (ICU). However, these tools were initially developed to predict mortality risk, and studies have demonstrated that the risk for death does not always equate with need for hospitalization or ICU care. The most widely studied scoring systems are the Pneumonia Severity Index (PSI) and the CURB‐65 (a modification of the British Thoracic Society rule). Each has advantages and limitations, with the more‐complex PSI developed to identify low‐mortality risk patients, and the CURB‐65, which is simpler, being developed to easily identify more severely ill individuals. No scoring system can replace clinical judgement about the admission decision, and prospective studies have shown that physicians still admit at least 30–60% of low mortality risk patients when using the PSI to guide this decision. Limitations of these prognostic tools include their variable utility in the elderly, and their failure to include certain comorbidities (COPD, immune suppression) and social factors, in their calculations. The need for ICU care is also not well‐defined by measuring the PSI or CURB‐65, and other tools such as those developed by the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guideline committee and the SMART‐COP rule may have greater utility for this purpose. In the future, measurements of serum biomarkers, such as procalcitonin, may augment the information provided by prognostic scoring tools for patients with CAP.
Treatment of obstructive sleep apnoea in Samoa progressively reduces daytime blood pressure over 6 months
Authors: MIDDLETON Sally , VERMEULEN Walter , BYTH Karen , SULLIVAN Colin E. , MIDDLETON Peter G.
Published: March 2009

Background and objective:  While recent meta‐analyses suggest that OSA elevates daytime blood pressure (BP), most studies have included patients with mild hypertension, so CPAP treatment has only reduced BP by 2–3 mm Hg. To determine the strength of the OSA–BP relationship, this study examined the effect of CPAP in a cohort where severe OSA and under‐treated hypertension coexist.

Methods:  Baseline demographic and sleep study data were recorded in 221 consecutive patients referred for sleep studies in Samoa. OSA was treated with CPAP and BP recorded for 6–7 months in 180 patients. A subgroup of 64 patients, representative of the entire group, but with regular follow‐up, is also described.

Results:  OSA was diagnosed in 218/221 patients; of those who commenced CPAP, 180 returned for follow‐up at least once within 7 months. Following CPAP, BP decreased by 7.1/5.9 mm Hg at 1 month and 12.9/10.5 mm Hg at 6 months (n = 180, P < 0.0001). In the 64 patients with regular follow‐up, those with the highest baseline BP had the greatest fall in BP with CPAP; BP in the hypertensive subgroup (32/64) decreased 21.5/13.1 mm Hg at 6 months (P < 0.0001).

Conclusions:  Hypertensive OSA patients can exhibit large falls in BP with CPAP at 1 month, with further significant reductions at 3 and 6 months. Overall, the fall in BP was proportional to the initial elevation of the BP with many patients achieving normal BP at 6 months.
Role and feasibility of psychomotor and dexterity testing in selection for surgical training
Authors: Gallagher Anthony G. , Leonard Gerald , Traynor Oscar J.
Published: March 2009

The practice of Surgery has undergone major changes in the past 20 years and this is likely to continue. Knowledge, judgement and good technical skills will no longer be enough to safely practice surgery and interventional procedures. Fundamental abilities (e.g. psychomotor skills, visuospatial ability and depth perception) are critically important for catheter‐based interventions, NOTES, robotic surgery and other procedural interventions of the future. Not all individuals possess the same amount of these innate fundamental abilities and those less endowed are likely to struggle during surgical training and thereafter in surgical practice. In contrast to other high‐skill professions/industries (e.g. aviation) we do not have a tradition of testing prospective surgical trainees for abilities/attributes that we now recognize as being important for surgical practice. Instead, we continue to rely on surrogate markers of future potential (e.g. academic record). However, many studies have shown that psychomotor ability is an important predictor of both learning rate and performance for complex laparoscopic tasks. Psychomotor skills, visuospatial ability and depth perception can all be tested objectively by validated tests. At the Royal College of Surgeons in Ireland, all short‐listed candidates for Higher Surgical Training now undergo formal testing of both technical skills and fundamental abilities (psychomotor skills, visuospatial ability and depth perception). Reports on each candidate’s performance are supplied to the interview committee. Furthermore, a prospective database is being kept for correlation with future surgical performance. We believe that selection into surgical training should take account of attributes that we know are important for safe and efficient surgical practice.
New focus on anatomy for surgical trainees
Authors: Standring Susan
Published: March 2009

The demise of anatomy teaching in the undergraduate medical curriculum has inevitably reduced the general level of applied anatomical knowledge displayed by junior doctors. Initiatives such as the European Working Time Directive have exacerbated the problem by reducing trainees’ opportunities to acquire appropriate anatomical knowledge and clinical skills through workplace training. Medical Schools and postgraduate Colleges and Schools of Surgery must work together to design and deliver quality‐assured courses in core and non‐core anatomy, that cross the undergraduate/postgraduate interface. All medical students should learn a core syllabus of anatomy, agreed by a panel of clinicians and anatomists but delivered according to the pedagogic style favoured by individual Medical Schools. This core will define the anatomy, that all F1 doctors should know, particularly the anatomy associated with clinical procedures: it will be assessed across all years of the undergraduate medical programme. Medical Schools should also offer modules in non‐core surgical and/or radiological anatomy, some of which may be designed and delivered in partnership with Colleges of Surgery and Radiology: these modules would be particularly attractive to students contemplating a career in surgery or interventional radiology, but would not be offered exclusively to this cohort. At present, the inadequate anatomical knowledge of Foundation doctors must be addressed by ensuring that early postgraduate training programmes include explicit, formal teaching in anatomy, for example, the Core Surgical Anatomy course currently being piloted at the Royal College of Surgeons of England.
Undergraduate perspectives on the teaching and learning of anatomy*
Authors: Mitchell Rob , Batty Lachlan
Published: March 2009

The volume of time dedicated to anatomy teaching has steadily decreased in the context of increasingly dense undergraduate curricula. We examine the complex topic of anatomical education from the undergraduate perspective, with a focus on student perceptions, their origins and their potential solutions. A limited dataset suggests students perceive their tuition in anatomy may be suboptimal. Multiple factors (including the intensity of pre‐clinical studies, academic criticism of modern courses, surgical culture and misinformation) may account for the unrest. It is difficult to objectively measure the impact of modified anatomy curriculum on clinical performance and patient safety. While there is a case (on the basis of student perception at least) for reinvigorating elements of undergraduate anatomy education, the modern medical educational framework is here to stay, and students and clinicians must learn to adapt. Anatomy must be linked with contemporary approaches to medical education and it should be integrated, continuous and guided. It is critical that clinicians engage in the teaching of anatomy in the clinical environment and they must be adequately resourced to do so. Graduates must emerge with a core understanding of anatomy, but not an encyclopaedic knowledge of the human form. Undergraduate programme should simply strive to equip their graduates with a foundation for lifelong learning and a platform for safe practice as interns.
Role of simulation in surgical education and training
Authors: Windsor John A
Published: March 2009

There are several challenges facing surgical education and training that simulation may help to address. A conceptual framework is required to allow the appropriate application of simulation to a given level and type of surgical skill and this should be driven by educational imperatives and not by technological innovation. Simple simulation is required for core skills training. Cognitive simulation is introduced as a way in which procedural skills training can be achieved. Virtual world simulation opens up significant opportunities for team skills training. A role for simulation in surgical education and training appears assured, but its success will be determined by the extent to which it is integral to high quality curricula, its importance determined by its contribution to both learning and assessment, and its sustainability determined by evidence of its advantages and cost‐effectiveness.
Ensuring a graduated integrated progression of learning in a changing environment
Authors: Thomas W. E. G.
Published: March 2009

Surgical training is under threat in the changing environment of today. In the past, training consisted of an apprenticeship, which is no longer feasible or practical within the time limitation imposed on trainees currently, and so a new and innovative approach is required to train the surgeons of tomorrow. There is therefore a need for an explicit curriculum that ensures a graduated and integrated progression of learning in which both trainees and trainers are aware of what is required for each stage in training and for each surgical specialty. Such a curriculum has now been developed in the UK.
Workplace‐based assessment: assessing technical skill throughout the continuum of surgical training
Authors: Beard Jonathan , Rowley David , Bussey Maria , Pitts David
Published: March 2009

The Royal Colleges of Surgeons and Surgical Specialty Associations in the UK have introduced competence‐based syllabi and curricula for surgical training. The syllabi of the Intercollegiate Surgical Curriculum Programme (ISCP) and Orthopaedic Curriculum and Assessment Programme (OCAP) define the core competencies, that is, the observable and measureable behaviours required of a surgical trainee. The curricula define when, where and how these will be assessed.

Procedure‐based assessment (PBA) has been adopted as the principal method of assessing surgical skills. It combines competencies specific to the procedure with generic competencies such as safe handling of instruments. It covers the entire procedure, including preoperative and postoperative planning. A global summary of the level at which the trainee performed the assessed elements of the procedure is also included. The form has been designed to be completed quickly by the assessor (clinical supervisor) and fed‐back to the trainee between operations. PBA forms have been developed for all index procedures in all surgical specialties. The forms are intended to be used as frequently as possible when performing index procedures, as their primary aim is to aid learning. At the end of a training placement the aggregated PBA forms, together with the logbook, enable the Educational Supervisor and/or Programme Director to make a summary judgement about the competence of a trainee to perform index procedures to a given standard.
Development of the surgical science examination of the Royal Australasian College of Surgeons surgical education and training programme: putting the chicken before the egg
Authors: Martin Jenepher , Blennerhassett John , Hardman David , Mundy Julie
Published: March 2009

Basic science knowledge is a foundational element of surgical practice. Increasing surgical specialization may merit a reconsideration of the ‘whole‐body’ approach to basic science curriculum in favour of specialty specific depth. The conundrum of depth or breadth of basic science curriculum is currently being addressed by the Royal Australasian College of Surgeons, which introduced a new surgical education and training programme for nine surgical specialties in 2008. This paper describes an innovative solution to the design of a basic science curriculum in the nine different surgical specialty streams of this programme. The task was to develop a curriculum and rigorous assessment in basic sciences to meet the needs of the training programme, for implementation within the first year. A number of political/cultural and technical issues were identified as critical to success. To achieve a robust assessment within the required time frame attention was paid to engagement, governance, curriculum definition, assessment development, and implementation. The pragmatic solution to curriculum and assessment was to use the existing assessment items and blueprint to determine a new curriculum definition and assessment. The resulting curriculum comprises a generic component, undertaken by all trainees, and specialty specific components. In a time critical environment, a pragmatic solution to curriculum, applied with predetermined, structured and meticulous methodology, allowed explicit definition of breadth for the generic basic science curriculum for surgical training in Australia and New Zealand. Implicit definition of specialty specific‐basic science curricula was through the creation of a blueprinted assessment.
Identification and management of the underperforming surgical trainee
Authors: Paice Elisabeth
Published: March 2009

Most surgical trainee make steady progress, delivering a safe and reliable service at an appropriate level at the same time as they as learn new skills under supervision. Trainees learn at different rates, and progress that is safe and steady although slower than the norm should not be classed as underperformance. Clinical performance issues may arise at any stage of a doctor’s cancer, and should be addressed promptly and constructively. Factors that may impact on performance, such as the personality of the trainee, their personal pressures, and the training and working environment, should be considered and where possible mitigated. Enhanced supervision; regular constructive feedback; psychological support; coaching and mentoring may all be required. A change of trainer or working environment may sometimes be necessary, and the duration of training may need to be extended. A supportive working and learning environment with a sound educational framework will help to ensure that trainees in difficulty are identified early and managed supportively and constructively.
Equipping surgeons as educators*
Authors: Fry Heather
Published: March 2009

There is a developing interest in equipping surgeons as educators but a perceived lack of knowledge and evidence about how to do this effectively, or how to reward and recognize educational expertise within the surgical career structure. A brief consideration of the surgical educator role is offered. The findings and conclusions of a meta‐analysis of the influence of faculty development in medical education are summarized. Various sources are drawn on to present an overview of master’s level provision in medical education and a master’s in surgical education is outlined. Issues relating to developing suitable curricula, educational accreditation, recognition, reward and career structure are raised and some UK approaches to these areas summarized. Evidence indicates the importance of context in training medical educators, the value of experiential learning, training that is spread over time and training that mixes theory, practice and reflection. A schema for recognizing educational expertise, created as an outcome of analysis of the evidence and current provision, is presented. The effect of a possible change from educational training being voluntary to the introduction of a compulsory regime is raised as an area requiring further discussion and evidence collection. Mechanisms by which to acknowledge, reward and recognize education expertise in surgeons do not generally exist; it is suggested their development would be timely.
Managing the complexity of change in postgraduate surgical education and training
Authors: Hillis David J.
Published: March 2009

Pressure of workforce shortages, educational reform, heightened regulatory requirements and increased community expectations and scrutiny, has led to demand for substantial change in the provision of surgical education and training. The Royal Australasian College of Surgeons has responded positively to these external factors through an extensive review of local and worldwide practice and opinion, providing ongoing realignment of its governance and committee structure, substantially adjusting the structure of its educational program and increasing the educational support to trainees and supervisors. The College looks to the Council and its senior Fellows to create the direction and drive, but these changes need to be supported and implemented with care by the management and administrative staff of the College and specialist societies. This is in an opinion‐rich zone with substantial regulatory scrutiny.
Role of trainees’ (residents’) associations in surgical education and training
Authors: Peters Matthew J , Pappalardo Juanita , Cresswell Adrian B
Published: March 2009

Surgical education and training is evolving as new educational techniques are developed amidst a greater societal requirement and pressure for a greater number of surgeons. The methods of delivering this education and training vary between institutions, but all have the common aim to produce effective well‐rounded surgeons who are capable of providing a safe and competent service that is relevant to the society within which they work.
Distorted Agricultural Incentives and Economic Development: Asia's Experience
Authors: Anderson Kym
Published: March 2009

Earnings from farming in many low‐income countries have been depressed by a pro‐urban bias in own‐country policies, as well as by governments of richer countries favouring their farmers with import barriers and subsidies. Both sets of policies reduce national and global economic welfare. The rapid development of many Asian emerging economies has been accompanied by a gradual reduction in their anti‐agricultural policies, but many distortions remain and some countries have moved from negative to positive assistance for farmers, following the earlier examples of first Japan and then Korea and Taiwan. Drawing on results from a new multi‐country research project, this paper examines the extent of these changes relative to those of other developing countries over the past five decades. It concludes by pointing to prospects for further policy reform in Asia.
Credit Availability and Capital Crunch: On the Role of the Heterogeneity of the Banking System
Authors: BRUNO OLIVIER
Published: March 2009

We analyze the impact of a credit crunch on aggregate investment via the heterogeneous structure of the banking system. We develop a model of endogenous credit allocation in which investors and two banks differ according to their level of capital and monitoring technology. In a context of moral hazard problem, we show that banks' cost advantage in the monitoring of small businesses must be compared to their relative amount of capital in order to explain firms' optimal choice of financing, the credit allocation in the economy and the asymmetric impact of a credit crunch on aggregate investment. A shock of the same magnitude on the two banks level of capital may have a different effect on total investment. We stress that the credit crunch is maximum when the shock hits the bank specialized in the financing of small businesses and when this bank is also the less capitalized. This result is supported by recent empirical studies (Hancock and Wilcox 1998).
A Distortive Wage Tax and a Countervailing Commuting Subsidy
Authors: WREDE MATTHIAS
Published: March 2009

Within a second‐best duocentric urban economics framework where labor income taxation distorts workplace choices on account of commuting costs, this paper studies a commuting subsidy, which distorts land use. It is shown that a commuting subsidy increases welfare if and only if it shifts labor supply from less to more productive business districts.
Optimal Income Taxation and Public Good Provision with Endogenous Interest Groups
Authors: BIERBRAUER FELIX
Published: March 2009

This paper studies public goods provision when agents differ in earning abilities as well as preferences. Heterogeneity in skills makes redistribution desirable and generates an equity‐efficiency trade‐off. If tax revenues are devoted to a public good, this trade‐off is affected in such a way that income transfers are less desirable. High‐skilled individuals thus have an incentive to exaggerate their preferences for public goods. Analogously, low‐skilled individuals lobby against public good provision. A requirement of collective incentive compatibility eliminates these biases. It implies that income transfers are increased whenever a public good is provided and are decreased otherwise.
Masturbation and Discourse on Female Sexual Practices in Early Modern Japan
Authors: Walthall Anne
Published: March 2009

Much of the discourse on female sexual practices in early modern Japan centred on masturbation, usually with a dildo, deemed necessary for a woman's mental and physical health when the male member was unavailable. References to female same‐sex relations suggest that they too made sense in situations where men were absent. Some sex manuals treated female sexual arousal within the context of conjugal relations, while a text written for wives in polygamous marriages places female sexual practice at the service of male interests. The texts analysed here show not only that early modern Japanese held different attitudes toward sex than their western counterparts, but also that they could hold multiple attitudes at the same time.
A Marginal Occupation? The Medieval Laundress and her Work
Authors: Rawcliffe Carole
Published: March 2009

Drawing upon a wide range of primary sources, this article argues that a study of the medieval laundress can illuminate wider social attitudes to hygiene as well as to low status women. Having considered the many types of laundry workers active in England and northern France between c.1300 and 1550, it examines the techniques they used, as well as the hazards encountered through exposure to difficult conditions. Such factors, along with the freedom of movement enjoyed by many laundresses, often harmed their collective reputation. That responses to those who dealt with the community's dirty clothing were highly ambivalent is reflected in contemporary writing about laundresses, and in the measures taken to regulate them. Finally, we turn to remuneration. The sporadic survival of financial evidence means that our knowledge of wage rates remains impressionistic. But some laundry workers were surprisingly well rewarded. This confirms the value placed, in elite households at least, upon the cleanliness of personal linen.
Patient-Reported Outcomes in Subjects with Painful Trigeminal Neuralgia Receiving Pregabalin: Evidence from Medical Practice in Primary Care Settings
Authors: Pérez C , Navarro A , SaldanTa MT , Martínez S , Rejas J
Published: March 2009

Effects of pregabalin (PGB) on patient-reported health outcomes were assessed in 65 PGB-naive subjects with trigeminal neuralgia refractory to previous analgesic therapy in a prospective, multicentre observational study carried out in primary care. Twelve weeks' monotherapy with PGB ( n = 36) or add-on ( n = 29), reduced baseline intensity of pain by a mean ± S.D. of −40.0 ± 22.1 mm [−55.4%, effect size (ES) 2.32; P < 0.0001] with 59.4% of responders (pain reduction ≥ 50%), and produced 34.6 ± 29.3 additional days with no/mild pain. Anxiety/depression symptoms decreased by −3.8 ± 3.5 and −4.5 ± 4.2 points (ES 0.95 and 1.02; P < 0.0001), respectively. PGB improved sleep by −17.9 ± 19.6 points (ES 1.18; P < 0.0001) and improved patient functioning (Sheehan Disability Index) by decreasing overall scoring by −8.6 ± 5.9 points (ES 1.59; P < 0.0001). Health state (EQ-5D) increased by 31.6 ± 22.2 mm (ES 1.67; P < 0.0001), with 0.0388 ± 0.0374 gained quality-adjusted life-years. In spite of the small sample size, results support the effectiveness of PGB for the improvement in pain and related health symptoms.
The Course of Migraine—A Diary Study in Unselected Patients
Authors: Lieba-Samal D , Bartl S , Salhofer S , Prajsnar A , Massl R , Freydl E , Fathinia P , Wöber-Bingöl Ç , Wöber C
Published: March 2009

The course of disease and the predictive value of depression and anxiety in patients with migraine were prospectively examined. We recruited 393 migraineurs through articles in newspapers and performed a follow-up examination 30 months later. At baseline and follow-up, patients underwent a semi-structured interview, filled out the Headache Impact Test (HIT-6), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) and they kept a headache diary for 30 days. One hundred and fifty-one patients (38.6%) were seen at follow-up. The baseline data of patients with and without follow-up were comparable. At follow-up the number of headache days per month had decreased from 9.6 ± 5.8 to 8.1 ± 6.3 ( P < 0.001) and the proportion of patients with chronic headache (15.4%) and medication overuse (13%) had remained stable. SDS and SAS scores were associated with a high migraine frequency and high initial SDS scores predicted high migraine frequency at follow-up. This longitudinal study in unselected patients with migraine not excluding subjects with chronic headache, medication overuse, depression or anxiety does not point towards migraine as a progressive disease in the vast majority of patients and confirms the importance of psychiatric comorbidity.
Effect of negative emotion on visual attention: Automatic capture by fear‐related stimuli1
Authors: MIYAZAWA SHIHO , IWASAKI SYOICHI
Published: March 2009

Abstract:  In this study, we examined the effect of threatening pictures (e.g., snakes and spiders) on control of spatial attention using a probe detection task. In addition to attentional capture by the threatening stimuli (Unpredictable task), the effects of affective valence of the pictures on the voluntary control of attention were explored (Predictable task). Results showed that reaction time (RT) was facilitated to the probe that appeared at the location of threatening stimuli when it occurred in the right visual field (but not in the left visual field), indicating that attention was captured automatically, at least in this visual field. However, when participants were able to predict the probe location, the attentional gains increased similarly for all the conditions (composed of visual field by picture type combinations) relative to those of Unpredictable task, with no indication of deferred deployment of attention to threatening stimuli. The results of this study suggested that the emotional valence, particularly negative valence, affected the automatic control of attention. This effect differed between the two visual fields in which emotional stimuli occurred.
Evolutionary relationships of sprint speed in Australian varanid lizards
Authors: Clemente C. J. , Thompson G. G. , Withers P. C.
Published: March 2009

Ecomorphological studies often seek to link morphology and performance to relevant ecological characteristics. Varanid lizards are unique in that species can vary in body size by almost four orders of magnitude within a single genus, and a question of considerable interest is whether similar ecomorphological relationships exist when constraints on body size are reduced. We studied sprint speed in relation to size, shape and ecology for 18 species of varanid lizards. Maximal speed scaled positively with mass0.166 using least squares regression, and mass0.21 using reduced major‐axis regression. However, a curvilinear trend better described this relationship, suggesting an optimal mass of 2.83 kg with respect to speed. Including data for the komodo dragon Varanus komodoensis moves the optimum mass to 2.23 kg. We use this relationship to predict the sprint speed of the Komodo's giant extinct relative Varanus (Megalania) prisca to be 2.6–3 m s−1 similar to that of extant freshwater crocodiles Crocodylus johnstoni. When differences in speed were compared to ecological characteristics, species from open habitats were significantly faster than species from semi‐open or closed habitat types, and remained so after correction for size and phylogeny. Thus, despite large variation in body size, varanids appear to share similar associations between performance and ecology as seen in other lizard groups. Varanids did, however, differ in morphological relationships with sprint speed. Differences in relative speed were not related to relative hindlimb length, as is commonly reported for other lizard groups. Instead, size‐free forefoot length was negatively related to speed as was the size‐free thorax–abdomen length. While shorter forefeet were thought to be an adaptation to burrowing, and thus open habitats, rather than speed per se, the reduction in the thorax–abdomen length may have significant advantages to increasing speed. Biomechanical models predicting this advantage are discussed in relation to a trade‐off between speed and manoeuvrability.
Direct paternal care in black‐and‐white snub‐nosed monkeys
Authors: Xiang Z.‐F. , Sayers K. , Grueter C. C.
Published: March 2009

Mothers of many colobines permit other females or juveniles to have contact with their infants, but paternal care has rarely been reported. This paper reports paternal care in free‐ranging black‐and‐white snub‐nosed monkeysRhinopithecus bietian endangered and little‐known high‐altitude species. Direct infant care, carrying or grooming infants, was observed in 2115 of 3988 infant behavioral samples, and 30 of these observations involved direct paternal care. Yearly paternal care was 1.63%, with highest rates in February and March. Monthly paternal care was negatively correlated with infant age, food availability and ambient temperature. Thus, energetic stress may be selective pressure favoring paternal care.
Spatiotemporal changes of beetle communities across a tree diversity gradient
Authors: Sobek Stephanie , Steffan‐Dewenter Ingolf , Scherber Christoph , Tscharntke Teja
Published: March 2009

Aim  Plant and arthropod diversity are often related, but data on the role of mature tree diversity on canopy insect communities are fragmentary. We compare species richness of canopy beetles across a tree diversity gradient ranging from mono‐dominant beech to mixed stands within a deciduous forest, and analyse community composition changes across space and time.

Location  Germany’s largest exclusively deciduous forest, the Hainich National Park (Thuringia).

Methods  We used flight interception traps to assess the beetle fauna of various tree species, and applied additive partitioning to examine spatiotemporal patterns of diversity.

Results  Species richness of beetle communities increased across the tree diversity gradient from 99 to 181 species per forest stand. Intra‐ and interspecific spatial turnover among trees contributed more than temporal turnover among months to the total γ‐beetle diversity of the sampled stands. However, due to parallel increases in the number of habitat generalists and the number of species in each feeding guild (herbivores, predators and fungivores), no proportional changes in community composition could be observed. If only beech trees were analysed across the gradient, patterns were similar but temporal (monthly) species turnover was higher compared to spatial turnover among trees and not related to tree diversity.

Main conclusions  The changes in species richness and community composition across the gradient can be explained by habitat heterogeneity, which increased with the mix of tree species. We conclude that understanding temporal and spatial species turnover is the key to understanding biodiversity patterns. Mono‐dominant beech stands are insufficient to conserve fully the regional species richness of the remaining semi‐natural deciduous forest habitats in Central Europe, and analysing beech alone would have resulted in the misleading conclusion that temporal (monthly) turnover contributes more to beetle diversity than spatial turnover among different tree species or tree individuals.
An animal model of testicular toxicity by cyclosporine: evaluation and protection
Authors: Ali Ridha Ben , Klouz Anis , Boubaker Samir , Lakhal Mohamed , Belkahia Chalbi
Published: March 2009

CyclosporineA (CsA) improves the survival of patients who benefited from transplantation. However, its use is generally limited by its side effects. The aim of our study was to measure, in an experimental model, the changes of the testosterone plasma levels after 21 days of CsA treatment and to explain the mechanism of this modification. After treatment, the levels of CsA, testosterone, corticosterone, transaminases were measured. The cytotoxic effect of CsA was evaluated by microscopic observation. The experimental study showed that CsA had no effect on the plasmatic levels of hepatic enzymes ‐ alanine aminotransferase, aspartate aminotransferase and gamma‐glutamyl‐transferase – because their plasma concentrations in treated rats did not differ from those of the sham group. The plasma concentration of corticosterone was not modified, the plasma level of testosterone decreased when the dose of cyclosporine was increased to 4 mg/kg/day. The photonic microscope observation showed that the number of Leydig cells was increased and the electronic microscope observation showed mitochondria alteration. The treatment by CsA and trimetazidine did not correct the alteration caused by CsA. N‐benzyl‐N’‐(2‐hydrox‐3, 4‐dimethyloxybenzyl)‐pipeazine did not protect the mitochondrial function but partially protected mitochondria structure from the deleterious effect induced by CsA. The decrease of the plasma level of testosterone induced by CsA was due to the inhibition of the mitochondrial 20–22 desmolase which blocked the formation of the testosterone precursor and the destruction of the mitochondria structure.
The core‐aldehyde 9‐oxononanoyl cholesterol increases the level of transforming growth factor β1‐specific receptors on promonocytic U937 cell membranes
Authors: Gargiulo Simona , Gamba Paola , Sottero Barbara , Biasi Fiorella , Chiarpotto Elena , Serviddio Gaetano , Vendemiale Gianluigi , Poli Giuseppe , Leonarduzzi Gabriella
Published: March 2009

Among the broad variety of compounds generated via oxidative reactions in low‐density lipoproteins (LDL) and subsequently found in the atherosclerotic plaque are aldehydes that are still esterified to the parent lipid, termed core aldehydes. The most represented cholesterol core aldehyde in LDL is 9‐oxononanoyl cholesterol (9‐ONC), an oxidation product of cholesteryl linoleate. 9‐ONC, at a concentration detectable in biological material, markedly up‐regulates mRNA expression and protein level of both the pro‐fibrogenic and pro‐apoptotic cytokine transforming growth factor β1 (TGF‐β1) and the TGF‐β receptor type I (TβRI) in human U937 promonocytic cells. We also observed increased membrane presentation of TGF‐β receptor type II (TβRII). Experiments employing the TβRI inhibitor SB431542, or the TGFβ antagonist DANFc chimera, have shown that the effect on TβRI is directly induced by 9‐ONC, while TβRII up‐regulation seems stimulated by its specific ligand, i.e. TGFβ1, over‐secreted meanwhile by treated cells. Increased levels of the cytokine and of its specific receptors in 9‐ONC‐treated cells clearly occurs through stimulation of extracellular signal‐regulated kinase 1 and 2 (ERK1/2), as demonstrated by ERK1/2 knockdown experiments using mitogen‐activated protein kinase/extracellular signal‐regulated kinase 1 and 2 (MEK1 and MEK2) siRNAs, or PD98059, a selective MEK1/2 inhibitor. 9‐ONC might thus sustain further vascular remodeling due to atherosclerosis, not simply by stimulating synthesis of the pro‐fibrogenic cytokine TGF‐β1 in vascular cells, but also and chiefly by enhancing the TGF‐β1 autocrine loop, because of the marked up‐regulation of the cytokine's specific receptors TβRI and TβRII.
Effects of dietary restriction on mortality and age‐related phenotypes in the short‐lived fish Nothobranchius furzeri
Authors: Terzibasi Eva , Lefrançois Christel , Domenici Paolo , Hartmann Nils , Graf Michael , Cellerino Alessandro
Published: March 2009

The short‐lived annual fish Nothobranchius furzeri shows extremely short captive life span and accelerated expression of age markers, making it an interesting model system to investigate the effects of experimental manipulations on longevity and age‐related pathologies. Here, we tested the effects of dietary restriction (DR) on mortality and age‐related markers in N. furzeri. DR was induced by every other day feeding and the treatment was performed both in an inbred laboratory line and a longer‐lived wild‐derived line. In the inbred laboratory line, DR reduced age‐related risk and prolonged maximum life span. In the wild‐derived line, DR induced early mortality, did not reduce general age‐related risk and caused a small but significant extension of maximum life span. Analysis of age‐dependent mortality revealed that DR reduced demographic rate of aging, but increased baseline mortality in the wild‐derived strain. In both inbred‐ and wild‐derived lines, DR prevented the expression of the age markers lipofuscin in the liver and Fluoro‐Jade B (neurodegeneration) in the brain. DR also improved performance in a learning test based on conditioning (active avoidance in a shuttle box). Finally, DR induced a paradoxical up‐regulation of glial fibrillary acidic protein in the brain.
How Good Are Networks for Migrant Job Seekers? Ethnographic Evidence from North Carolina Farm Labor* Camps
Authors: Balderrama Rafael , Molina II Hilario
Published: March 2009

Migrant farmworker networks are vital components in their job seeking and underemployment minimization strategies. Yet, farmworker cultural, physical, and institutional isolation along with the itinerant and clandestine features of farmwork have become major obstacles in the development of robust lateral communitywide network ties that would otherwise favor reciprocity and resource sharing. Thus, contrary to the positive social capital assumption, we argue that the paucity and fragmented features of farmworkers’ lateral ties have increased their vulnerability and locked them in exploitative relationships in a hostile social environment that makes impractical or impossible the formation of alternative ties. Our study is based on participant observation through a 6‐week stay in three North Carolina farm labor camps. On‐site evidence shows that the two larger groups of solitary male farmworkers and farmworking families break up into smaller groups, each group in pursuit of its own short‐term goals. We conclude that, even though farmworker networks help them to find and ensure temporary jobs, their inability to use the networks to share resources is ultimately detrimental for participants’ long‐term socioeconomic prospects.
Cross‐Movement Coalition Formation: Bridging the Labor‐Environment Divide*
Authors: Mayer Brian
Published: March 2009

Relations between the labor and environmental movements exist within a complex web of clashing interests, electoral politics, and attempts to form enduring blue‐green coalitions. Unions and other labor organizations are often portrayed as solely interested in economic growth. Environmental organizations are often seen as solely interested in preserving the natural world at the expense of economic growth, thus creating a direct conflict between the interests of labor and environmental organizations. Despite these perceived differences, efforts to bridge the divide between the two movements are increasingly common. This article examines the formation of a collective identity shared by workers and environmentalists participating in the coalition. I develop this argument through an ethnographic analysis of the formation of a blue‐green coalition, the Alliance for a Healthy Tomorrow, using in‐depth interviews, observations, and content analyses. I demonstrate how coalition leaders and bridge brokers work to bridge and consolidate the identities of labor and environmental groups to campaign for environmental health regulatory changes in Massachusetts.
S‐nitrosylation of caspase‐3 is the mechanism by which adhesion fibroblasts manifest lower apoptosis
Authors: Jiang Zhong L. , Fletcher Nicole M. , Diamond Michael P. , Abu‐Soud Husam M. , Saed Ghassan M.
Published: March 2009

We have previously found that adhesion fibroblasts exhibit lower apoptosis and higher protein nitration as compared with normal peritoneal fibroblasts. In this study, we sought to determine whether the decreased apoptosis observed in adhesion fibroblasts is caused by lower caspase‐3 activity due to an increase in caspase‐3 S‐nitrosylation. For this study, we have utilized primary cultures of fibroblasts obtained from normal peritoneum and adhesion tissues of the same patient(s). Cells were treated with increasing concentrations of peroxynitrite and cell lysates were immunoprecipitated with anti‐caspase‐3 polyclonal antibody. The biotinylated proteins were detected using a nitrosylation detection kit. Caspase‐3 activity and apoptosis were measured by colorimetric and TUNEL assays, respectively. Our results showed that caspase‐3 S‐nitrosylation is significantly higher in adhesion fibroblasts as compared with normal peritoneal fibroblasts. This increase in S‐nitrosylation resulted in a 30% decrease in caspase‐3 activity in adhesion fibroblasts. Peroxynitrite treatment resulted in a dose response increase in caspase‐3 S‐nitrosylation, leading to a decrease in caspase‐3 activity and apoptosis in normal peritoneal fibroblasts. We conclude that S‐nitrosylation of caspase‐3 is the reason for its decreased activity and subsequent decrease in apoptosis of adhesion fibroblasts. The mechanism by which caspase‐3 S‐nitrosylation occurs is not fully understood. However, the role of hypoxia in the formation of peroxynitrite via superoxide production may suggest a possible mechanism.
Validity of pressure ulcer diagnosis using digital photography
Authors: Baumgarten Mona , Margolis David J. , Selekof Joan L. , Moye Nancy , Jones Patricia S. , Shardell Michelle
Published: March 2009

The purpose of this study was to evaluate the validity of digital photographs for the assessment of the presence of pressure ulcers stage 2 or higher. Participants were 48 patients (28 white and 20 black) with pressure ulcers identified in the course of a wound specialist's routine clinical practice at the University of Maryland Medical Center. One pressure ulcer and one unaffected skin area were photographed on each participating patient. The gold standard diagnosis (stage 2 pressure ulcer vs. stage 1 or no pressure ulcer) was recorded by the wound specialist based on bedside examination. The photographs were reviewed blindly by another wound expert. The sensitivity of the blinded assessment was 97% (95% confidence interval [CI] 91–100%). The specificity was 97% (95% CI 92–100%). The sensitivity and specificity were both 100% in the white patients. In black patients, the sensitivity and specificity were 92% (95% CI 75–100%) and 93% (95% CI 82–100%), respectively. These results suggest that the use of photographic images to assess the presence or absence of a pressure ulcer stage 2 or higher has a high degree of validity. Since blinded outcome assessment is one of the cornerstones of good clinical trial design, photography offers the potential to strengthen future studies.
Interactions between extracellular matrix and growth factors in wound healing
Authors: Schultz Gregory S. , Wysocki Annette
Published: March 2009

Dynamic interactions between growth factors and extracellular matrix (ECM) are integral to wound healing. These interactions take several forms that may be categorized as direct or indirect. The ECM can directly bind to and release certain growth factors (e.g., heparan sulfate binding to fibroblast growth factor‐2), which may serve to sequester and protect growth factors from degradation, and/or enhance their activity. Indirect interactions include binding of cells to ECM via integrins, which enables cells to respond to growth factors (e.g., integrin binding is necessary for vascular endothelial growth factor‐induced angiogenesis) and can induce growth factor expression (adherence of monocytes to ECM stimulates synthesis of platelet‐derived growth factor). Additionally, matrikines, or subcomponents of ECM molecules, can bind to cell surface receptors in the cytokine, chemokine, or growth factor families and stimulate cellular activities (e.g., tenascin‐C and laminin bind to epidermal growth factor receptors, which enhances fibroblast migration). Growth factors such as transforming growth factor‐β also regulate the ECM by increasing the production of ECM components or enhancing synthesis of matrix degrading enzymes. Thus, the interactions between growth factors and ECM are bidirectional. This review explores these interactions, discusses how they are altered in difficult to heal or chronic wounds, and briefly considers treatment implications.
Venous ulcers: A reappraisal analyzing the effects of neuropathy, muscle involvement, and range of motion upon gait and calf muscle function
Authors: Shiman Michael I. , Pieper Barbara , Templin Thomas N. , Birk Thomas J. , Patel Asha R. , Kirsner Robert S.
Published: March 2009

Chronic venous insufficiency is a complex disease that can result in severe sequelae including venous ulceration. Though the exact progression from chronic venous insufficiency to venous ulcer remains unclear, the high cost and burden of this disease on patients and society is quite clear. Sustained ambulatory venous pressures or venous hypertension plays an integral role in the development of venous ulceration and involves the failure of the calf muscle pump system. Standard of care involves compression therapy to assist the calf muscle pump. However, several cofactors may contribute to or exacerbate this disease and understanding their impact may provide insight into new treatment modalities. Nerve involvement, which may result in neuropathic pain and muscle dysfunction, alterations in mobility and a decrease in range of motion may lead to gait alterations all affecting calf muscle pump function. In this paper, we analyze these cofactors and discuss possible treatment options to target them. Physicians treating this disease should be aware of the numerous factors involved in its development. Exploring new treatment options may 1 day lessen the burden and suffering caused by venous insufficiency.