bluuebunny/crossref_metadata_2025 huggingface dataset:
Contribution of a liaison clinical pharmacist to an inpatient palliative care unit
Authors: Lucas Cherie , Glare Paul A , Sykes Joanna V
Published: November 2007

The impact on patient care of interventions made by a liaison clinical pharmacist visiting a busy inpatient palliative care unit were evaluated using a validated six-point scoring system. Interventions made in 13% of patients could improve patient care, save money or both, but rarely involved the drugs that are commonly used for symptom control in patients with terminal cancer. Advice to rationalize inappropriate drug regimens (53%) was the commonest intervention, followed by warnings about drug interactions (24%) and advice about therapeutic drug monitoring (8%). The interventions were evaluated by the pharmacist, a palliative medicine registrar and two independent doctors, confirming that the pharmacist was valid and accurate in assessing her own work. Although more than 60% of interventions could significantly improve patient care, compliance by medical and nursing staff with advice was only 55%, reflecting possible tensions between palliative and general hospital medicine. This survey emphasizes the role of liaison clinical pharmacists in palliative care, the need for much more critical appraisal of prescribing practices and the utility of ranking pharmacist interventions as a quality assurance and educational tool. In particular, providing palliative care for patients with advanced acquired immunodeficiency syndrome (AIDS) is enhanced when a pharmacist with a specialist knowledge of AIDS therapeutics is available.
Drug combinations in syringe drivers: the compatibility and stability of diamorphine with cyclizine and haloperidol
Authors: Grassby Paul F , Hutchings Lynne
Published: November 2007

The compatibility and stability of 28 combinations of diamorphine hydrochloride (5-100 mg/ml) with cyclizine lactate (5-50 mg/ml), eight combinations of diamorphine (10-100 mg/ml) with haloperidol (2-4 mg/ml) and eight combinations of all three drugs was assessed after storage in 1 ml polypropylene syringes. Samples were stored for periods up to seven days in the light and at room temperature (22°C).

Five combinations of diamorphine with cyclizine precipitated immediately upon preparation. After analysis and determination of t90% values (the time taken for 10% degradation), 16 of the remaining 23 combinations were judged to be compatible (no signs of crystallization or precipitation) and stable (less than 10% loss of potency of either drug) after storage for 24 h. After seven days storage only four remained compatible and stable. The results indicate that ratios of diamorphine to cyclizine of 1:1 are stable at concentrations up to 20 mg/ml. An increase in diamorphine concentration necessitates a reduction in cyclizine to 10 mg/ml, and an increase in cyclizine concentration necessitates a reduction in concentration of diamorphine to 15 mg/ml to maintain stability over 24 h.

All the combinations of diamorphine with haloperidol remained compatible and stable for seven days. The addition of haloperidol (2 mg/ml) to the diamorphine and cyclizine combinations had no detrimental effect on their compatibility and stability.

A stability curve is included as an easy way for palliative care personnel to avoid potential problems with incompatibilities and reduced stability when using these combinations. Furthermore, to reduce the possibility of precipitation with mixtures containing cyclizine, the use of 0.9% sodium chloride should be avoided.
Transdermal fentanyl for severe cancer-related pain
Authors: Yeo Winnie , Lam Kwok K , Chan Anthony TC , Leung Thomas WT , Wu Nip Sau Y , Johnson Philip J
Published: November 2007

A prospective phase II study was conducted to define the analgesic efficacy, acceptability and toxicity of the transdermal therapeutic system (TTS) of fentanyl in Chinese patients with severe cancer-related pain. A total of 14 patients was treated with TTS fentanyl at doses ranging from 25 to 100 μg h-1; initial doses were chosen according to their previous opioid requirement. Standard supportive therapy was given as required. A brief pain inventory (using a 10-point scale) was used to assess patients at days 0, 7 and 14. Pain control on day 14 with TTS fentanyl was successful in six patients, with a reduction in the common side-effects of other opioids and improvement in general well-being. Seven patients did not complete the 14-day trial: two developed dizziness and nausea within 3 h of application; and in five, TTS fentanyl was insufficiently flexible to control increasing pain during the first week. TTS fentanyl was effective and well tolerated in 43% of patients. Acute dizziness and nausea within the first few hours after application and the relative inflexibility of dose-adjustment both limited the use of TTS fentanyl.
Adjuvant psychological therapy for cancer patients
Authors: Greer Steven , Moorey Stirling
Published: November 2007

Adjuvant psychological therapy (APT), a brief, problem-focused, cognitive-behavioural treatment for patients with cancer, is described. A previously published randomized trial demonstrated a significant reduction in cancer-related emotional distress. APT is recommended for cancer patients suffering from such distress.
Is it cancer or not?
Authors: Johnson MJ , Adam JS
Published: November 2007

Two cases are reviewed in whom a positive bone scan led to a diagnosis of metastatic bone disease and hospice referral. One of these was subsequently shown on magnetic resonance image (MRI) scanning to have benign metabolic bone disease; in the other, a repeat bone scan 18 months later confirmed benign pathology.

The potential impact on patient and family in these situations is considerable and the usefulness of MRI in distinguishing benign from malignant bone disease is discussed.
Does being religious help or hinder coping with chronic illness? A critical literature review
Authors: Dein S. , Stygall J.
Published: November 2007

This paper reviews a number of studies relating to religion and coping with chronic illness, emphasizing those aspects relevant to palliative care. After pointing out that religious and existential needs are common in chronic illness, a critical examination is made of those studies which purport to demonstrate associations between spiritual beliefs, religious practices and psychological prognosis. Recommendations are made as to how religious issues can be dealt with in clinical practice, with particular relevance to the multidisciplinary palliative care team.
Organization and patients' perception of palliative care: a crosscultural comparison
Authors: Voltz Raymond , Akabayashi Akira , Reese Carol , Ohi Gen , Sass Hans-Martin
Published: November 2007

The hospice model of care for patients with advanced diseases exists in almost all industrialized countries. To date, there have been no international or crosscultural comparisons of the organization and patient outcomes associated with hospice services in different parts of the world. This survey evaluated 159 patients in the USA, Germany and Japan. There were differences between countries in the time of first contact, who recommended palliative care first, the underlying diagnoses, the location of patients, and how consent for hospice care was obtained. Across all countries, there were similar levels of comfort and satisfaction with care. We conclude that the hospice philosophy addresses the basic needs of dying patients which are independent of cultural background, but may be adapted to very different cultures.
Palliative care in a multicultural society: perceptions of health care professionals
Authors: McNamara Beverley , Martin Karen , Waddell Charles , Yuen Kevin
Published: November 2007

This study assesses the perceived competence of 191 Australian palliative care professionals in delivering crosscultural care. The relationship between the perceived competence levels of professionals and their experience and training is examined. Strategies to improve crosscultural palliative care, as suggested by palliative care providers, are also presented. Information about perceived competence and the kinds of difficulties encountered in crosscultural palliative care interactions form the basis of suggested guidelines for proposed education programmes. The results of this study suggest that specific education, rather than individual experience of crosscultural interactions, which may not always be positive, is needed to improve the competence of palliative care professionals. Education, therefore, is the key to the provision of culturally appropriate care to patients and their families from all cultural backgrounds.
Difficulty of symptom control and general practitioners' knowledge of patients' symptoms
Authors: Grande GE , Barclay Sig , Todd CJ
Published: November 2007

The purpose of this study was to investigate barriers to adequate symptom control in palliative care within primary care by surveying health professionals' perceptions of their ability to control symptoms and awareness of their patients' symptoms.

General practitioners (GPs) and district nurses were surveyed about general views of symptom control. Interviews with terminally ill patients were conducted, and GPs completed questionnaires about these specific patients.

GPs and district nurses differed greatly in the symptoms they felt confident in controlling. There was generally low agreement between patients' and GP's reports of patients' symptoms. GPs were most likely to miss symptoms which were perceived to be difficult to control and which were less prevalent in the patient sample.

As GPs and district nurses differ in the symptoms they feel confident in controlling, close teamwork between the two professions may enhance the prospects for adequate control of some symptoms. Perceived ability to control symptoms and the prevalence of symptoms may both influence which symptoms come to the attention of the GP Unless GPs ask directly about symptoms, many symptoms are likely to be missed.
How do palliative physicians manage venous thromboembolism?
Authors: Johnson MJ
Published: November 2007

This postal survey among 174 UK palliative physicians, aimed to assess current practice and perceived problems within the management of venous thromboembolism (VTE) in patients with advanced cancer. The questionnaire was returned by 131 out of 174 (74%) of the doctors surveyed. The most common estimated incidence of patients with VTE was 1-5%. The diagnosis of VTE is usually confirmed by further investigation and in general, outpatients are more likely to be anticoagulated than inpatients. Problems with anticoagulation include bleeding, international normalized ratio instability, appropriateness of anticoagulation, practical difficulties associated with monitoring, and recurrent VTE. Although probably less effective, 77 out of 128 (60%) of respondents use subtherapeutic regimes in order to minimize the risks. Patients with advanced malignancy and VTE are anticoagulated, if considered appropriate, by the vast majority of palliative physicians in the UK. Warfarin has been abandoned in favour of low-molecular-weight heparin (LMWH) by 26%. LMWH provides anticoagulation with no need for monitoring, has no significant drug interactions and is not affected by liver dysfunction. Theoretically, LMWH is more effective than warfarin in the secondary prevention of VTE with less risk of bleeding.
Forest decline
Authors: Innes John L.
Published: November 2007

Forest decline is a major environmental issue today. However, there are numerous examples of past declines in the condition of individual species within forests or of the entire forests themselves. Many of these declines are natural, being brought about by a variety of factors, including stand dynamics, pests and diseases. The emphasis that has been placed on air pollution in recent declines does not appear to be justified, although air pollution has undoubtedly brought about the decline of forests at some locations. Much of the literature exaggerates the extent of the decline in forest health in Europe. The overestimation of its extent has occurred because of the assessment techniques that are used: these are unable to distinguish trees that have recently declined from those that have always been in poor condition. In addition, the techniques that are most frequently used are nonspecific and no cause can be readily attributed to the defoliation that has been observed.
Twenty years of systematic physical geography: issues for a 'New Environmental Age'
Authors: Newson Malcolm
Published: November 2007

This review assesses the role of physical geography in the 'New Environmental Age'; it addresses especially the role of the natural systems approach after 20 years in which this has constituted the main fabric of physical geography in the UK. It also necessarily examines the role of geomorphology, the dominant partner in British physical geography, in positioning the subject as an environmental science. Systems thinking has clearly pervaded pedagogic aspects of physical geography but its full holistic methodology has not provided a coherent disciplinarity in research or applications. A holistic, conservationist perspective has often been disowned by physical geographers, leaving professional environmental applications largely in the hands of applied geomor phology. Now, however, there are major opportunities for a broader physical geography, especially one prepared to re-espouse the social science and humanities aspects of geography whose knowledge-base is so essential to the environmental manager's 'scenario-setting' (as opposed to pure physical modelling). Breadth-versus-depth arguments seem, however, likely to continue in physical geography, with those favouring breadth necessarily becoming environmentalists whilst those retaining depth become less preoccupied by equilibrium conditions of systems, stressing instead discontinuity and natural hiatuses.
Iceberg calving and the glacioclimatic record
Authors: Warren Charles R.
Published: November 2007

Glacier fluctuations can yield climatic information. However, the relationship between climate and calving glaciers is not straightforward. Iceberg calving introduces instability to the glacier system causing glaciers to oscillate asynchronously with each other and with noncalving glaciers, and out of phase with climate change. Calving rates are controlled primarily by water depth, but, for any given depth, are an order of magnitude greater in tidewater than in freshwater. Calving dynamics are poorly understood, but differ between temperate and cold glaciers, and between grounded and floating termini. Nonclimatic behaviour of calving glaciers has been documented in a large number of locations, both in historical time and during the Late Glacial and Holocene. Interactions between calving dynamics, sedimentation and topographic geometry can partially decouple calving glaciers and marine ice sheets from climate, initiating independent advance/retreat cycles; it is therefore rarely possible to make reliable inferences about climate from their oscillations.
The Australian summer monsoon: a review
Authors: Suppiah R.
Published: November 2007

The Australian summer monsoon influences the climate of the Australian tropics during the period from December to March. During this period, interannual and intraseasonal variations of rainfall associated with global-scale circulation anomalies strongly effect human life and economic activities in this region. Any changes in the global-scale circulation patterns in relation to changes in the heat balance components under enhanced greenhouse condition could alter monsoonal circulation characteristics and thus could bring serious impacts to human life in the monsoon-dominated region. To provide a basis for looking at changes in monsoonal characteristics under enhanced greenhouse condition, the current understanding of the Australian summer monsoonal circulation characteristics is reviewed here. Detailed information is given on the formation and the steady development of the Pilbara heat low over the northwestern part of Australia and the importance of the location of the monsoon shear line, active and break cycles of the monsoon, influence of South China Sea cold surges on monsoon activity, 40-50 oscillation in monsoon rainfall and winds and their link to El Nino/ Southern Oscillation (ENSO) phenomenon, the influence of the ENSO phenomenon on rainfall on interannual time scales and the link between monsoonal activity and tropical cyclones. The problems related to the above mentioned topics and their research priorities are highlighted.
The Swedish varve chronology - a review
Authors: Boygle Jane
Published: November 2007

Varve chronologies are regarded as one of the most accurate dating techniques of the Quaternary. Most work currently focuses on the process of varve formation and the environmental histories revealed in the sediments. This review aims to examine the latest investigations in relation to the recent linking of the Swedish Varve Chronology to the present (Cato, 1986). It is concluded that the Chronology would benefit from a more detailed study of the processes of formation, and that this may be achieved by using volcanic ash (tephra) as an environmental tracer.
Approaches to the study of hillslope development due to mass movement
Authors: Brooks S.M. , Richards K.S. , Anderson M.G.
Published: November 2007

Slope-angle histograms have traditionally provided a data base for the evaluation of changing angles over geological time. Ideas relating to hillslope development due to mass movement have considered a lowering in regolith shear resistance due to weathering, producing slope-angle decline. Decreasing values for angles of internal friction, along with increasing pore water pressures, have been suggested to explain slope-angle decline through time. These ideas have considered simple changes in undifferentiated regolith. This article considers the role of progressive pedogenesis in determining the changing stability of slopes. For this it is necessary to evaluate the changes which occur within individual horizons to produce an increasingly differentiated soil cover. Angles of internal friction alter at different rates and in different ways depending on whether the horizon is losing or gaining weathered material through translocation. Furthermore, the increasing internal differentiation of the soil cover has complex effects on its hydrological response. Instead of the two scenarios previously envisaged, one involving the water table below the slip surface and the other involving the water table at the ground surface, slope stability needs to be evaluated in the light of continually changing negative or positive pore water pressures. Each storm produces a different response, and this response alters with soil development, complicating the assessment of failure timing and depth. The study of evolving soil profiles is of fundamental significance to a range of geomorphological processes, requiring closer evaluation in the future.
Contemporary erosion of the Canadian landscape
Authors: Ashmore Peter
Published: November 2007

Studies of contemporary patterns of erosion in the glaciated and largely undisturbed Canadian landscape reveal spatial patterns that do not conform to the conventional concepts of drainage basin sediment delivery. In particular stream and valley side sediment sources dominate over erosion of the land surface, and specific (unit) sediment yield is often positively, rather than inversely, related to drainage area. Much of this is a legacy of glaciation that left large quantities of sediment in the landscape and disrupted regional drainage patterns. The absence of an integrated drainage network affects sediment delivery in many areas. To some extent unusual patterns of specific yield are to be expected in large drainage basins where environmental and geologic conditions may vary considerably within the basin. Only in the agricultural areas of the Great Lakes basin and St. Lawrence valley do more conventional patterns of erosion occur. Applied studies related to agricultural soil erosion and pollution have helped to illuminate the pathways and sources of sediment in particular cases and show the effects of landscape disturbance.
Organic matter in tropical soils: current conditions, concerns and prospects for conservation
Authors: Ross Sheila M.
Published: November 2007

Soil organic matter (SOM) plays a central role in maintaining tropical soil fertility. Its conservation and maintenance in tropical cultivation systems is imperative if soil degradation is to be halted and cropping made sustainable. Around 22-23% of global carbon is present in tropical ecosystems but only 2-3% of this is present in the soil. Fluxes of CO2 to the atmosphere from tropical soils after deforestation contributes to the greenhouse effect and could represent a 1-4% increase in the overall steady-state annual CO2 release to the atmosphere.

The composition of SOM is extremely diverse, with active, or labile, fractions decomposing in a matter of months while the more resistant, or nonlabile, fractions remain in soil for many years. SOM plays a central role in providing good soil structure, in supplying nutrients and in providing ion exchange capacity in tropical soils. Organic matter decomposition rates in tropical soils are generally faster than in temperate soils because decay of the nonlabile fraction is generally faster.

Changes in tropical land use have profound effects on SOM status. Tropical deforestation causes significant losses of soil carbon and nitrogen which tend to decline further under continuous cultivation. Reasons for declines in soil fertility include accelerated soil erosion, loss of litter influx after canopy removal and enhanced decomposition and nutrient mineralization rates after forest clearance. A wide range of soil management techniques have been designed to conserve and improve SOM stocks in tropical cultivation systems. These include agroforestry techniques, intercropping with legumes and the use of mulches and other organic inputs. While many of these techniques look promising in terms of improved crop yields, there is urgent need for research on how these practices alter the physical, chemical and biological processes and conditions of tropical soils.
Seed banks as a neglected area of biogeographic research: a review of literature and sampling techniques
Authors: Warr Susan J. , Thompson Ken , Kent Martin
Published: November 2007

The article highlights a comparatively neglected area of biogeographical research - seed banks and the distribution of seeds in the soil. The article reviews some of the relevant literature on seed banks and the methods for their study. Attention is focused on aspects of seed banks of particular relevance to biogeographers, with detailed examples drawn from seed bank studies in both temperate and tropical environments. In the review of the seed bank literature, the topics covered include the seed banks of successional communities and the size of seed banks in different vegetation types. The species composition of seed banks in different plant communities is discussed, particularly the degree of correlation between the species composition of seed banks and associated ground flora. The relationships between seed persistence, depth of burial in the soil and soil properties, such as moisture and pH, are explored. Seed bank heterogeneity is examined and a number of studies which have attempted to describe and measure the spatial variability of seed banks are summarized. Ways of classifying seed banks in terms of seed bank strategies are explained. The role of seed banks in conservation is discussed, for example in restoration projects, where preferred species have been lost from the vegetation but survive in the seed bank. The relevance of seed banks for the conservation of rare species and in landscape management is considered. Lastly, the contribution of seed banks to the recovery of vegetation following disturbance in various plant communities is discussed. In the review of seed bank sampling techniques, the subjects considered include methods of sample collection, the sampling intensity required for reliable estimates of seed density, a consideration of the relative merits of random and systematic sample distribution, as well as the importance of the timing of sampling. Various methods for the estimation of seed numbers in samples are appraised; these either involve extraction of seeds from the soil, followed by seed identification or enumeration by germination and seedling identification. Problems of analysing seed bank data are considered and several useful techniques for data analysis are suggested. Finally, the article draws attention to areas of future seed bank research for biogeographers and plant ecologists.
Ecological biogeography
Authors: Hengeveld R.
Published: November 2007

In this article, I first review recent developments in biogeography, after which I discuss some attempts at synthesis. The main body of the article, however, is devoted to the conception of ranges in terms of physiological responses to environmental variation. Because of this variation, such deterministic responses have to be described in stochastic terms in the case of local processes. Moreover, because of the same variation, species ranges will change location, size, and shape all the time, whereas internally their numerical structure shows up their dynamic nature. Ranges, therefore, are to be conceived as processes rather than as patterns, as they have been for long in the past.
Climatic geomorphology: a critique
Authors: Twidale C.R. , Lageat Y.
Published: November 2007

Though climatic geomorphology has long been perceived as providing a realistic framework for landform analysis, only the arid, nival and glacial systems and some constructional forms on the coast are readily identified in the landscape, present and past, as climatically zonal in character. Of course these features together account for a substantial part of the Earth's land surface at present. Nevertheless, the remaining areas have been subdivided into morphogenetic regions said to be characterized by distinctive landform assemblages. Even in those regions shaped by distinctive climatically driven processes, however, structural forms and those of etch origin are significant components, as they are also in humid tropical and midlatitude lands. In addition, various landforms are shaped by processes and mechanisms which, though climatically generated, vary genetically, and are active in a wide range of conventionally delineated climatic regions. They transgress arbitrary climatic boundaries. The climatic factor in landform development is by no means as clear cut and simple as was once thought and is certainly not of over-riding importance over at least half the world's land surface.
Fluvialism or diluvialism? Changing views on superfloods and landscape change
Authors: Huggett R.J.
Published: November 2007

In a series of recent articles, the possibility was raised that, owing to the occasional impact of asteroids and comets in the oceans, lowlands on continental margins might be prone to superflooding (Huggett, 1988a; 1988b; 1989a). It was suggested that a number of landscape features, including diverted drainage systems, gorges, valley meanders and extensive sheets of gravel might have been created by these superfloods. At the conclusion of the 1989 article it was noted that many landscape changes that might be ascribed to the action of superwaves are the same as the landscape changes accredited to the Noachian Deluge by the old school of diluvialists led at its zenith in the 1820s by William Buckland (see Huggett, 1989b). Thus, the bombardment hypothesis, through its prediction of superwaves and superfloods, leads to a new brand of diluvialism. This article explores the nature of neodiluvialism a little further, drawing attention to a growing body of evidence suggesting that, owing to various agencies, truly catastrophic floods have occurred in the past. It also discusses landscape features which can be expected to have been fashioned by diluvial, rather than by fluvial, action.
Tropical secondary forests
Authors: Corlett R.T.
Published: November 2007

The clearance, cultivation and abandonment of tropical forest lands has resulted in a rapid increase in the area of tropical secondary forests. Despite their growing extent, however, these forests have received relatively little attention from ecologists, foresters and conservationists. In this article the use of the term 'secondary forest' is restricted to forests which have reoccupied a site after clearance. Forests resulting from selective logging and other disturbances which permit most plant species to survive on the site are excluded. The literature on tropical forest succession is reviewed, showing the importance of the type, intensity and scale of the disturbance, the nature of the surrounding landscape and the composition of the surviving disperser fauna. The value of tropical secondary forests is compared to primary forest, with regards to regulatory function, commercial value and conservation significance. Finally, major research needs are briefly discussed.
Predictive vegetation mapping: geographic modelling of biospatial patterns in relation to environmental gradients
Authors: Franklin Janet
Published: November 2007

Predictive vegetation mapping can be defined as predicting the geographic distribution of the vegetation composition across a landscape from mapped environmental variables. Comput erized predictive vegetation mapping is made possible by the availability of digital maps of topography and other environmental variables such as soils, geology and climate variables, and geographic information system software for manipulating these data. Especially important to predictive vegetation mapping are interpolated climatic variables related to physiological tolerances, and topographic variables, derived from digital elevation grids, related to site energy and moisture balance. Predictive vegetation mapping is founded in ecological niche theory and gradient analysis, and driven by the need to map vegetation patterns over large areas for resource conservation planning, and to predict the effects of environmental change on vegetation distributions. Predictive vegetation mapping has advanced over the past two decades especially in conjunction with the development of remote sensing-based vegetation mapping and digital geographic information analysis. A number of statistical and, more recently, machine-learning methods have been used to develop and implement predictive vegetation models.
Twentieth-century variability in snow- cover conditions and approaches to detecting and monitoring changes: status and prospects
Authors: Barry R.G. , Fallot J.-M. , Armstrong R.L.
Published: November 2007

The extent, and variability of seasonal snow cover are important parameters in the climate system. Changes in snow cover may provide an indicator of global climatic trends and are of considerable practical significance. The question of the most suitable indices of changes in snow cover conditions, in terms of their use for change detection and for monitoring applications, is discussed. The use of passive microwave-derived estimates of snow cover extent and water equivalent for continental and regional-scale mapping is illustrated. Problems in interpreting the microwave signatures, as well as difficulties in comparing such data to ground observations, are also noted.

Up to now analyses have focused primarily on trends in Northern Hemisphere snow extent based on monthly averages using the NOAA weekly snow charts 1972-present, or on station data spanning 50-100 years. However, the latter are generally less readily available, or accessible. An overview is provided of current information on recent hemispheric trends and, for the former USSR, the relationship of changes in snow depth, to variations in temperature and precipitation since the late nineteenth century are described, based on newly available station records. Interpretation of these changes and comparisons with other records are presented.

Model projections of changes in snow cover conditions and associated snowmelt runoff that may occur as a result of greenhouse gas-induced warming are discussed for several mountain regions. Long-term station records of snow depth variability provided a valuable context within which such modeling results can be examined.
The suitability of montane ecotones as indicators of global climatic change
Authors: Kupfer John A. , Cairns David M.
Published: November 2007

Because of the difficulties involved with separating natural fluctuations in climatic variables from possible directional changes related to human activities (e.g., heightened atmospheric CO2 concentrations related to fossil fuel consumption), some researchers have focused on developing alternative indicators to detect hypothesized climate changes. It has, for example, been suggested that the locations of ecotones, transitions between adjacent ecosystems or biomes, should be monitored. It is assumed that changes in climate, especially increases in atmospheric temperature, will result in shifts in the location (altitude or latitude) of ecotones as plants respond to the newly imposed climatic conditions. In this article, we address the use of two montane ecotones, the alpine tree-line ecotone and the deciduous/Boreal forest ecotone, in monitoring global climatic change. In so doing, we 1) outline the factors that create and maintain each ecotone's position at a given location; 2) assess the projected response of the ecotones to various aspects of global warming; and 3) discuss the usefulness of both ecotones as indicators of global climate change. While it is likely that extended periods of directional climate change would bring about an altitudinal shift in the ranges of montane species and the associated ecotones, we question whether the response at either ecotone will be at a timescale useful for detecting climate change (a few decades) owing to disequilibrium related to upslope edaphic limitations and competitive interactions with established canopy and subcanopy indi viduals. Further, limitations related to the prediction of the complex and interacting effects of projected changes in temperature, precipitation and site water balance on photosynthetic pro cesses of plant species raise uncertainties about the expected responses of both ecotones.
Forest edges and the soil-vegetation- atmosphere interaction at the landscape scale: the state of affairs
Authors: Veen Arthur W. L. , Klaassen Wim , Kruijt Bart , Hutjes Ronald W.A.
Published: November 2007

Although the soil-vegetation-atmosphere exchange of momentum and heat is fairly well understood for many types of homogeneous surfaces, the disturbances created by tran sitions of one surface type to another remain to be analysed more fully. This is especially true for the impact which a large transition such as the forest edge has on the average fluxes in a small-scale heterogeneous landscape with forest. Recently acquired experimental evidence appears to some extent contradictory and at variance with conventional concepts.
Exploring DNA damage responses in human cells with recombinant adenoviral vectors
Authors: Armelini Melissa G. , Lima-Bessa Keronninn M. , Marchetto Maria Carolina N. , Muotri Alysson R. , Chiganças Vanessa , Leite Ricardo A. , Carvalho Helotonio , Menck Carlos F. M.
Published: November 2007

Recombinant adenoviral vectors provide efficient means for gene transduction in mammalian cells in vitro and in vivo. We are currently using these vectors to transduce DNA repair genes into repair deficient cells, derived from xeroderma pigmentosum (XP) patients. XP is an autosomal syndrome characterized by a high frequency of skin tumors, especially in areas exposed to sunlight, and, occasionally, developmental and neurological abnormalities. XP cells are deficient in nucleotide excision repair (affecting one of the seven known XP genes, xpa to xpg) or in DNA replication of DNA lesions (affecting DNA polymerase eta, xpv). The adenovirus approach allows the investigation of different consequences of DNA lesions in cell genomes. Adenoviral vectors carrying several xp and photolyases genes have been constructed and successfully tested in cell culture systems and in vivo directly in the skin of knockout model mice. This review summarizes these recent data and proposes the use of recombinant adenoviruses as tools to investigate the mechanisms that provide protection against DNA damage in human cells, as well as to better understand the higher predisposition of XP patients to cancer. Human & Experimental Toxicology (2007) 26, 899—906
Lack of a role for creatine phosphate kinase in sulphur mustard-induced cytotoxicity
Authors: Nelson P. , Burczyk A. , Sawyer T.W.
Published: November 2007

Several compounds involved in the creatine phosphate kinase (CPK) pathway were evaluated for their protective effects against the chemical warfare (CW) agent sulphur mustard (HD), in primary chick embryo neuron and first passage human skin keratinocyte cultures. High concentrations of both creatine and creatine phosphate were found to be protective under all culture conditions and increased the LC50 of HD in both culture systems up to ~250%. Little difference was observed in the protective activity of these compounds in undifferentiated versus differentiated neuronal culture, or in proliferating versus differentiating cultures of keratinocytes. The protective effect of these compounds was found to be strictly prophylactic in nature. Although a modest decline in HD half-life was measured in buffer containing creatine phosphate, this did not account for the protective effects of this compound. In contrast to historical literature reporting 90—100% HD-induced CPK inhibition of purified enzyme, less than 30% of CPK activity was found to be inhibited by HD in both human keratinocytes and in swine blood plasma. Incubation of keratinocyte cultures with creatine or creatine phosphate prior to HD exposure did not alter CPK activity, compared with HD-only treated cultures. Although high mM concentrations of both creatine and creatine phosphate exert significant protective effects against HD, these results do not support a role for CPK in its toxicity or in the development of medical countermeasures against this CW agent. Human & Experimental Toxicology (2007) 26, 891—897.
Disease activity, damage and survival in Mexican patients with acute severe systemic lupus erythematosus
Authors: Zonana-Nacach A. , Yañez P. , Jiménez-Balderas F.J. , Camargo-Coronel A.
Published: November 2007

Systemic lupus erythematosus (SLE) is a clinical syndrome of varying severity. Although the survival and prognosis of SLE have steadily improved, there is a group of patients who present an acute fatal outcome despite aggressive therapy. We designed this study to evaluate the factors associated with mortality in patients with acute severe SLE. During 2004—06, 41 Mexican SLE patients that could not be managed in the out-patient clinic and with acute severe major organ system involvement [nephritis, severe thrombocytopenia (platelet count below 20 000 per μL) acute neuropsychiatric pulmonary, gastrointestinal or cardiac disease and generalized vasculitis] were studied. During the first admission, disease activity (SLE Disease Activity Index (SLEDAI), SLE Activity Measured), damage [SLE International Collaborating Clinics (SLICC)], and therapy were assessed. Survival using Kaplan—Meier curves, odd ratios with 95% confidence interval and logistic regression analysis were used to determine risk factors for mortality. Ninety percent were female with a mean age of 29 ± 19 years and mean disease duration of 21 ± 9 months. The principal causes of first admission were renal (27%), SNC (22%) and cardiopulmonary (15%). After a mean follow-up of 9.7 ± 6 months, 16 (39%) patients died. Deceased patients had significantly higher SLEDAI ( P = 0.004), and SLICC ( P = 0.03) scores. The manifestations associated with mortality were renal disease activity (odds ratio, OR 4.6, confidence interval, CI 95% 1.0—20.6), infections (OR 3.2 CI 95% 2.0—5.3) and thrombocytopenia (OR 4.0, CI 95% 1.0—15.9). The survival at 9.7 months was 72, 62 and 50% in patients with an SLEDAI score of 3—10, 11—20 and ≥21, respectively. The SLEDAI score, the presence of damage and infection were associated with death in patients with acute severe SLE. Lupus (2007) 16, 997—1000.
Aspirin therapy and thromboxane biosynthesis in systemic lupus erythematosus
Authors: Avalos Ingrid , Chung Cecilia P. , Oeser Annette , Milne Ginger L. , Borntrager Holly , Morrow Jason D. , Raggi Paolo , Solus Joseph , Stein C. Michael
Published: November 2007

Incomplete suppression of thromboxane biosynthesis during aspirin therapy is associated with increased cardiovascular risk. Since systemic lupus erythematosus (SLE) is associated with platelet activation and increased cardiovascular mortality, we compared thromboxane and prostacyclin biosynthesis in patients with SLE and control subjects, and measured inhibition of thromboxane excretion in aspirin-treated subjects. We measured the urinary excretion of 11-dehydro thromboxane B 2 (TXB2) and 2,3-dinor 6-ketoPGF1α (PGI-M), the stable metabolites of thromboxane A2 and prostacyclin, respectively, in 74 patients with SLE and 70 controls. In subjects who were not receiving aspirin, TXB2 excretion was higher in patients with SLE [0.40 ng/mg creatinine (0.26—0.64), median (interquartile range)] than controls [0.31 ng/mg creatinine (0.23—0.44)] ( P = 0.04), and in these patients, TXB2 excretion correlated with disease activity (rho = 0.28, P = 0.03) and tumor necrosis factor alpha (rho = 0.48, P < 0.001). Aspirin therapy resulted in significantly lower TXB2 excretion in controls ( P = 0.01), but not in patients with SLE ( P = 0.10), compared with subjects not receiving aspirin. Prostacyclin biosynthesis did not differ among patients and controls, and was not affected by aspirin ( P all >0.35). Thromboxane biosynthesis is increased in SLE and is associated with disease activity. Additionally, response to aspirin may be attenuated in some patients with SLE. Lupus (2007) 16, 981—986.
Microarray analysis of microRNA expression in peripheral blood cells of systemic lupus erythematosus patients
Authors: Dai Y. , Huang Y.-S. , Tang M. , Lv T.-Y. , Hu C.-X. , Tan Y.-H. , Xu Z.-M. , Yin Y.-B.
Published: November 2007

MicroRNAs (miRNAs) are noncoding RNA molecules of 21—24 nt that regulate the expression of target genes in a post-transcriptional manner. Evidence indicates that miRNAs play essential roles in embryogenesis, cell differentiation and pathogenesis of human diseases. This study describes a comparison between the miRNA profile of the systemic lupus erythematosus (SLE) patients and the controls to develop further understanding of the pathogenesis of SLE. Peripheral blood mononuclear cells were isolated from blood samples of 23 SLE patients, 10 idiopathic thrombocytopenic purpura patients and 10 healthy controls. The miRNA microarray chip analysis identified 16 miRNAs differentially expressed in SLE. The chip results were confirmed by northern blot analysis. This work indicates that miRNAs are potential diagnosis biomarkers and probable factors involved in the pathogenesis of SLE. Lupus (2007) 16, 936—946.
Cutaneous alternariosis in a patient with systemic lupus erythematosus
Authors: Akman A. , Sakalli Cakcak D. , Ozhak Baysan B. , Yazisiz V. , Terzioglu E. , Ciftcioglu M.A. , Alpsoy E.
Published: November 2007

Alternaria species are common saprophytic fungi that naturally subsist on decaying plant materials, and occasionally may cause diseases in human beings and domestic animals. They can be a potential opportunistic pathogen in immunocompromized hosts or those with significant underlying disease. However, rarely they are also pathogen in otherwise healthy hosts. We report here the first case of cutaneous alternariosis in a 30-year-old woman who was on systemic steroid therapy for active systemic lupus erythematosus. The patient was referred to our department with purple papules and ulcerated nodules on the dorsum of the hands, wrists and ankles. Skin biopsy showed granulomatous reaction with fungal elements that were subsequently identified as Alternaria species. Individual lesions were successfully treated with oral itracanozole 200mg daily for six weeks. Besides the patient's own disease, the use of systemic steroid use might be a possible predisposing factor for the development of cutaneous alternariosis. Lupus (2007) 16, 993—996.
Role of distinct immune components in the radiation-induced abrogation of systemic lupus erythematosus development in mice
Authors: e Brito R.R.N. , De Lorenzo B.H.P. , Xander P. , Godoy L.C. , Lopes J.D. , da Silva N.P. , Sampaio S.C. , Mariano M.
Published: November 2007

The New Zealand Black × New Zealand White F1 [(NZB/NZW) F1] mouse develops an autoimmune condition resembling aspects of human systemic lupus erythematosus (SLE). We investigated the effects of a novel prophylactic thoraco-abdominal gamma irradiation protocol on the onset and evolution of lupus in these animals. Survival of irradiated mice was higher when compared with nonirradiated mice. Kidney lesions were milder and autoantibody levels were lower in irradiated mice. To identify possible mechanisms involved in the radiation-induced improvement of disease, distinct components of humoral and cellular immune responses were evaluated. Because B-1 cells are known to be involved in various autoimmune diseases, we investigated the participation of these cells in SLE progression. Unexpectedly, B-1 cells were not depleted in (NZB/NZW) F1, even after several rounds of irradiation. No alterations were found in viability and physiology of B-1 cells in SLE animals with the exception of constitutive overexpression of the anti-apoptotic molecule Bcl-2, which may account for the observed radioresistance. Thus, a role for B-1 cells in murine SLE cannot be excluded, since the irradiation protocol did not effectively eliminate these cells. Additionally, we demonstrate a marked delay in the ability of splenocytes to repopulate the spleen after irradiation in (NZB/NZW) F1, in contrast to leucocytes in other cellular compartments. The implications of these findings for the fate of SLE in this model are discussed. Lupus (2007) 16, 947—954.
Mycophenolate mofetil as induction and maintenance therapy for lupus nephritis: rationale and protocol for the randomized, controlled Aspreva Lupus Management Study (ALMS)
Authors: Sinclair A. , Appel G. , Dooley M.A. , Ginzler E. , Isenberg D. , Jayne D. , Wofsy D. , Solomons N.
Published: November 2007

The Phase III Aspreva Lupus Management Study (ALMS) will investigate mycophenolate mofetil (MMF) therapy for lupus nephritis (LN). Eligibility criteria include: 12—75 years of age; diagnosis of systemic lupus erythematosus according to revised American College of Rheumatology criteria; and biopsy-demonstrated LN (Class III—V). Randomized patients will receive open-label induction therapy with MMF or cyclophosphamide in combination with corticosteroids for 24 weeks. The primary efficacy endpoint is treatment response [decreased proteinuria and stabilized (within 25% of baseline) or improved serum creatinine level]. Patients achieving response or complete remission (normalization of all parameters) will be rerandomized to double-blind, placebo-controlled maintenance treatment with MMF or azathioprine, both plus corticosteroids. The maintenance phase primary endpoint is time to treatment failure. To detect a 15% rate improvement in the MMF group compared with cyclophosphamide, and to provide 90% power, a total of 358 patients will be required for the induction phase. On the basis of a projected 278 rerandomized patients, the maintenance phase will have 90% power to detect a difference between treatment groups assuming azathioprine and MMF three-year failure rates of 59.5% and 40.7%, respectively. Aspreva Lupus Management Study may provide invaluable comparative data on the efficacy and safety of MMF as LN induction and maintenance therapy. Lupus (2007) 16, 972—980.