bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone mineral density, body composition and bone turnover in patients with congenital hypogonadotropic hypogonadism
Authors: Laitinen E.‐M. , Hero M. , Vaaralahti K. , Tommiska J. , Raivio T.
Published: January 2012

Patients with congenital hypogonadotropic hypogonadism (HH) may have reduced peak bone mass in early adulthood, and increased risk for osteoporosis despite long‐term hormonal replacement therapy (HRT). To investigate the relationship between HRT history and measures of bone health in patients with HH, we recruited 33 subjects (24 men, nine women; mean age 39.8 years, range: 24.0–69.1) with congenital HH (Kallmann syndrome or normosmic HH). They underwent clinical examination, were interviewed and medical charts were reviewed. Twenty‐six subjects underwent dual‐energy X‐ray absorptiometry for evaluation of BMD of lumbar spine, hip, femoral neck and whole body; body composition and vertebral morphology were evaluated in 22 and 23 subjects, respectively. Circulating PINP, ICTP and sex hormone levels were measured. HRT history clearly associated to bone health: BMDs of lumbar spine, femoral neck, hip and whole body were lower in subjects (n = 9) who had had long (≥5 years) treatment pauses or low dose testosterone (T) treatment as compared to subjects without such history (n = 17; all p‐values < 0.05). In addition, fat mass and body mass index (BMI) were significantly higher in men with deficient treatment history (median fat mass: 37.5 vs. 23.1%, p = 0.005; BMI: 32.6 vs. 25.2 kg/m2, p < 0.05). Serum PINP correlated with ICTP (rs = 0.61; p < 0.005) in men, but these markers correlated neither with circulating T, nor with serum estradiol levels in women. In conclusion, patients with congenital HH require life‐long follow‐up to avoid inadequate HRT, long treatment pauses and further morbidity.
Behavioural adjustments of a large carnivore to access secondary prey in a human‐dominated landscape
Authors: Valeix Marion , Hemson Graham , Loveridge Andrew J. , Mills Gus , Macdonald David W.
Published: January 2012

1. Conflict between people and large carnivores is an urgent conservation issue world‐wide. Understanding the underlying ecological drivers of livestock depredation by large carnivores is greatly needed.

2. We studied the spatial, foraging and behavioural ecology of African lions Panthera leo in the Botswana Makgadikgadi ecosystem. This ecosystem comprises a protected area, characterized by high seasonal fluctuation in wild prey abundance, and adjacent lands, which are used for livestock grazing and characterized by stable livestock abundance, but also a risk of anthropogenic mortality.

3. Makgadikgadi lions preferentially preyed upon migratory wild herbivores when they were present; however, data from GPS (Global Positioning System) radiocollared lions revealed that the majority of the study lions did not follow the migratory herds but remained resident at one or other border of the park and switched to livestock (abundant and readily available), and to a lesser extent resident wild herbivores (relatively scarce), in periods of migratory wild herbivore scarcity.

4. Resident lions’ use of space differed between periods of wild prey abundance and scarcity. These changes were likely to increase the frequency of encounter with their primary prey in periods of primary prey abundance and with livestock in periods of primary prey scarcity.

5. The risk of conflict with humans was a major driver of lion ecology in the human‐dominated landscape surrounding the protected area. Resident lions generally avoided the close vicinity of cattle‐posts. When they used such areas, they avoided temporal overlap with periods that humans were most active and travelled at high speed reducing the time spent in these areas.

6. Synthesis and applications. This study suggests that lions balance the benefits of accessing livestock with the costs associated with livestock raiding. Hence, reduction in livestock availability through effective livestock husbandry in periods of wild prey scarcity should lead to reduced conflict.
Tracking earthworm communities from soil DNA
Authors: BIENERT FRIEDERIKE , DE DANIELI SÉBASTIEN , MIQUEL CHRISTIAN , COISSAC ERIC , POILLOT CAROLE , BRUN JEAN‐JACQUES , TABERLET PIERRE
Published: January 2012

Earthworms are known for their important role within the functioning of an ecosystem, and their diversity can be used as an indicator of ecosystem health. To date, earthworm diversity has been investigated through conventional extraction methods such as handsorting, soil washing or the application of a mustard solution. Such techniques are time consuming and often difficult to apply. We showed that combining DNA metabarcoding and next‐generation sequencing facilitates the identification of earthworm species from soil samples. The first step of our experiments was to create a reference database of mitochondrial DNA (mtDNA) 16S gene for 14 earthworm species found in the French Alps. Using this database, we designed two new primer pairs targeting very short and informative DNA sequences (about 30 and 70 bp) that allow unambiguous species identification. Finally, we analysed extracellular DNA taken from soil samples in two localities (two plots per locality and eight samples per plot). The two short metabarcode regions led to the identification of a total of eight earthworm species. The earthworm communities identified by the DNA‐based approach appeared to be well differentiated between the two localities and are consistent with results derived from inventories collected using the handsorting method. The possibility of assessing earthworm communities from hundreds or even thousands of localities through the use of extracellular soil DNA will undoubtedly stimulate further ecological research on these organisms. Using the same DNA extracts, our study also illustrates the potential of environmental DNA as a tool to assess the diversity of other soil‐dwelling animal taxa.
Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography1
Authors: Bredenoord A. J. , Fox M. , Kahrilas P. J. , Pandolfino J. E. , Schwizer W. , Smout A. J. P. M. ,   The International High Resolution Manometry Working Group
Published: January 2012

Background  The Chicago Classification of esophageal motility was developed to facilitate the interpretation of clinical high resolution esophageal pressure topography (EPT) studies, concurrent with the widespread adoption of this technology into clinical practice. The Chicago Classification has been an evolutionary process, molded first by published evidence pertinent to the clinical interpretation of high resolution manometry (HRM) studies and secondarily by group experience when suitable evidence is lacking.

Purpose  This publication summarizes the state of our knowledge as of the most recent meeting of the International High Resolution Manometry Working Group in Ascona, Switzerland in April 2011. The prior iteration of the Chicago Classification was updated through a process of literature analysis and discussion. The major changes in this document from the prior iteration are largely attributable to research studies published since the prior iteration, in many cases research conducted in response to prior deliberations of the International High Resolution Manometry Working Group. The classification now includes criteria for subtyping achalasia, EGJ outflow obstruction, motility disorders not observed in normal subjects (Distal esophageal spasm, Hypercontractile esophagus, and Absent peristalsis), and statistically defined peristaltic abnormalities (Weak peristalsis, Frequent failed peristalsis, Rapid contractions with normal latency, and Hypertensive peristalsis). The Chicago Classification is an algorithmic scheme for diagnosis of esophageal motility disorders from clinical EPT studies. Moving forward, we anticipate continuing this process with increased emphasis placed on natural history studies and outcome data based on the classification.
Plasmodium chabaudi AS induces pregnancy loss in association with systemic pro‐inflammatory immune responses in A/J and C57BL/6 mice
Authors: SARR D. , SMITH G. M. , POOVASSERY J. S. , NAGY T. , MOORE J. M.
Published: January 2012

The molecular mechanisms that underlie poor birth outcomes in malaria during pregnancy remain poorly defined. To assess the role of host immune responses, mice known to respond differentially to Plasmodium chabaudi AS infection were studied. Following infection at day 0 of pregnancy, A/J mice developed significantly higher parasitemia than C57BL/6 (B6) mice and succumbed to infection. Both strains had evidence of parasite accumulation in the placenta at mid‐gestation and aborted, with significantly higher embryo loss in infected A/J mice on day 9. While infection‐induced systemic tumour necrosis factor (TNF) and interleukin (IL)‐1β in the latter were significantly higher at day 11, day 10 IL‐10 levels were higher in B6 mice. No differences in the levels of splenic lymphocyte subsets, neutrophils or monocytes between infected pregnant A/J and B6 mice were observed, with most cell types expanding in response to infection regardless of pregnancy. Antibody ablation of TNF exacerbated infection in A/J mice and did not ameliorate pregnancy outcome. Thus, malaria induces poor pregnancy outcome in both the mouse strains in the context of quantitatively different systemic inflammatory responses. Further evaluation of the roles of soluble and cellular immune components, particularly at the uteroplacental level, will be required to define the most critical pregnancy‐compromising mechanisms.
GPS ground deformation patterns at Mount St. Helens (Washington, USA) from 2004 to 2010
Authors: Palano Mimmo , Guarrera Elisa , Mattia Mario
Published: January 2012

Terra Nova, 24, 148–155, 2012

GPS measurements on Mount St. Helens spanning the 2004.00–2010.85 time interval, encompassing the 2004–2008 dome‐building eruption, were analysed. First, a local reference frame was derived to isolate the volcanic ground deformation from the background tectonic pattern related to the interactions between the Pacific, Juan de Fuca and North American plates. Secondly, the resulting ground deformation patterns were modelled to constrain magmatic sources. Results suggest a vertically elongated magma chamber centred at 8–9 km depth beneath the summit area that deflated during the beginning of the dome growth and inflated since January 2008, indicating that the same primary magma reservoir was active both during and after the eruption in a magmatic system that is persistent over the time.
Oleoma: rare complication of mesotherapy for cellulite
Authors: Ramos‐e‐Silva Marcia , Pereira Ana Libia Cardozo , Ramos‐e‐Silva Stella , Piñeiro‐Maceira Juan
Published: January 2012

Background  Mesotherapy or intradermotherapy is used as a cosmetic procedure for many purposes, among them for cellulite.

Methods  We report a case of oleoma on the thighs and buttocks that appeared two years after the injection of an unknown substance for improvement of cellulite.

Results  Lesions and associated pruritus resolved with colchicine, leaving depressed scars.

Conclusions  Serious and peer‐reviewed investigations must be performed to certify the efficacy and safety of this procedure.
Prurigo pigmentosa in Korea: clinicopathological study
Authors: Shin Jung W. , Lee Sung Y. , Lee Jong S. , Whang Kyu U. , Park Young L. , Lee Hong K.
Published: January 2012

Background  Prurigo pigmentosa (PP) is an inflammatory dermatosis characterized by recurrent pruritic erythematous papules, mainly located on the trunk. It was first described by Nagashima in 1971 in Japan. Since then, more than 300 cases have been reported in Japan, but reports from other parts of the world are quite rare.

Materials and methods  We studied clinical and histopathological data from six patients with PP diagnosed in our hospital and 43 patients (18 reports) who were diagnosed with PP in Korea between 1988 and 2008.

Results  The number of Korean patients reported in recent years is higher than the number of other non‐Japanese patients reported. Clinicopathological characteristics in Korean patients were not significantly different from those previously reported. Therapeutic results with minocycline were successful in our patients.

Conclusions  We suspect that PP is not uncommon in Korea, and the disease may be underestimated. Strict restriction of diet as well as known associated factors like wet condition are suggested as one of the important factors contributing to the occurrence of PP in Korea.
Cojedes: a leprosy hyperendemic state
Authors: Aranzazu Nacarid , Parra Juan J. , Cardenas Maritza , Rada Elsa , Zerpa Olga , Rivera Teresa , Borges Rafael , Gonzalez Pablo , Morales José , Sosa Ramon , Sanchez Forquis , Convit Jacinto
Published: January 2012

Background  Leprosy is a chronic infectious disease produced by Mycobacterium leprae. In 1997 Venezuela reached the goal of elimination of leprosy as a public health problem (according to the World Health Organization a prevalence rate of ≤1/10,000 inhabitants), but five states still had prevalence rates over that goal. For this study we selected Cojedes State, where prevalence rates remain over the elimination goal.

Objective  Evaluate the real leprosy situation in high‐prevalence areas of Cojedes State.

Materials and methods  Seven communities of Cojedes State were selected because they had the highest historic prevalence, as well as the highest prevalence in the year to be studied (1997).

Results  A rank correlation using Spearman’s test comparing historical prevalence rates (1946–1996) and detection rates (1998–2004) gave a statistically significant P < 0.05 value. Diagnosed leprosy cases were as follows: age: 3.2% under 15 years old; sex: male/female rates between 60% and 91.66% males. The highest number of cases were paucibacillary forms: indeterminate leprosy (33.07%) and borderline tuberculoid leprosy (32.28%); tuberculoid leprosy (7.00%); and multibacillary cases (lepromatous leprosy, LL) were only 2.36%. Bacteriologically, 18.52 patients were M. leprae positive. At the moment of diagnosis, 96.6% showed no disabilities, 3.4% showed grade I disabilities, and there were no grade II or III disabilities.

Conclusion  This study confirms that several communities in Cojedes State have extremely high leprosy rates.
The management of EGFR inhibitor adverse events: a case series and treatment paradigm
Authors: Wnorowski Amelia M. , de Souza Aieska , Chachoua Abraham , Cohen David E.
Published: January 2012

Background  Epidermal growth factor receptor (EGFR) inhibitors are widely used medications in the treatment of cancers.

Objective  To review the cutaneous adverse events related to EGFR inhibitors.

Methods  A retrospective chart review of all cases referred for the management of cutaneous adverse events after the initiation of EGFR inhibitor therapy between the years of 2006 and 2009 was performed. The study was approved by the institutional review board.

Results  Four men and 11 women had cutaneous adverse events while receiving erlotinib (mean dose: 112.5 mg) for lung and pancreatic cancer. The most common cutaneous adverse reaction observed was a papulopustular rash in 12 cases (80%). Eczema and xerosis were the only findings in three patients, alopecia in one case, and nail changes in three cases. The treatment modalities prescribed were doxycycline and topical antibiotics for the papulopustular rash; topical high potency steroids, tacrolimus, pimecrolimus, and moisturizers for xerosis and eczema; and cetirizine for the pruritus. The paronychia was treated with warm soaks, topical steroids, and podiatry referral. The majority of patients improved with symptomatic therapy, with the exception of one patient who experienced herpes zoster super infection and Stevens‐Johnson syndrome. The patient was hospitalized and required discontinuation of the erlotinib therapy.

Conclusion  The most common cutaneous adverse event in our cohort was papulopustular rash, followed by eczema and xerosis. Patients were managed with symptom target therapy, and suspension of the EGFR inhibitor was rarely required. As the use of EGFR inhibitors increases, it is important to promptly identify and treat adverse events. Further studies are necessary to develop targeted therapeutic and preventative measures.
Idiopathic granulomatous lobular mastitis
Authors: Pereira Frederick A. , Mudgil Adarsh V. , Macias Edgar S. , Karsif Karen
Published: January 2012

Idiopathic granulomatous lobular mastitis (IGLM) is a rare breast condition with prominent skin findings. It is typically seen in young parous women. Painful breast masses, draining sinuses, scarring, and breast atrophy are the main clinical manifestations. IGLM can resemble a variety of other inflammatory and neoplastic processes of the breast. It is thought to result from obstruction and rupture of breast lobules. Extravasated breast secretions then induce an inflammatory reaction. Corynebacteria have also been implicated in the pathogenesis. Treatment is surgical, but systemic corticosteroids, methotrexate, and antibiotics also play a role.
Dermatologic infestations
Authors: Shmidt Eugenia , Levitt Jacob
Published: January 2012

Head lice are transmitted by head to head contact. Optimal therapy includes malathion lotion 0.5% repeated in one week left on for 30 minutes to 8 hours. Spinosad topical suspension 0.9% repeated in one week left on for 10 minutes is another option. Scabies is transmitted mainly by direct contact but also via heavily infested fomites due to crusted scabies. Permethrin 5% cream to the body repeated in four days is often sufficient; however, scalp treatment with malathion lotion 0.5% is helpful in crusted scabies and in infested children. Oral ivermectin 200 mcg/kg is another option, repeated in four days. For scabies more than lice, fomites should be placed in a drier at 60 °C for 10 minutes to kill the arthropods. Treatment of close contacts in both cases will control outbreaks and repeated infestations. Both have been associated with methicillin‐resistant Staphylococcus aureus infection. Bed bugs are a common cause for papular urticaria. Identification of the insect in the mattress or bedding confirms the diagnosis. Prevention involves encasing the mattress in a sealed plastic cover and extermination. Delusions of parasitosis is a diagnosis of exclusion that is best treated with an antipsychotic.
The successful treatment of flat warts with auricular acupuncture
Authors: Ning Suli , Li Fajie , Qian Lijie , Xu Dong , Huang Yi , Xiao Ming , Duan Gengli , Li Yan
Published: January 2012

Background  Flat warts are a common presenting complaint in adolescents and adults and may be a cosmetic problem as well. Patients suffering from flat warts are often unsatisfied with conventional medical care because of adverse effects such as intolerable pain, hyperpigmentation, hypopigmentation, or occasionally allergic contact dermatitis. To offset the possibilities of hyperpigmentation, hypopigmentation, and scar formation, the method of auricular acupuncture was used.

Methods  Single‐blind method adopted, 60 subjects with flat warts were all outpatients and randomly allocated to a treatment group or a control group, with 30 patients in each group. Thirty subjects in the treatment group were treated with weekly auricular acupuncture for 10 weeks while the other subjects in the control group were treated with 0.1% of tretinoin ointment topically for 10 weeks.

Results  Sixteen subjects in the treatment group (53.33%) recovered fully from flat warts without recurrence during the ensuing six months’ follow‐up after 10 weeks’ surgery compared with only one subject in the control group (3.33%). The therapeutic effect of the treatment group was statistically better than that of the control group by Mann–Whitney U‐test with SPSS software (P < 0.01). During the treatment period and the ensuing six months’ follow‐up, no adverse effects were observed by the investigators or reported by patients.

Conclusions  Our findings suggest that auricular acupuncture may be a viable alternative for the treatment of flat warts. Larger randomized studies are needed to fully evaluate auricular acupuncture against more conventional treatments, and these are planned.
Should we retransplant a patient who is non‐adherent? A literature review and critical reflection
Authors: Dobbels F. , Hames A. , Aujoulat I. , Heaton N. , Samyn M.
Published: January 2012

Dobbels F, Hames A, Aujoulat I, Heaton N, Samyn M. Should we retransplant a patient who is non‐adherent? A literature review and critical reflection.  Pediatr Transplantation 2012: 16: 4–11. © 2012 John Wiley & Sons A/S.

Abstract:  The majority of transplant centers around the world face an ethical debate whether to retransplant a young non‐adherent patient. Non‐adherence to lifelong immunosuppressants presents a significant risk for graft loss, yet rates remain consistently high. Despite a number of these patients presenting for retransplantation, there is little evidence to guide professionals in their decision‐making. This paper aims to provide such guidance, by systematically reviewing the existing outcome data for retransplantation in patients who are known to be non‐adherent to their immunosuppressants. This review searched for original papers that addressed retransplantation of a solid organ and included quantitative data on adherence or graft function. Only one original research paper was found to meet the inclusion criteria. This paper is reviewed, and details of the protocol to determine eligibility for retransplantation are summarized. The findings are discussed within the ethical context that transplant professionals work within, and the arguments for and against retransplantation are considered. The need for effective integration of adherence management into routine practice is highlighted, with an emphasis on reliable measurement of adherence throughout the patient’s life. Examples of good practice are discussed, favoring prevention over cure.
Design, implementation and initial assessment of the Northern Territory Point‐of‐Care Testing Program
Authors: Shephard Mark D.S. , Spaeth Brooke , Mazzachi Beryl C. , Auld Malcolm , Schatz Steven , Loudon John , Rigby Janet , Daniel Vinod
Published: January 2012

Objective:  The objective of the study was to improve pathology services in selected remote health centres from the Northern Territory (NT) through the implementation of a quality managed point‐of‐care pathology testing (POCT) service.

Design:  Study of the efficacy of the POCT service after 1 year and qualitative survey of POCT device operators.

Setting:  The study was set in thirty‐three remote health centres in the NT administered by the NT Department of Health.

Participants:  Remote health centre staff at participating remote health centres participated in the study.

Interventions:  The introduction of the i‐STAT device to perform on‐site POCT.

Main outcome measures:  The main outcome measures used in the study were the number of remote staff trained, volume of testing performed and satisfaction of POCT device operators.

Results:  One hundred and sixty‐four health professional staff were trained to perform i‐STAT POCT during the first year of the program. A total of 2290 POCT tests were performed on the i‐STAT. The volume of testing consistently increased across the year. Tests for international normalised ratio were the most frequently performed (averaging 70 tests per month). Stakeholder satisfaction with the i‐STAT device was high, with a statistically significant improvement in satisfaction levels with pathology service provision being reported after the introduction of POCT. Greater than 80% of respondents stated POCT was more convenient than the laboratory service and assisted in the stabilisation of acutely ill patients.

Conclusions:  The NT POCT Program has been operationally effective and well received by staff working as i‐STAT POCT operators in remote health centres. Retention of remote health centre staff is the most significant challenge to ensuring the program's long‐term viability.
Farming suicides during the Victorian drought: 2001–2007
Authors: Guiney Robyn
Published: January 2012

Objective:  The objective of this study was to determine whether farming suicides increased in Victoria during the prolonged drought in south eastern Australia and gain an understanding of Victorian farming suicides during the period.

Method:  Intentional self‐harm deaths of farmers and primary producers notified to the Victorian State Coroner from 2001 to 2007 were examined to identify characteristics and determine whether the annual number of farming suicides increased.

Results:  Farming suicides accounted for just over 3% of Victorian suicides. The total number of farming suicides was 110 for the period and ranged between 11 and 19 deaths per year, rising and falling inconsistently from year to year. Males accounted for nearly 95% of farming suicides, with firearms and hanging the most frequently used methods, and most deaths occurring between 30 and 59 years of age.

Conclusions:  The small number of relevant cases and fluctuations in the annual number of deaths provides no evidence of a pattern of increasing farming suicides during the drought years, when there was approximately one suicide every 3 weeks. Given the elevated suicide risk in male farmers and association with multiple psychosocial and environmental factors, it cannot be concluded, however, that suicide risk itself did not increase during this period of heightened uncertainty and stress. Drought should not be dismissed among the many risk factors, and it is possible that increased mental health awareness and community support programs targeting drought‐affected areas contributed to improved management of stress and suicide risk in regional and rural Victoria over the past decade.
Communicating about breast cancer: Rural women's experience of interacting with their surgeon
Authors: Ristevski Eli , Regan Melanie , Birks David , Steers Nicole , Byrne Anny , McGrail Matthew R.
Published: January 2012

Objective:  This study examined rural women's satisfaction with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Differences in satisfaction were investigated between treatment groups (mastectomy and breast conservation surgery) and demographic variables (age, marital status, education level, employment status and place of residence). Practice was compared with clinical practice guidelines.

Design:  The study was designed as a cross‐sectional survey.

Setting:  The study was set in Eastern regional Victoria, Australia.

Participants:  Seventy women diagnosed with early breast cancer participated in the study.

Main outcome measures:  The main outcome measures used by the study were satisfaction in three areas of practice: (i) telling a woman she has breast cancer; (ii) providing information and involving the woman in the decision‐making; and (iii) preparing the woman for specific management.

Results:  No differences in satisfaction were found between treatment groups and demographic variables. Overall, women in this study were highly satisfied (>93%) with the interaction and communication with their surgeon. Women reported that the surgeon created a supportive environment for discussion, that they were provided with adequate information and referrals, and that they were actively involved in the decision‐making. Practice could have been improved for women who were alone at diagnosis as women without a partner made a quicker decision about treatment.

Conclusion:  Rural women in Victoria Australia were largely satisfied with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Current practice was predominately in line with clinical practice guidelines.
Personal–professional boundary issues in the satisfaction of rural clinicians recruited from within the community: Findings from an exploratory study
Authors: Gillespie Judy , Redivo Rhea
Published: January 2012

Objective:  The objective of this paper is to highlight, from within a broad study of recruitment/retention, findings that identify personal–professional boundaries as key challenges for rural child and youth mental health clinicians recruited from within the community.

Design:  Two mixed methods online questionnaires followed by semistructured telephone interviews with a small subset of respondents were administered to clinicians, team leaders, supervisors and managers whose practice responsibilities encompass rural settings in three regions of British Columbia, Canada.

Participants:  Forty‐four clinicians and 27 team leaders/managers participated in the survey while eight clinicians and one team leader/manager participated in the semistructured interviews. Half the clinician respondents were recruited from within the community. Of those recruited from outside the community, half had prior experience living or working in a rural community.

Main outcome measures:  Levels of satisfaction with lifestyle, practice and preparation for practice were compared across categories of respondents identified earlier. Open‐ended comments were coded by theme and also compared across categories of respondents.

Results:  While expressing their higher levels of satisfaction with rural lifestyle and professional practice, clinicians recruited from within rural communities report significant initial and ongoing stress related to personal–professional boundaries and dual relationships. They also report lower levels of satisfaction with orientation and preparation for practice relevant to dealing with these stressors.

Conclusion:  Prior attachment to rural communities, increasingly viewed as an effective recruitment and retention strategy, requires better preparation and ongoing supports to enable practitioners to deal with dual relationships and the personal–professional boundary issues that are a direct consequence of their attachments.
Reproductive bet‐hedging in a rare yet widespread rainforest tree, Syzygium paniculatum (Myrtaceae)
Authors: THURLBY KATIE A. G. , WILSON PETER G. , SHERWIN WILLIAM B. , CONNELLY CAROLYN , ROSSETTO MAURIZIO
Published: January 2012

The rare rainforest tree species, Syzygium paniculatum, is the only known Australian species of the genus to produce seeds that regularly have multiple embryos. Evidence from other species suggests that this is a case of adventitious polyembryony, with the embryos arising from maternal nucellar tissue. In the present study we use microsatellite data to determine whether sexual reproduction does occur and, if it does, to investigate the relative fitness of asexual versus sexual seedlings. Genotyping suggested that the species is a polyploid and our results found very little genetic diversity within and among populations (with a total of nine genotypic combinations across the entire species). The only significant variation was between the three northernmost populations and the other eight populations sampled. Analysis of individual embryos showed that sexually derived embryos did occur in some seeds but that these were not necessarily the fittest. In general, the seedling from the largest embryo is the first to emerge and maintains a competitive advantage over the other seedlings from the same seed. We discuss the ramifications of the low levels of genetic diversity and consider whether there is a direct relationship between polyembryony and the inferred polyploidy of the species. We consider the possible advantages of reproductive bet‐hedging but also highlight the susceptibility of a species with low genetic diversity to extreme stochastic events. Syzygium paniculatum occurs in areas heavily impacted by human activity and these findings should contribute to improved management of this threatened species.
Trends in colorectal cancer incidence rates in New Zealand, 1981–2004
Authors: Shah Ankit B. , Sarfati Diana , Blakely Tony , Atkinson June , Dennett Elizabeth R.
Published: January 2012

Background:  Incidence rates of colorectal cancer (CRC) in New Zealand rank among the highest worldwide. Internationally, there has been evidence of a shift in colon cancer from left‐ to right‐sided. The objective of this study was to determine trends in left‐ and right‐sided colon and rectal cancers incidence by sex, age and ethnicity.

Methods:  Using datasets created by linking data from the New Zealand Cancer Registry to the census data, we analysed a total of 47 694 CRCs from 1981 to 2004. Cancers were divided into right‐sided colon (cecum to the splenic flexure); left‐sided colon (descending and sigmoid colon); and rectal (rectosigmoid junction and rectum).

Results:  Left‐ and right‐sided colon, and rectal cancer incidence rates increased by 13–20% among men. In women, colon cancer rates increased by 25% for right‐sided cancers, decreased by 8% for left‐sided cancers and remained unchanged for rectal cancers. This corresponds with an increase in right‐sided cancers from 57% to 65% of total colon cancers in women. The incidence of all CRCs increased at a faster rate among Māori than non‐Māori.

Conclusion:  We identified a left‐ to right‐sided shift in colon cancer limited to women over the age of 65. While Māori trends in site distribution parallel those of their non‐Māori counterparts, the rapid increase in Māori incidence rates is noteworthy. It is unclear why such shifts in CRC site distribution are occurring.
Dispositional empathy modulates vicarious effects of dynamic pain expressions on spinal nociception, facial responses and acute pain
Authors: Mailhot Jean‐Philippe , Vachon‐Presseau Etienne , Jackson Philip L. , Rainville Pierre
Published: January 2012

Pain communication is thought to promote automatic vicarious self‐protective responses as well as empathic concern towards others’ suffering. This duality was recently highlighted in a study showing that highly empathic individuals display increased vicarious facilitation of low‐level pain processing (nociceptive flexion reflex, NFR) combined with an unexpected reduced facilitation of self‐pain perception (pain ratings) while viewing static pictures evoking pain in others. The present study sought to test further the moderating effects of dispositional empathy on vicarious responses induced by viewing dynamic pain expressions. Twenty‐four healthy volunteers viewed 1‐s videos showing different levels of pain expression before noxious electric shocks were delivered to the sural nerve. Viewing stronger pain expressions generally increased shock–pain unpleasantness ratings, the amplitude of the NFR, and facial responses (corrugator muscle) to the noxious stimulation. However, self‐pain ratings (intensity and unpleasantness) increased less or were reduced following clips of pain expression in individuals scoring higher on the Empathy Quotient. These results suggest that vicarious processes facilitate low‐level defensive responses, while the experience of self‐pain and the associated negative affect may be partly tuned‐down by higher‐order empathic processes.
Directional biases and resource‐dependence in dispersal generate spatial patterning in a consumer–producer model
Authors: Anderson Kurt E. , Hilker Frank M. , Nisbet Roger M.
Published: January 2012

Ecology Letters (2012)

Directional dispersal plays a large role in shaping ecological processes in diverse systems such as rivers, coastlines and vegetation communities. We describe an instability driven by directional dispersal in a spatially explicit consumer–producer model where spatial patterns emerge in the absence of external environmental variation. Dispersal of the consumer has both undirected and directed components that are functions of producer biomass. We demonstrate that directional dispersal is required for the instability, while undirected diffusive dispersal sets a lower bound to the spatial scale of emerging patterns. Furthermore, instability requires indirect feedbacks affecting consumer per capita dispersal rates, and not activator–inhibitor dynamics affecting production and mortality as is described in previous theory. This novel and less‐restrictive mechanism for generating spatial patterns can arise over realistic parameter values, which we explore using an empirically inspired model and data on stream macroinvertebrates.
Senescence and age‐specific trade‐offs between reproduction and survival in female Asian elephants
Authors: Robinson Matthew R. , Mar Khyne U , Lummaa Virpi
Published: January 2012

Although studies on laboratory species and natural populations of vertebrates have shown reproduction to impair later performance, little is known of the age‐specific associations between reproduction and survival, and how such findings apply to the ageing of large, long‐lived species. Herein we develop a framework to examine population‐level patterns of reproduction and survival across lifespan in long‐lived organisms, and decompose those changes into individual‐level effects, and the effects of age‐specific trade‐offs between fitness components. We apply this to an extensive longitudinal dataset on female semi‐captive Asian timber elephants (Elephas maximus) and report the first evidence of age‐specific fitness declines that are driven by age‐specific associations between fitness components in a long‐lived mammal. Associations between reproduction and survival are positive in early life, but negative in later life with up to 71% of later‐life survival declines associated with investing in the production of offspring within this population of this critically endangered species.
Implications of sentinel lymph node mapping on nodal staging and prognosis in colorectal cancer
Authors: van der Zaag E. S. , Bouma W. H. , Peters H. M. , Bemelman W. A. , Buskens C. J.
Published: January 2012

Aim  Sentinel lymph node (SN) mapping for staging in colorectal cancer remains controversial and needs to be validated before it can be implemented in daily practice. We prospectively assessed the effect of SN mapping on nodal staging and its implication on survival in patients with colorectal cancer.

Method  Between November 2005 and July 2009, 331 patients underwent a resection for colorectal cancer. In 189 patients (group A) an ex‐vivo SN procedure was performed with immunohistochemical analysis of the SN. Tumour cell deposits between 0.2 mm and 2.0 mm were referred to as micrometastases (pN1mi+). The remaining patients (n = 142, group B) had standard nodal staging. Multivariate Cox regression analysis was performed to identify prognostic factors for disease recurrence.

Results  The average number of harvested lymph nodes was higher in group A than in group B (15.5 ± 7.3 vs 12.1 ± 5.2, P < 0.0001). After conventional staging, 81 (43%) patients of group A were judged to have nodal metastasis. This increased to 89 (47%) patients when immunohistochemically detected micrometastases were included. In group B, 50 (35%) patients had nodal metastasis. During follow up, a lower recurrence rate was seen in N0 patients after SN mapping compared with the conventional staging group (4%vs 15.2%, P = 0.04). The SN procedure (hazard ratio = 4.1) was an independent predictor of disease recurrence.

Conclusion  The SN procedure results in a more accurate staging of patients with colorectal cancer. This is reflected by a better prognosis of N0 patients after SN mapping.
Correlation of circulating dehydroepiandrosterone with activated protein C generation and carotid intima‐media thickness in male patients with Type 2 diabetes
Authors: Suzuki T. , Yano Y. , Sakamoto M. , Uemura M. , Yasuma T. , Onishi Y. , Sasaki R. , Matsumoto K. , Hayashi T. , Maruyama‐Furuta N. , Akatsuka H. , Gabazza E. C. , Sumida Y. , Takei Y.
Published: January 2012

Diabet. Med. 29, e41–e46 (2012)

Aims  Dehydroepiandrosterone exerts a protective effect against cardiovascular diseases. However, the relationship of dehydroepiandrosterone with the anticoagulant factor activated protein C, generated by the thrombin–thrombomodulin complex on vascular endothelial cells, remains unknown. This study aimed at studying the relationship between dehydroepiandrosterone and activated protein C generation in patients with Type 2 diabetes.

Methods  Sixty‐two male patients with Type 2 diabetes were enrolled in this study. Data obtained from 40 healthy male subjects were used as controls. The plasma levels of dehydroepiandrosterone, the activated protein C–protein C inhibitor complex, high‐sensitivity C‐reactive protein and monocyte chemoattractant protein‐1 were measured by enzyme immunoassays. Carotid intima‐media thickness was measured by ultrasonography.

Results  The plasma levels of dehydroepiandrosterone (5.15 ± 2.81 vs. 3.76 ± 2.16 ng/ml; P < 0.005) and the activated protein C–protein C inhibitor complex (1.90 ± 1.07 vs. 1.02 ± 0.51 ng/ml; P < 0.001) were significantly lower in patients with diabetes than in normal subjects. Univariate analysis showed a significant correlation of the plasma level of dehydroepiandrosterone with that of the activated protein C–protein C inhibitor complex (r = 0.48, P < 0.001), high‐sensitivity C‐reactive protein (r = −0.30, P < 0.05) and with the mean intima‐media thickness (r = −0.28, P < 0.05) in patients with diabetes. Stepwise multiple regression analysis showed that the plasma level of dehydroepiandrosterone is significantly correlated with the plasma levels of the activated protein C–protein C inhibitor complex (F = 18.06) and high‐sensitivity C‐reactive protein (F = 4.94). There was no correlation between the plasma levels of dehydroepiandrosterone and monocyte chemoattractant protein‐1.

Conclusions  These results suggest that lower circulating levels of dehydroepiandrosterone are associated with decreased activated protein C generation and higher intima‐media thickness in patients with Type 2 diabetes.
Targeted treatment of invasive fungal infections accelerates healing of foot wounds in patients with Type 2 diabetes
Authors: Chellan G. , Neethu K , Varma A. K. , Mangalanandan T. S. , Shashikala S. , Dinesh K. R. , Sundaram K. R. , Varma N. , Jayakumar R. V. , Bal A. , Kumar H.
Published: January 2012

Diabet. Med. 29, e255‐e262 (2012)

Aim  To test the hypothesis that fluconazole plus standard care is superior to the standard care for diabetic foot wounds infected with deep‐seated fungal infections.

Methods  We carried out a randomized, controlled, open‐label, parallel‐arm study in 75 patients with both fungal and bacterial infections in deep tissues of diabetic foot wounds. Thirty‐seven patients (control group) were given standard care (surgical debridement + culture‐specific antibiotics + offloading + glycaemic control) and 38 patients (treatment group) were given fluconazole 150 mg daily plus standard care. Wound surface area was measured every 2 weeks until the endpoints (complete epithelialization or skin grafting) were met.

Results  By week 4, the mean wound surface area reduced to 27.3 from 111.5 cm2 in the treatment group, as opposed to 67.1 from 87.3 cm2 in the control group. Subsequently, the mean wound surface areas were remarkably smaller in the treatment group compared with the control group, and statistically significant differences (P ≤ 0.05) in mean wound surface area were observed between the treatment group and the control group at week 6. However, no statistically significant (P ≤ 0.47) difference in complete healing was observed between the treatment group and the control group, 20 vs. 24. The mean wound healing time for the treatment group was 7.3 weeks, whereas for the control group it was 11.3 weeks (P ≤ 0.022). Similarly, the probability of wound healing in the treatment group was 50 vs. 20% in the control group at week 10.

Conclusions  Fluconazole plus standard care was superior to standard care alone in accelerating wound reduction among patients with diabetes with deep‐seated fungal infections in diabetic foot wounds. Those in the treatment group who did heal, healed more quickly (P ≤ 0.022), but overall healing was not different.
Regional differences in the prevalence of known Type 2 diabetes mellitus in 45–74 years old individuals: Results from six population‐based studies in Germany (DIAB‐CORE Consortium)
Authors: Schipf S. , Werner A. , Tamayo T. , Holle R. , Schunk M. , Maier W. , Meisinger C. , Thorand B. , Berger K. , Mueller G. , Moebus S. , Bokhof B. , Kluttig A. , Greiser K. H. , Neuhauser H. , Ellert U. , Icks A. , Rathmann W. , Völzke H.
Published: January 2012

Diabet. Med. 29, e88–e95 (2012)

Aim  In Germany, regional data on the prevalence of Type 2 diabetes mellitus are lacking for health‐care planning and detection of risk factors associated with this disease. We analysed regional variations in the prevalence of Type 2 diabetes and treatment with antidiabetic agents.

Methods  Data of subjects aged 45–74 years from five regional population‐based studies and one nationwide study conducted between 1997 and 2006 were analysed. Information on self‐reported diabetes, treatment, and diagnosis of diabetes were compared. Type 2 diabetes prevalence estimates (95% confidence interval) from regional studies were directly standardized to the German population (31 December 2007).

Results  Of the 11 688 participants of the regional studies, 1008 had known Type 2 diabetes, corresponding to a prevalence of 8.6% (8.1–9.1%). For the nationwide study, a prevalence of 8.2% (7.3–9.2%) was estimated. Prevalence was higher in men (9.7%; 8.9–10.4%) than in women (7.6%; 6.9–8.3%). The regional standardized prevalence was highest in the east with 12.0% (10.3–13.7%) and lowest in the south with 5.8% (4.9–6.7%). Among persons with Type 2 diabetes, treatment with oral antidiabetic agents was more frequently reported in the south (56.9%) and less in the northeast (46.0%), whereas treatment with insulin alone was more frequently reported in the northeast (21.6%) than in the south (16.4%).

Conclusion  The prevalence of known Type 2 diabetes showed a southwest‐to‐northeast gradient within Germany, which is in accord with regional differences in the distribution of risk factors for Type 2 diabetes. Furthermore, the treatment with antidiabetic agents showed regional differences.
Innovation for Inclusive Growth: Towards a Theoretical Framework and a Research Agenda
Authors: George Gerard , McGahan Anita M. , Prabhu Jaideep
Published: January 2012

abstract

Inclusive innovation, which we define as innovation that benefits the disenfranchised, is a process as well as a performance outcome. Consideration of inclusive innovation points to inequalities that may arise in the development and commercialization of innovations, and also acknowledges the inequalities that may occur as a result of value creation and capture. We outline opportunities for the development of theory and empirical research around this construct in the fields of entrepreneurship, strategy, and marketing. We aim for a synthesis in views of inclusive innovation and call for future research that deals directly with value creation and the distributional consequences of innovation.
The Rural Creative Class: Counterurbanisation and Entrepreneurship in the Danish Countryside
Authors: Herslund Lise
Published: January 2012

The paper discusses why well educated urban dwellers choose to move to rural areas and start micro businesses, the problems they face, how they try to solve these problems and the implications for rural development. With a dwelling far from the city, the well‐educated in‐migrants start businesses which seek to combine a less stressful everyday life with a continued career. In the start‐up phase, the majority of businesses is in the knowledge sectors, within media and business services, and is oriented towards the metropolitan market. Few businesses seek to private services for the local market. After some years in the countryside, however, the businesses evolve into ‘regional lifestyle businesses’. They remain within the urban sector but have now adapted themselves to the regional market in order to minimise time spent on meeting customers in the city. These rural entrepreneurs combine a small number of well‐established customers in the city with a broader array of services directed toward the regional market. Although their impact on the local rural area is minimal, they operate over a larger regional area, extending networks and providing ‘organisational energy’.