bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of the Child's Challenging Behaviour Scale (CCBS) for mothers of school‐aged children with disabilities
Authors: Bourke‐Taylor H. , Law M. , Howie L. , Pallant J. F.
Published: December 2009

Background  Caring for a child with a disability can be especially difficult when the child exhibits challenging behaviours. Childhood disability often calls for the mother to be conscientious, capable and organized to meet the child's health and developmental needs. Mothers are known to feel particularly stressed when their child also behaves in ways that are difficult to manage. In these circumstances maternal mental health may be compromised and mothers therefore need more support. The Child's Challenging Behaviour Scale (CCBS) is an 11‐item scale that measures a mother's report of challenging behaviours exhibited by their child with disability, that are associated with compromised maternal mental health and caregiving difficulties. This paper describes the initial development and psychometric evaluation of the CCBS.

Methods  A mixed methodology instrument design model was used to develop the CCBS. A qualitative study generated items, and quantitative data were collected from 152 mothers of a child with a disability.

Results  The CCBS showed excellent internal consistency (Cronbach's alpha = 0.89) and factor analysis supported its unidimensionality. Construct validity was supported by correlations with the PedsQL Psychosocial Health Summary Score (rho =−0.51) and cooperation taking medication (rho = 0.40). There were significant differences in CCBS scores between groups of children with and without either autism or psychiatric conditions. The CCBS showed moderate correlations with self‐reported health status; the mother's sense of empowerment (rho =−0.44); and family cohesion (rho =−0.30). Mothers with a mental health condition recorded significantly higher CCBS scores.

Conclusions  The CCBS is a brief, psychometrically sound instrument that provides clinicians with a new tool that measures a mother's rating of their child's behaviours that are challenging and associated with reduced maternal well‐being. The CCBS assists professionals to identify mothers and family situations who may be in need of more support and interventions.
The continuum of growth hormone–IGF‐I axis defects causing short stature: diagnostic and therapeutic challenges
Authors: Savage Martin O. , Burren Christine P. , Rosenfeld Ron G.
Published: December 2009

The growth hormone (GH)–IGF‐I axis is essential for normal foetal and childhood growth. Defects at different sites in the axis frequently result in short stature which may compromise adult height. We describe a continuum of clinically relevant abnormalities from GH deficiency through to GH resistance and discuss the implementation and interpretation of investigations. We consider appropriate therapy for patients with abnormal auxology and subnormal adult height prognosis, highlighting new data to clarify therapeutic choices leading to optimal clinical outcome.
Iron stores, liver transaminase levels and metabolic risk in healthy teenagers
Authors: Aigner E. , Hinz C. , Steiner K. , Rossmann B. , Pfleger J. , Hohla F. , Steger B. , Stadlmayr A. , Patsch W. , Datz C.
Published: December 2009

Eur J Clin Invest 2010; 40 (2): 155–163

Background  Iron overload may contribute to the pathogenesis of insulin resistance. We aimed to investigate the relationship among iron stores, liver transaminases and components of the metabolic syndrome in healthy teenagers in a cross‐sectional study.

Material and methods  We determined body mass index (BMI), waist‐to‐hip‐ratio (WHR), blood pressure, liver ultrasound, serum lipids, insulin, fasting glucose, liver transaminase levels, hsCRP, iron parameters in 325 of 341 (95·3%) students (234 men, 16·7 ± 1·7 years; 91 women, 16·5 ± 1·7 years) of one single high school. Male and female study participants were allocated to increasing quartiles of body iron stores as assessed by sTfr/ferritin and alanine aminotranspeptidase (ALT) levels, and the distribution of cardiometabolic risk factors along quartiles was analysed. Regression analysis was performed to confirm the independent relationship between parameters.

Results  In male students, BMI, WHR, systolic and diastolic blood pressure, serum triglyceride levels and hsCRP were higher in the top sTfR/ferritin and ALT quartiles compared with the lowest quartiles (P < 0·01 for all parameters). In female students, sTfR/ferritin were not associated with antropomorphic cardiometabolic risk factors but with insulin resistance (HOMA‐IR, P = 0·046). Moreover, ALT levels were independently related to BMI, waist and hip circumference, systolic blood pressure, serum triglyceride and insulin concentrations (P < 0·05 for all parameters) in female students.

Conclusion  These results provide evidence for linkage among body iron stores, transaminase activity and the prevalence of cardiometabolic risk factors in apparently healthy, non‐obese adolescents even within the range of normal laboratory and anthropomorphic values and suggest that iron stores should be investigated as a potentially modifiable risk factor in healthy teenagers.
Industry sponsorship and selection of comparators in randomized clinical trials
Authors: Lathyris D. N. , Patsopoulos N. A. , Salanti G. , Ioannidis J. P. A.
Published: December 2009

Eur J Clin Invest 2010; 40 (2): 172–182

Background  Most clinical trials on medical interventions are sponsored by the industry. The choice of comparators shapes the accumulated evidence. We aimed to assess how often major companies sponsor trials that involve only their own products.

Methods  Studies were identified by searching ClinicalTrials.gov for trials registered in 2006. We focused on randomized trials involving the 15 companies that had sponsored the largest number of registered trials in ClinicalTrials.gov in that period.

Results  Overall, 577 randomized trials were eligible for analysis and 82% had a single industry sponsor [89% (166/187) of the placebo‐control trials, 87% (91/105) of trials comparing different doses or ways of administration of the same intervention, and 78% (221/285) of other active control trials]. The compared intervention(s) belonged to a single company in 67% of the trials (89%, 81% and 47% in the three categories respectively). All 15 companies strongly preferred to run trials where they were the only industry sponsor or even the only owner of the assessed interventions. Co‐sponsorship typically reflected co‐ownership of the same intervention by both companies. Head‐to‐head comparison of different active interventions developed by different companies occurred in only 18 trials with two or more industry sponsors.

Conclusions  Each company generates a clinical research agenda that is strongly focused on its own products, while comparisons involving different interventions from different companies are uncommon. This diminishes the ability to understand the relative merits of different interventions for the same condition.
Plant traits, leaf palatability and litter decomposability for co‐occurring woody species differing in invasion status and nitrogen fixation ability
Authors: Kurokawa Hiroko , Peltzer Duane A. , Wardle David A.
Published: December 2009

1. Non‐native invasive and nitrogen (N)‐fixing plant species can cause large ecosystem‐level impacts, particularly when they differ in functionally important plant traits from native and non N‐fixing species. However, it remains unclear as to whether and how plant invasion status and N fixation ability consistently influence key plant leaf and litter traits, and trait‐driven processes like herbivory and decomposition.

2. We compared leaf and litter traits, leaf palatability and litter decomposability for 41 co‐occurring woody species, including native N‐fixers, native non N‐fixers, invasive N‐fixers and invasive non N‐fixers, from a New Zealand floodplain. We tested the hypotheses that: (i) invasive and N‐fixing species have higher foliar N and specific leaf area, and lower concentrations of defensive phenolics and structural compounds than do native and non N‐fixing species, and (ii) invasive and N‐fixing species generally produce more decomposable litter and palatable foliage than do native and non N‐fixing species.

3. Consistent with our hypotheses, invaders had higher foliar N and N : P ratio, and lower C : N ratio, than did native species. However, in contrast to our hypotheses, foliar phenolics were higher for the invaders while other leaf and litter traits were unaffected by invasion status. Further, N‐fixers had higher N and N : P ratios, and lower C : N ratios than did non N‐fixers, but other leaf and litter traits were unaffected by N fixation ability.

4. Leaf palatability was unaffected by invasion status but was higher for N‐fixers than for non N‐fixers. Litter decomposability was unaffected both by invasion status and N fixation ability. We found a significant positive relationship between leaf palatability and litter decomposability across all species, because similar traits, particularly the C : P ratio and total phenolic concentrations of plant tissues, were correlated with both processes.

5. Our results demonstrate that a small number of key traits, such as C : P ratio and total phenolic concentrations, drive both herbivory and decomposition irrespective of plant invasion status or N fixation ability. As such, they highlight that interspecific differences in particular plant traits, rather than plant functional group memberships based on invasion status and N fixation ability, are more effective in predicting palatability and decomposability.
Ecophysiological significance of leaf size variation in Proteaceae from the Cape Floristic Region
Authors: Yates Megan J. , Anthony Verboom G. , Rebelo Anthony G. , Cramer Michael D.
Published: December 2009

1. Small leaves of species endemic to Mediterranean‐type climate areas have been associated with both low rainfall and nutrient availability, but the physiological reasons for this association remain unknown.

2. We postulated that small leaves have thin boundary layers that facilitate transpiration in winter and sensible heat loss in summer. High transpiration rates when water is available may facilitate nutrient acquisition in winter, whereas efficient sensible heat loss reduces the requirement for transpirational leaf cooling in summer.

3. The consequences of varying leaf sizes for water and heat loss in Cape Proteaceae were examined at two scales. At the leaf level, gas exchange and thermoregulatory capacities of 15 Proteaceae species with varying leaf size were assessed under controlled conditions using phylogenetically independent contrasts. At an environmental level, leaf attributes of Proteaceae occurring in the winter‐rainfall area of the Cape Floristic Region were correlated with climatic environments derived from distribution data for each species.

4. Leaf temperature was positively correlated with leaf size when wind speed was negligible. However, transpiration decreased significantly with increasing leaf size when measured on individual leaves, detached branches and when expressed on a per stoma basis.

5. From multiple stepwise regression analysis of climatic variables obtained from distribution data, leaf size was negatively correlated with A‐Pan evaporation, mean annual temperatures and water stress in January. We conclude that leaf size is conservative for survival over relatively rare periods of hot dry conditions with low wind speeds.

6. Narrow leaves enable plants to shed heat through sensible heat loss during summer droughts, without the need for transpirational cooling. Additionally, small leaf dimensions confer a capacity for high transpiration when evaporative demand is low and water is abundant (i.e. winter). This may be a particularly important strategy for driving nutrient mass‐flow to the roots of plants that take up most of their nutrients in the wet winter/spring months from nutrient‐poor soils.
Interlocus non‐random association of multiallelic polymorphisms spanning the coagulation factor VIII gene on human chromosome distalmost Xq28
Authors: MEDINA‐ACOSTA E.
Published: December 2009

Summary.  The most common severe hereditary bleeding disorder phenotype in humans, the coagulation factor VIII (F8) deficiency haemophilia A (HEMA), maps on Xq28 band, a region that comprises 11.7% of genes and 14.2% of phenotypes on X chromosome. Information about the distribution and extent of gametic disequilibrium (GD) covering the F8 gene is scarce, despite its relevance for linkage and association studies. The aim of this study was to determine the patterns, by frequency and strength, of non‐random multiallelic interallelic associations between two‐locus combinations of seven microsatellite loci (REN90833, F8Int25.2, F8Int22, F8Int13.2, HEMA154311.3, TMLHEInt5 and HEMA154507.3, in that physical order) spanning 0.813 Mb on distalmost Xq28. We measured sign‐based interallelic D′ coefficients in 106 men and in 100 women drawn from a single unrelated Brazilian population. Significance and patterns of GD using haploid and phased diploid sample probabilities were close to conformity. Only 9.18% of the variance of D′ could be accounted for by changes in length, indicating that GD is not a monotonically decreasing function of length. We defined two regions of overlapping long‐range GD extending 698 735 base pairs (bp) (REN90833/TMLHEInt5 block) and 689 900 bp (F8Int13.2/HEMA154507.3 block) The extent of GD overlap is 575 637 bp (F8Int13.2/TMLHEInt5 interstice). Extended haplotype homozygosity analysis centred at the F8 intronic loci revealed that the most frequent core haplotypes decay the least in the flanking GD. The F8 intronic loci attend distinct non‐random association forces; F8Int13.2 serves at maintenance of the long‐range overlapping pattern of GD, whereas F8Int25.2 and F8Int22 serve at lessening it in force or effect.
Diagnostic sensitivity and specificity of different methods used by two laboratories for the detection of Phytophthora ramorum on multiple natural hosts
Authors: Vettraino A. M. , Sukno S. , Vannini A. , Garbelotto M.
Published: December 2009

Five detection methods were comparatively tested on putative Phytophthora ramorum field samples from 41 wild plant species. The tested methods included two culture‐based assays, a DAS‐ELISA‐based polyclonal assay, a nested PCR‐based assay, and a TaqMan real‐time PCR assay. Diagnostic values including sensitivity, specificity, positive predictive value and negative predictive value were calculated for each method. The effects of host species, seasonality and host location were analysed and compared between two laboratories. Significant effects of season, host species and laboratory were detected. It is concluded that a combination of either culturing and molecular diagnosis or of two molecular assays is the most promising approach to diagnose this pathogen. Based on the results of this and other studies, diagnosis should occur as much as possible during wet and warm periods favourable to the pathogen, and proficiency tests should be performed to compare results obtained with molecular approaches in different laboratories. Furthermore, length of time lapsed between sample collection and processing strongly affected the diagnostic sensitivity of culture‐based methods, and therefore needs to be taken into account when comparing results from different laboratories.
Role of rainfall in the development of coffee berry disease in Coffea arabica caused by Colletotrichum kahawae, in Cameroon
Authors: Mouen Bedimo J. A. , Bieysse D. , Nyassé S. , Nottéghem J. L. , Cilas C.
Published: December 2009

The development of coffee berry disease (CBD) epidemics (caused by Colletotrichum kahawae) in Cameroon was monitored over two successive years (2004 and 2005) on coffee trees protected from rainfall by transparent plastic sheets and on unprotected control trees. This work was done to assess how rain affected disease development when it did not fall directly onto the coffee trees and to determine the influence of primary inoculum on the severity of CBD. Weekly observations over the 2 years showed that there were 1·1% diseased berries on coffee trees completely protected from rainfall, compared with 45% diseased berries on unprotected coffee trees. Disease severity on unprotected trees during the 2 years of the experiment was estimated at 53% diseased berries, compared with 27% on trees only protected in the first year. These results confirmed rainfall as one of the key physical factors in the development of Arabica CBD. They also provided evidence of a subsequent effect of protecting coffee trees from rainfall in 2004 on the severity of CBD in 2005. This suggested some practices that might lead to very effective cultural control of CBD in regions where severe epidemics of the disease occur.
Haplotype diversity of Tilletiopsis spp. causing white haze in apple orchards in Northern Italy
Authors: Baric S. , Lindner L. , Marschall K. , Dalla Via J.
Published: December 2009

White haze (WH), a manifestation of extensive colonization of anamorphic smut fungi of the genus Tilletiopsis on the surface of apple fruit, has recently been described as a new postharvest disorder of the cultivar Elstar. This study shows that these fungi can also affect apple fruit of different cultivars prior to harvest, and therefore seriously compromise the quality of the produce in Northern Italy. In order to identify the Tilletiopsis taxa involved in the induction of WH in this region, 48 isolates, mainly derived from fruit samples, were analysed by DNA sequencing of the internal transcribed spacer region. Six haplotypes were identified that could be assigned to three different phylogenetic lineages, the T. washingtonensis group, the T. pallescens group and the Entylomataceae. More than 40% of the isolates were classified as T. washingtonensis which had not previously been associated with WH. Furthermore, this is the first study that reports the occurrence of this species on field‐grown fruit samples. The extensive overgrowth of apple fruit by Tilletiopsis spp., appearing erratically in the last decade, may be a consequence of moist weather conditions and novel cultural practices, such as the use of hail nets and the intensive application of foliar nutrients.
An effective system for detecting Iris yellow spot virus transmission by Thrips tabaci
Authors: Inoue T. , Murai T. , Natsuaki T.
Published: December 2009

A simple, effective and convenient laboratory leaf system was developed to detect transmission of Iris yellow spot virus (IYSV) by thrips. It was shown that IYSV was transmitted highly efficiently by adults and also by larvae of five thelytokous populations of Thripstabaci from distinct areas in Japan: over all these populations, transmission efficiency of adults ranged from 20·4% (19/93) to 41·1% (76/185) and that of larvae from 17·3% (14/81) to 44·1% (67/152). Finally, it was demonstrated that IYSV infection was not detrimental to the development and fecundity of thrips until early adulthood. Larval mortalities of virus‐exposed thrips were higher than in their unexposed counterparts in all three populations, but the differences were not significant. The results demonstrated that T. tabaci populations have considerable potential to cause outbreaks of IYSV and spread the disease because of their efficient transmission of the virus.
A comparative study of Turkish and Israeli populations of Didymella rabiei, the ascochyta blight pathogen of chickpea
Authors: Ozkilinc H. , Frenkel O. , Abbo S. , Eshed R. , Sherman A. , Shtienberg D. , Ophir R. , Can C.
Published: December 2009

The Fertile Crescent is the centre of domestication of chickpea (Cicer arietinum) and also the place of origin of its pathogens. Agrosystems provide different environments to natural eco‐systems, thus imposing different types of selection on pathogens. Here, the genetic structure and in vitro temperature growth response of the chickpea pathogen Didymella rabiei from domesticated chickpea (59 isolates from Turkey and 31 from Israel) and wild Cicer spp. (three isolates from Turkish C. pinnatifidum and 35 from Israeli C. judaicum) were studied. Six sequence‐tagged microsatellite site (STMS) primer pairs were used to determine the genetic structure of the 128 D. rabiei isolates. Turkish isolates exhibited the highest genetic diversity (H = 0·69). Turkish and Israeli D. rabiei from domesticated chickpea were genetically closer to each other than isolates from the wild Cicer spp. Analysis of molecular variance showed that 54% of the genetic variation resided between isolates from wild and domesticated origins. EF1‐α sequences distinguished between D. rabiei isolates from domesticated and wild Cicer spp. by four polymorphic sites. Nevertheless, a certain degree of mixing between isolates from wild and domesticated origin was demonstrated using the Bayesian algorithm as well as with principal coordinates analysis. Isolates sampled from domesticated chickpea from both countries were better adapted to temperatures typical of Levantine spring and had a significantly larger colony area at 25°C than at 15°C (typical Levantine winter temperature). These observations were in accordance to the heritability values of the temperature growth response.
Biocontrol of sclerotinia stem rot (Sclerotinia sclerotiorum) of soybean using novel Bacillus subtilis strain SB24 under control conditions
Authors: Zhang J. X. , Xue A. G.
Published: December 2009

Sclerotinia stem rot (SSR), caused by Sclerotinia sclerotiorum, is a major disease of soybean in Canada. Laboratory and greenhouse experiments were conducted to evaluate potential effectiveness of cell suspensions, cell‐free culture filtrates and broth cultures of Bacillus subtilis strain SB24 for suppression of SSR. The SB24 cell suspensions and cell‐free culture filtrates significantly reduced mycelial growth of S. sclerotiorum by 50 to 75% and suppressed sclerotial formation by > 90%. The severity on soybean was negatively correlated (r < −0·84, P < 0·01) to the concentrations of cell suspension, cell‐free culture filtrate and broth culture applied. The cell suspension and broth culture preparations significantly (P < 0·01) reduced SSR severity by 45 to 90% at concentrations ranging from 5 × 106 to 109 CFU mL−1. The most effective concentration was 5 × 108 CFU mL−1 for all three preparations, reducing the severity by 60 to 90%. The B. subtilis SB24 was most effective in reducing disease severity when applied ≤ 24 h before plant inoculation with S. sclerotiorum and a significant effectiveness was observed up to 15 days after plant inoculation. The population density of B. subtilis on soybean leaves decreased by 1·5 to 2·5 log units over 15 days under field conditions, and by 0·8 log units over 5 weeks under control conditions. The decrease in population density was significantly correlated with rainfall in the field (r < −0·93, P < 0·01), suggesting that the biocontrol bacteria may be washed away by rain.
Significance of patient self‐monitoring for long‐term outcomes after lung transplantation
Authors: Kugler Christiane , Gottlieb Jens , Dierich Martin , Haverich Axel , Strueber Martin , Welte Tobias , Simon Andre
Published: December 2009

Kugler C, Gottlieb J, Dierich M, Haverich A, Strueber M, Welte T, Simon A. Significance of patient self‐monitoring for long‐term outcomes after lung transplantation. Clin Transplant 2009 DOI: 10.1111/j.1399‐0012.2009.01197.x © 2009 John Wiley & Sons A/S.

Abstract:  Background:  Lung transplant (LTx) recipients’ adherence to regular self‐monitoring of lung function (SMLF) is important in maintaining health. This study investigated patients’ behavior based on electronic monitoring (EM) and compared these findings with self‐reported data.

Methods:  This single‐center study included 269 patients following LTx. Patients reported on adherence regarding SMLF, and data were compared to electronically stored measurements for the last three months prior to self‐reporting.

Results:  Non‐adherence was 59.4% based on EM for a total of 22 052 measurements performed. Main reported reasons for non‐adherence were forgetfulness (22%), lack of time (19%), and good self‐perception of health status (19%). Determinants for non‐adherence were patients constraining beliefs (p ≤ 0.0001), low perceived support from the transplant center (p ≤ 0.008), a history of infections (p ≤ 0.014) and rejections (p ≤ 0.043), and bronchiolitis obliterans (p ≤ 0.006). Multiple logistic regression revealed low‐perceived support from the transplant center (OR 3.22; 95% CI 1.32–7.83; p < 0.01), and lack of support from patient organizations (OR 2.19; 95% CI 1.02–4.72; p < 0.04) as independent predictors for non‐adherence.

Conclusions:  LTx recipients had some difficulties maintaining SMLF on a daily basis. Non‐adherence regarding lung function monitoring may provide a clinically relevant estimate of suspect cases for critical events impacting outcomes after LTx.
Unilateral Beau's lines associated with a fractured olecranon
Authors: Avery Helen , Cooper Hywel L , Karim Amin
Published: December 2009

We report a case of unilateral Beau's lines developing after an olecranon fracture of the right elbow. Unilateral Beau's lines are an uncommon phenomenon but have been previously reported after trauma to the wrist, hands, forearm and elbow.
Population‐based study of cystic fibrosis disease severity and haemochromatosis gene mutations
Authors: PRATAP Upasna , QUINN Stephen , BLIZZARD Leigh B. , REID David W.
Published: December 2009

Background and objective:  Haemochromatosis (HFE) mutations increase the risk of bowel obstruction in cystic fibrosis (CF), but the impact on other disease manifestations is unknown.

Methods:  We determined the prevalence of HFE mutations (C282Y and H63D) in the Tasmanian CF population and assessed the relationship to systemic iron stores, Pseudomonas aeruginosa infection, lung disease severity and prevalence of diabetes.

Results:  DNA was obtained from 82 individuals (96% of the entire CF population); 19 (23.2%) were H63D heterozygotes, three (3.7%) were H63D homozygotes and two patients were compound C282Y/H63D (2.4%). Seven (8.5%) patients were heterozygous for the C282Y mutation. Overall, 31 (37.8%) patients carried a HFE mutation. CF patients possessing HFE mutations had significantly better iron stores than non‐carriers (P < 0.05). The mean slopes of annual decline in FEV1 and FVC % predicted were significantly steeper in HFE carriers compared with non‐carriers (P < 0.01). Patients with HFE mutations were more likely to have had childhood bowel obstruction (RR 2.44, 95% CI: 1.04–5.74, P < 0.05). Diabetes was more common in HFE carriers (RR 2.96, 95% CI: 0.99–8.8, P = 0.05), but this effect attenuated when corrected for age (RR 2.89, 95% CI: 0.91–9.21, P = 0.07).

Conclusions:  HFE gene mutations modify disease severity in CF, through probable effects on iron homeostasis.
Stopping tuberculosis in the 21st century: Goals and strategies
Authors: ONOZAKI Ikushi , RAVIGLIONE Mario
Published: December 2009

The Stop TB Strategy and the Global Plan to Stop TB were launched in 2006 to achieve the tuberculosis (TB)‐related Millennium Development Goals and the Stop TB Partnership targets, and to address new challenges such as that of HIV‐associated TB and multi‐drug‐resistant TB. This paper reviews the historical and recent progress in TB control to show what has changed since the introduction of directly observed therapy (DOTS) in the mid‐1990s, why we needed the new strategy and what the global agenda is today. Major progress was seen in most countries in the last two decades. Globally, the estimated rates of TB prevalence and mortality are declining, but not quickly enough to reach the 2015 Stop TB Partnership targets of halving TB prevalence and death rates compared with 1990. In 2007, it was estimated that more than one‐third of TB patients were not detected or properly treated under proper conditions. Enhancing case detection, while maintaining high treatment success rates, is essential to achieve the 2015 targets. The ultimate goal of TB control is the elimination of the disease as a public health problem. The Stop TB Partnership aims at eliminating TB by 2050 by reaching a global incidence of disease of less than one case per million population. This target will not be achieved unless TB control efforts are further intensified and effective and affordable new technologies to prevent both disease and infection are developed and rapidly introduced in all countries worldwide.
Lung cancer: Progress in diagnosis, staging and therapy
Authors: SPIRO Stephen G. , TANNER Nichole T. , SILVESTRI Gerard A. , JANES Sam M. , LIM Eric , VANSTEENKISTE Johan F. , PIRKER Robert
Published: December 2009

Lung cancer remains one of the greatest medical challenges with nearly 1.5 million new cases worldwide each year and a growing tobacco epidemic in the developing world. This review summarizes briefly the current status in growing areas of clinical research. The value of screening for early disease is not yet established and trials to see if mortality can be improved as a result are in progress. Better and more accurate staging will both streamline investigation and prove cost‐effective once ultrasound‐guided biopsy and aspiration of mediastinal nodes become universally accepted. This, allied to the new staging classification, will improve selection of cases for surgery, intensive multimodality therapy and for adjuvant treatment postoperatively. Much still needs to be done to refine staging as within a particular stage group, the outcome shows great variation. More information is needed on the genetic make‐up in some groups of tumours and not just their size; that is, more biological data on tumour growth patterns are likely to be at least as discriminating. The place of the stem cell theory of tumorigenesis is also explored in this paper. Finally, targeted therapy for advanced non‐small‐cell lung cancer is highlighted as a development with early promise, but still much clarification is required, before it can be considered as a universal approach in late disease.
Clinical characteristics of combined pulmonary fibrosis and emphysema
Authors: KITAGUCHI Yoshiaki , FUJIMOTO Keisaku , HANAOKA Masayuki , KAWAKAMI Satoshi , HONDA Takayuki , KUBO Keishi
Published: December 2009

Background and objective:  Patients with combined pulmonary fibrosis and emphysema (CPFE) are sometimes seen, and we speculate that these patients have some different clinical characteristics from COPD patients. This study clarifies the clinical characteristics of CPFE patients.

Methods:  This was a retrospective study of 47 stable patients with concurrent emphysema and diffuse parenchymal lung disease with fibrosis, based on the findings of chest CT (CPFE patients). The clinical characteristics of CPFE patients were compared with those of emphysema‐dominant COPD patients without parenchymal lung disease (COPD patients).

Results:  Forty‐six of the 47 CPFE patients were male. Paraseptal emphysema was particularly common in the CPFE group. Honeycombing, ground‐glass opacities and reticular opacities were present in 75.6%, 62.2% and 84.4% of CPFE patients, respectively. Twenty‐two of the 47 CPFE patients (46.8%) had lung cancer. Pulmonary function tests showed that the CPFE group had milder airflow limitation and lower diffusing capacity than the COPD group. Desaturation during 6‐min walking test in CPFE patients tended to be more severe than in COPD patients, if the level of FEV1 or 6MWD was equal.

Conclusions:  CPFE patients had some different clinical characteristics in comparison with COPD patients and may also have a high prevalence of lung cancer.
Surgery should be the first line of treatment for empyema
Authors: PETRAKIS Ioannis E. , HEFFNER John E. , KLEIN Jeffrey S.
Published: December 2009

Few thoracic conditions present such considerable challenges as pleural space infections, herein termed ‘empyema’ as a general term. Patients may present with free‐flowing infected pleural effusions that readily drain by catheter or, at the other extreme, with organized intrapleural collections of pus with thick pleural peels that require open decortication. In the transition from a simple to complex empyema, patients pass through the intermediary, or ‘fibrinopurulent’ stage. Such patients require careful assessment to determine the ideal management approach. Although existing trials provide insufficient evidence to standardize drainage approaches, an accepted principle directs clinicians to drain empyemas promptly and completely. In this pro‐con presentation, two recognized experts on empyema––a thoracic surgeon and an interventional radiologist—approach management from decidedly opposite perspectives. The surgeon prefers video‐assisted thoracoscopic surgery as primary therapy for fibrinopurulent empyemas. The radiologist counters that imaging‐guided, small‐bore catheters, sometimes with adjunctive fibrinolytic drugs, provide effective therapy for select patients. In the absence of high‐quality data to settle this debate, both experts present reasoned and thoughtful approaches, which produce superior clinical outcomes in their own institutions. So readers should recognize that controversy exists in empyema management and carefully review each expert's comments. Within each are essential elements of care that can be integrated into a multidisciplinary approach. Readers may conclude from this debate that each institution should develop a collaborative model for managing empyemas that integrates differing expertise to customize care for individual patients and continuously measure and improve their patients' outcomes.
Non‐invasive positive pressure ventilation during sleep at 3800 m: Relationship to acute mountain sickness and sleeping oxyhaemoglobin saturation
Authors: JOHNSON Pamela L. , POPA Daniel A. , PRISK G. Kim , EDWARDS Natalie , SULLIVAN Colin E.
Published: December 2009

Background and objective:  Ascent to high altitude results in hypobaric hypoxia and some individuals will develop acute mountain sickness (AMS), which has been shown to be associated with low oxyhaemoglobin saturation during sleep. Previous research has shown that positive end‐expiratory pressure by use of expiratory valves in a face mask while awake results in a reduction in AMS symptoms and higher oxyhaemoglobin saturation. We aimed to determine whether positive pressure ventilation would prevent AMS by increasing oxygenation during sleep.

Methods:  We compared sleeping oxyhaemoglobin saturation and the incidence and severity of AMS in seven subjects sleeping for two consecutive nights at 3800 m above sea level using either non‐invasive positive pressure ventilation that delivered positive inspiratory and expiratory airway pressure via a face mask, or sleeping without assisted ventilation. The presence and severity of AMS were assessed by administration of the Lake Louise questionnaire.

Results:  We found significant increases in the mean and minimum sleeping oxyhaemoglobin saturation and decreases in AMS symptoms in subjects who used positive pressure ventilation during sleep. Mean and minimum sleeping SaO2 was lower in subjects who developed AMS after the night spent without positive pressure ventilation.

Conclusions:  The use of positive pressure ventilation during sleep at 3800 m significantly increased the sleeping oxygen saturation; we suggest that the marked reduction in symptoms of AMS is due to this higher sleeping SaO2. We agree with the findings from previous studies that the development of AMS is associated with a lower sleeping oxygen saturation.
Comparison of pulmonary diseases in common variable immunodeficiency and X‐linked agammaglobulinaemia
Authors: AGHAMOHAMMADI Asghar , ALLAHVERDI Abdolreza , ABOLHASSANI Hassan , MOAZZAMI Kasra , ALIZADEH Hooman , GHARAGOZLOU Mohammad , KALANTARI Najmoddin , SAJEDI Vahid , SHAFIEI Alireza , PARVANEH Nima , MOHAMMADPOUR Masoud , KARIMI Nasser , SADAGHIANI Mohammad Salehi , REZAEI Nima
Published: December 2009

Background and objective:  Pulmonary disease is the most common complication in patients with common variable immunodeficiency (CVID) or X‐linked agammaglobulinaemia (XLA). Pulmonary disease may progress despite immunoglobulin replacement therapy. In this study pulmonary complications were compared in patients with CVID or XLA.

Methods:  Pulmonary complications were evaluated in 115 patients (76 with CVID and 39 with XLA) by reviewing hospital records of chest infections, pulmonary function tests and high‐resolution CT scans.

Results:  Thirty‐two patients with XLA (82%) presented with 59 episodes of pneumonia before diagnosis, whereas 15 patients (38.4%) experienced pneumonia after immunoglobulin replacement therapy (1.67 vs 0.45 episodes per patient per year). Among the CVID patients, 196 episodes of pneumonia were documented in 59 patients (77.6%) before diagnosis, while 36 patients (47.3%) experienced pneumonia after therapy (1.11 vs 0.58 episodes of pneumonia per patient per year). Forty‐seven (41%) patients (38 with CVID and 9 with XLA) developed chronic lung disease. The CVID patients developed more complications, including bronchiectasis and lymphoid interstitial pneumonitis, than the XLA patients.

Conclusions:  Patients with CVID had a greater likelihood of developing lung disease, possibly due to delayed diagnosis and immune dysregulation, as compared with XLA patients. Early diagnosis of patients with primary antibody deficiencies and adequate i.v. immunoglobulin replacement therapy substantially reduces the number of pulmonary infections. However, CVID patients are prone to progression of lung disease despite optimal immunoglobulin therapy because of the nature of the disease. This important issue should be addressed in further studies.
Emerging technologies for the thorax: Indications, management and complications
Authors: YARMUS Lonny , ERNST Armin , FELLER‐KOPMAN David
Published: December 2009

The field of interventional pulmonology has rapidly expanded to include the management and treatment of complex diseases of the chest. The management of central airway obstruction, pleural disease diagnosis, treatment and palliation, advanced bronchoscopic techniques to aid in the diagnosis of lung cancer and innovative therapies to treat asthma and COPD have all emerged over the past decade. As astute clinicians, we are all aware of the risks and benefits of using these therapies to treat our patients. In order to appropriately treat and manage these often complex medical situations, the physician should have an expert knowledge of all available modalities, the expertise to safely perform the procedure and the ability to minimize the risk of and manage the associated complications that may arise. In this chapter we review and update some of the bronchoscopic and pleural interventions offered by interventional pulmonologists as well as the associated complications and management.
Evaluation of individual and facility factors that promote hand washing in aged‐care facilities in Japan
Authors: Takahashi Ikuko , Turale Sue
Published: December 2009

Internationally, it has been found that regular and timely hand washing is part of hand‐hygiene practices that can reduce rates of infection in health‐care facilities, but research has shown that there is a low level of compliance with hand washing in hospitals worldwide, including Japan. The number of aged‐care facilities is growing throughout the world as our populations age, but hand‐washing compliance appears even lower in such settings where there are vulnerable and frail elderly persons. This study used a correlational, cross‐sectional design to clarify, for the first time, individual and facility factors related to the hand‐washing behaviors of care staff at Japanese aged‐care facilities. In 56 facilities (31 special nursing homes and 25 health‐service facilities) in Yamaguchi Prefecture, data were gathered through survey questionnaires from care staff and facility managers. A total of 1323 (79.6%) questionnaires were returned and 1016 (61.1%) were analyzed. Using logistical regression analysis, two individual factors were investigated (“willingness to practice standard precautions” and “attendance at seminars”) and two facility factors were investigated (“implementation of hand‐washing evaluation” and “hand‐washing environment”). These factors were found to promote hand washing, but no single factor was particularly related to its promotion in aged‐care settings. If the health of elderly residents is to be better protected and infection rates lowered, especially in an era of increasing pandemics and epidemics, the compliance rate of health‐care workers needs to be increased. We conclude that diverse approaches to both individual and facility factors are necessary to improve compliance with hand washing.
Manuscript rejection in ophthalmology and visual science journals: identifying and avoiding the common pitfalls
Authors: Wyness Tami , McGhee Charles NJ , Patel Dipika V
Published: December 2009

Abstract

Purpose:  The majority of ophthalmology and visual science journals reject more original manuscripts than they accept. Submissions to Clinical and Experimental Ophthalmology were analysed over a 12‐month period with the aim of identifying common reasons for editorial rejection of manuscripts.

Methods:  A content analysis was carried out of reviewer and section editor comments of all rejected manuscripts (original papers) submitted to Clinical 0mp; Experimental Ophthalmology between 1 January 2008 and 31 December 2008. Comments were categorized by reasons for rejection.

Results:  A total of 662 manuscripts were submitted to Clinical and Experimental Ophthalmology via ScholarOne Manuscripts from 1 January 2008 to 31 December 2008 with a final decision date of up to 1 April 2009. The overall rejection rate for these manuscripts was 73.6%. The most common reason for rejection of manuscripts was ‘does not add to current literature’, followed by ‘poor methodology’, ‘problematic control groups’, ‘poor English and grammar/poorly organized’, ‘needs further work/clarification’ and ‘simultaneous submission to another journal/plagiarized’; the remainder had either no readily categorized reason stated or were grouped into an ‘other’ category.

Discussion:  Understanding why original research work is rejected can be invaluable to an author's publishing career. The categories that emerged from this content analysis are reflected in other literature on the topic, therefore the flaws in manuscripts rejected by Clinical and Experimental Ophthalmology appear to be both common and avoidable. Armed with this knowledge an author may strive towards a more ‘rejection‐proof’ manuscript when submitting to ophthalmology and visual science journals.
Publication and citation analysis of the Australian and New Zealand Journal of Ophthalmology and Clinical and Experimental Ophthalmology over a 10‐year period: the evolution of an ophthalmology journal
Authors: Chou Chi‐Ying , Chew Shenton SL , Patel Dipika V , Ormonde Susan E , McGhee Charles NJ
Published: December 2009

Abstract

Purpose:  To analyse the pattern of change in publication content and citations generated by a mid‐ranking ophthalmology journal as it evolved from the Australian and New Zealand Journal of Ophthalmology (ANZJO) to its successor, Clinical and Experimental Ophthalmology (CEO).

Methods:  The Science Citation Index was used to analyse the publications of ANZJO and CEO over two 10‐year periods (1990–1999 and 2000–2009, respectively). Publication and citation patterns were analysed in terms of source authors, institutions and countries. As a secondary measure, journal impact factors (JIFs) were retrieved from the Journal Citation Reports at the end of each period.

Results:  Over the specified periods, 859 articles published in ANZJO were cited 1210 times, and 1529 articles published in CEO were cited 5374 times. Australia was the largest contributing country to both journals; however, the proportional contributions from other countries including New Zealand, UK, USA, India and China increased significantly in CEO. Articles were cited by authors from 793 institutions in 60 countries for ANZJO and 2997 institutions in 95 countries for CEO. The contribution by key authors (identified as the top 10 most‐published authors) towards total journal publications was 24% in ANZJO, but only 16% in CEO; however, these publications were responsible for 26.6% and 28.8% of the total citations, respectively. With respect to the most recent JIFs, ANZJO was 0.433 in 1999 (ranked 33 of 43 journals) and CEO was 1.35 in 2008 (ranked 27 of 48 journals).

Conclusion:  CEO has substantially increased the number of publications, citation counts and international sources compared with its well‐established predecessor, ANZJO, over the assessed periods. CEO also appears to have a higher international profile with increasing citations counts from more countries. This evolution from a regional, to a more international, journal has been substantial and is reflected by a significant increment in JIF, and a modest increase in overall JIF‐ranking, for CEO.
SEM study of overload effects during fatigue crack growth using an image analysing technique and potential drop measures
Authors: JACOBSSON L. , PERSSON C. , MELIN S.
Published: December 2009

To study the mechanisms affecting the crack propagation rate for fatigue cracks exposed to an overload, an in situ scanning electron microscope technique was used, together with potential drop measurements. High‐resolution images were analysed with an image analysis program to measure the displacements along the crack, and the potential drop technique was employed to measure the electrical contact between the fatigue crack surfaces. The crack closure level could, by image analysis, be determined as close as 1 μm from the crack tip. The indications from the image analysis pointed towards a somewhat lower closure load as compared to the potential drop technique. The effect of an overload on the crack propagation rate was found to depend on the magnitude of the overload in combination with the steady‐state conditions. Both overload induced crack retardation and crack acceleration was noticed to occur.
Perioperative complications in children with pulmonary hypertension undergoing general anesthesia with ketamine
Authors: WILLIAMS GLYN D. , MAAN HARJOT , RAMAMOORTHY CHANDRA , KAMRA KOMAL , BRATTON SUSAN L. , BAIR ELLEN , KUAN CALVIN C. , HAMMER GREGORY B. , FEINSTEIN JEFFREY A.
Published: December 2009

Background:  Pulmonary arterial hypertension (PAH) is associated with significant perioperative risk for major complications in children, including pulmonary hypertensive crisis and cardiac arrest. Uncertainty remains about the safety of ketamine anesthesia in this patient population.

Aim:  Retrospectively review the medical records of children with PAH to ascertain the nature and frequency of peri‐procedural complications and to determine whether ketamine administration was associated with peri‐procedural complications.

Methods:  Children with PAH (mean pulmonary artery pressure ≥25 mmHg and pulmonary vascular resistance index ≥3 Wood units) who underwent general anesthesia for procedures during a 6‐year period (2002–2008) were enrolled. Details about the patient, PAH, procedure, anesthetic and postprocedural course were noted, including adverse events during or within 48 h of the procedure. Complication rates were reported per procedure. Association between ketamine and peri‐procedural complications was tested.

Results:  Sixty‐eight children (median age 7.3 year, median weight 22 kg) underwent 192 procedures. Severity of PAH was mild (23%), moderate (37%), and severe (40%). Procedures undertaken were major surgery (n = 20), minor surgery (n = 27), cardiac catheterization (n = 128) and nonsurgical procedures (n = 17). Ketamine was administered during 149 procedures. Twenty minor and nine major complications were noted. Incidence of cardiac arrest was 0.78% for cardiac catheterization procedures, 10% for major surgical procedures and 1.6% for all procedures. There was no procedure‐related mortality. Ketamine administration was not associated with increased complications.

Conclusions:  Ketamine appears to be a safe anesthetic option for children with PAH. We report rates for cardiopulmonary resuscitation and mortality that are more favorable than those previously reported.