bluuebunny/crossref_metadata_2025_split huggingface dataset:
A longitudinal evaluation of medical student knowledge, skills and attitudes to alcohol and drugs
Authors: Cape Gavin , Hannah Annette , Sellman Doug 
Published: May 2006

ABSTRACTAim  To examine the knowledge, skills and attitudes of medical students to alcohol and drugs as training progresses.Design  A longitudinal, prospective, cohort‐based design.Setting  The four schools of medicine in New Zealand.Participants  All second‐year medical students (first year of pre‐clinical medical health sciences) in New Zealand were administered a questionnaire which was repeated in the fourth (first year of significant clinical exposure) and then sixth years (final year). A response rate of 98% in the second year, 75% in the fourth year and 34% in the sixth year, with a total of 637 respondents (47.8% male) and an overall response rate of 68%.Questionnaire  The questionnaire consisted of 43 questions assessing knowledge and skills—a mixture of true/false and scenario stem‐based multiple‐choice questions and 25 attitudinal questions scored on a Likert scale. Demographic questions included first language, ethnicity and personal consumption of alcohol and tobacco.Findings  The competence (knowledge plus skills) correct scores increased from 23.4% at the second year to 53.6% at the fourth year to 71.8% at the sixth year, being better in those students who drank alcohol and whose first language was English (P < 0.002). As training progressed the student’s perceptions of their role adequacy regarding the effectiveness of the management of illicit drug users diminished. For example, at second year 21% and at sixth year 51% of students felt least effective in helping patients to reduce illicit drug use. At the sixth year, 15% of sixthyear students regarded the self‐prescription of psychoactive drugs as responsible practice.Conclusion  Education on alcohol and drugs for students remains a crucial but underprovided part of the undergraduate medical curriculum. This research demonstrated that while positive teaching outcomes were apparent, further changes to medical student curricula need to be considered to address specific knowledge deficits and to increase the therapeutic commitment and professional safety of medical students to alcohol and drugs.
Switch patterns before and after patent expiry of omeprazole: a case study in The Netherlands
Authors: KLOK R. M. , BOERSMA C. , OOSTERHUIS I. , VISSER S. T. , DE JONG‐VAN DEN BERG L. T. W. , POSTMA M. J. 
Published: May 2006

SummaryBackgroundAn increase of therapeutic substitution after patent expiry might have a negative effect on cost‐savings generated with newly introduced generic drugs. To evaluate influences of patent expiry on therapeutic substitution, switch behaviour before and after patent expiry was investigated.AimTo describe proton pump inhibitor use and investigate substitution patterns from omeprazole before and after patent expiry.MethodsData were obtained from the InterAction DataBase. Proportional proton‐pump inhibitor use was identified per quarter during the study period 2000–2003. For the second part two cohorts – one before and one after patent expiry – were defined. The number of switchers was quarterly identified during 2‐year follow‐up period. For statistical analyses the chi‐square test and hazard ratio were used.ResultsIn proportional use, a downward trend for omeprazole was found. After patent expiry, significantly more patients switched to other proton pump inhibitors (P < 0.001). The hazard ratio of 0.62 (95% CI: 0.57–0.69), indicates that for every six patients switching before patent expiry, 10 patients switch after patent expiry.ConclusionAfter patent expiry more patients switch to another proton pump inhibitor. In light of the total savings achieved with generic omeprazole, the importance of this negative impact on total cost‐savings on proton pump inhibitors is unclear.
Personal view: current role of artificial liver support devices
Authors: O'GRADY J. 
Published: May 2006

SummaryEnthusiasm for liver support devices, particularly cell‐based biological systems and albumin dialysis, increased over the last decade and there has been considerable clinical activity both within and without the construct of clinical trials. Most data have been generated on patients with acute liver failure or in patients with decompensation of chronic liver disease, often referred to as acute‐on‐chronic liver failure.In acute liver failure liver, liver support devices are more realistically being used as a ‘bridge’ to liver transplantation rather than to transplant‐free survival. In acute‐on‐chronic liver failure the clinical objective of attaining clinical stability with treatment appears more achievable.The so‐called bioartificial liver device, based on porcine hepatocytes, is the most extensively evaluated biological device. A sizeable clinical trial failed to demonstrate efficacy, but secondary analyses suggest it would be unwise to assume futility had been established with this device.Molecular adsorbent recirculating system leads the way in the non‐biological category in terms of the number of patients treated, but data from large clinical trials are not yet available.One of the strongest conclusions of this review is that the amount of high‐quality data available on liver support devices dramatically understates the effort and money that have been expended in their assessment. It is very clear that randomized controlled trials are mandatory to establish clinical efficacy, but it is less clear how the ideal trial should be constructed.
Effect of frequent dosing of an oral proton pump inhibitor on intragastric pH
Authors: PAIS S. A. , NATHWANI R. A. , DHAR V. , NOWAIN A. , LAINE L. 
Published: May 2006

SummaryBackgroundTreatment with a continuous i.v. proton pump inhibitor is presumed to promote clot formation and stability by sustaining intragastric pH ≥ 6.AimWe postulated that very frequent oral dosing of proton pump inhibitors should simulate i.v. infusion and achieve similar pH control.MethodsTwenty healthy volunteers were stratified by Helicobacter pylori status (10 positive; 10 negative) and had determination of CYP2C19 status. After an overnight fast, an intragastric pH probe was placed. Subjects received 120 mg of lansoprazole at 8 am and 30 mg every 3 h until 8 pm. Intragastric pH was measured over 24 h, and lansoprazole plasma concentrations were determined at five time points.ResultsIntragastric pH was ≥6 for 41% (95% CI: 30–53%) of the 15‐h period from 8 am–11 pm and 46% (95% CI: 35–56%) of the 24‐h period (8–8 am). The mean proportion of patients with pH ≥6 was not significantly different in H. pylori‐positive vs. negative patients. Only 25% of subjects sustained pH ≥6 for at least 60% of the 15‐h period, and 35% had a sustained pH ≥6 for at least 60% of the 24‐h period.ConclusionsA dose of 120 mg of oral lansoprazole followed by standard 30 mg doses of lansoprazole every 3 h did not reliably sustain pH at the desired level of 6.
Hyperpyrexia and prolonged postoperative disorientation following methylene blue infusion during parathyroidectomy
Authors: Mathew S. , Linhartova L. , Raghuraman G. 
Published: May 2006

SummaryA 65‐year‐old man underwent parathyroidectomy for hyperparathyroidism secondary to renal failure. Intra‐operatively he received methylene blue infusion (7.5 mg.kg−1, a total of 650 mg in 500 ml 0.9% sodium chloride) for visualisation of parathyroid glands. At the end of surgery, following extubation he developed agitation, intense shivering and hyperpyrexia, and his level of consciousness decreased to a Glasgow Coma score of 7. The differential diagnoses included methylene blue toxicity or malignant hyperpyrexia. His lungs were ventilated, and intravenous dantrolene was administered to control hyperpyrexia. Haemodialysis was started to remove the methylene blue dye. We review the literature on the pharmacological actions of methylene blue, and discuss the differential diagnosis and management of this patient.
Endobronchial tubes – a case for re‐evaluation
Authors: Conacher I. D. , Velasquez H. , Morrice D. J. 
Published: May 2006

SummaryAn endobronchial tube (Macintosh‐Leatherdale) was used to secure the airway for a tracheal resection and end‐to‐end anastomosis. This lung separation device enabled insertion of both a fibreoptic bronchoscope and a tube exchange catheter. These were required after the trachea was transected and re‐anastomosis proved surgically difficult. The airway exchange catheter allowed for jet ventilation and later a tube change when an emergency occurred. Options and management issues for tracheal surgery and lung separators are discussed. A case is made for a re‐evaluation of endobronchial tubes both as a useful conduit for modern airway instruments and as an alternative to small double‐lumen tubes for the increasing population of obese patients weighing > 100 kg, requiring thoracic surgery.
Epidural anaesthesia as a complication of attempted brachial plexus blockade using the posterior approach
Authors: Gomez R. S. , Mendes T. C. B. S. 
Published: May 2006

SummaryWe report a case of accidental epidural anaesthesia as a complication of attempted brachial plexus blockade using a posterior approach in a 31‐year‐old man scheduled to undergo elective shoulder surgery. The block was inserted with the patient in the lateral position before induction of general anaesthesia. On emergence from anaesthesia, the patient could breathe but could not move his arms. He had no pain sensation from the fifth cervical dermatome to the third thoracic dermatome bilaterally; this resolved 8 h after surgery and he was discharged well 2 days later. Although proponents of the posterior approach to the brachial plexus claim that its use is associated with a lower incidence of significant complications, this case proves that the technique is not devoid of potentially serious complications.
Major colorectal surgery in a patient with cold agglutinin disease
Authors: Young S. , Haldane G. 
Published: May 2006

SummaryWe present the case of a 62‐year‐old man with severe cold agglutinin disease who underwent major colorectal surgery. Cold agglutinin disease is a condition in which auto‐antibodies, usually immunoglobulin M, cause red blood cell agglutination at decreased body temperature. Haemolysis may result. Agglutination results in impaired perfusion, resulting in symptomatic Raynaud's phenomenon and acrocyanosis. Haemolysis can result in anaemia and thrombotic events caused by microvascular occlusion, in addition to haemoglobinuria and renal failure. Peri‐operative hypothermia is common in all patients and may be associated with significant morbidity, but is potentially catastrophic in a patient suffering from cold agglutinin disease.
Use of the fibreoptic intubating LMA‐CTrach™ in two patients with difficult airways
Authors: Goldman A. J. , Rosenblatt W. H. 
Published: May 2006

SummaryWe report two patients with difficult airways who underwent tracheal intubation using the new fibreoptic intubating Laryngeal Mask Airway CTrach™. The imaging technology of the LMA‐CTrach was decisive in the management of these two patients. The first patient had lingual tonsillar hyperplasia, and an omega‐shaped retroflexed epiglottis. The second patient had a C2‐occipital fusion and was completely unable to extend her head. Given the anatomical difficulties encountered, it was likely that intubation would have been difficult or impossible through the LMA‐Fastrach™. The aim of this report is to describe the successful use of this new intubating laryngeal mask airway in these two challenging patients.
Sensitization to different pollens and allergic disease in 4‐year‐old Swedish children
Authors: Ghunaim N. , Wickman M. , Almqvist C. , Söderström L. , Ahlstedt S. , Van Hage M. 
Published: May 2006

SummaryBackground
Although the relationship between sensitization to different inhalant allergens in adolescents and adults has been intensively studied, information concerning sensitization in children is scarce in particular to pollens.Objectives
In 4‐year‐old children to elucidate the pollen immunoglobulin (IgE) antibody profile (birch only, timothy only and combinations of three pollens (birch, timothy or mugwort) and to relate the results to other inhalant and food allergens, as well as the presence of allergic diseases.Methods
A total of 2551 4‐year‐old children belonging to a prospective birth cohort, which has been followed longitudinally (BAMSE), were investigated with respect to IgE antibodies to pollen and other inhalant and food allergens, and expression of allergic disease, based on questionnaire data.Results
Eleven percent (n=285) of the children were sensitized to pollen. Birch was the dominating cause of pollen sensitization (birch sensitization only, n=133); followed by timothy grass pollen (n=56) and a combination of two (n=64) or three (n=30) pollens. A remarkably high proportion of the children sensitized only to birch was also sensitized to other inhalant allergens. This was not seen for children sensitized only to timothy. The highest frequencies of IgE reactivity to food were found in the group of children sensitized to the combination of birch, timothy and mugwort pollen. Children sensitized to timothy only, exhibited symptoms of allergic disease significantly less frequently compared with children sensitized to birch only. Sensitization to birch pollen was found to be closely associated with rhinitis and eczema compared with asthma. The highest frequency of asthma and/or rhinitis and/or eczema was reported in children sensitized to at least two pollens.Conclusion
Our results demonstrate that birch is the dominating source of pollen sensitization at the age of four in Sweden. This might associate with the pattern of sensitization to other inhalant and food allergens as well as influence on the expression of allergic disease in this particular age group.
The effect of allergic rhinitis on adenosine concentration in exhaled breath condensate
Authors: Vass G. , Huszár É. , Augusztinovicz M. , Baktai G. , Barát E. , Herjavecz I. , Horváth I. 
Published: May 2006

SummaryBackgroundPatients with allergic rhinitis (AR) frequently develop asthma. This initiating inflammation in the lower airways may result in increased levels of inflammatory mediators such as adenosine in the exhaled breath.ObjectiveWe compared adenosine levels in exhaled breath condensate (EBC) and both exhaled and nasal nitric oxide (NO) levels of AR patients and healthy control subjects. We also tested whether inhalation through inflamed nasal cavity during EBC sampling influences adenosine concentrations in exhaled air.MethodsExhaled and nasal NO levels were measured and EBC samples (at oral inhalation) were collected from 27 patients and 15 healthy controls. EBC collection was repeated after 15 min with subjects inhaling through their nose. Adenosine was measured by HPLC and NO was determined by chemiluminescence.ResultsThe concentration of EBC adenosine was higher in patients with AR than in healthy controls (12.4±1.3 nmvs. 6.5±0.7 nm,P=0.0019) and this was accompanied by an increase in the concentration of exhaled NO (10.2±1.3 ppb vs. 5.3±0.5 ppb;P=0.0099, respectively). No difference in nasal NO was detected. EBC adenosine concentration showed a significant positive correlation with the level of exhaled NO. In contrast to healthy control subjects, patients with rhinitis had higher levels of exhaled adenosine when inhaling via the nose instead of the mouth (17.7±2.8 nm,P=0.007).ConclusionWhen compared with healthy subjects, patients with AR exhibit an increased concentration of exhaled adenosine and a related increase in exhaled NO concentration. EBC adenosine is further increased when rhinitis patients inhale through their nose than via their mouth. Our data suggest that non‐asthmatic patients with rhinitis may have subclinical inflammation in their lower airways.
Leaf endophytes affect mycorrhizal status and growth of co‐infected and neighbouring plants
Authors: OMACINI M. , EGGERS T. , BONKOWSKI M. , GANGE A. C. , JONES T. H. 
Published: May 2006

SummaryFungal leaf endophytes and arbuscular mycorrhizal (AM) fungi are common constituents of natural grasslands. The simultaneous presence of these two grass plant symbionts is highly probable.We describe the results of a glasshouse experiment investigating the outcome of dual infection of a cool‐season grass species,Lolium multiflorum, by the fungal endophyteNeotyphodium occultansand three species ofGlomusAM fungi.Mycorrhizal colonization was investigated on monocultures of plants with or without leaf endophytes, and on mixtures of endophyte‐infected and uninfected plants. In both scenarios, endophyte‐infected plants had lower levels of mycorrhizal colonization, but in the endophyte mixtures the presence of endophyte‐infected plants caused an increase in AM colonization in non‐endophyte‐infected conspecific neighbours.Host‐plant biomass, nutrient (nitrogen and phosphorus) accumulation, and competitive ability were increased by the presence of endophytes. AM fungi did not improve host performance or nutrient content (concentration or accumulation) in the presence or absence of the endophyte.Interactions between host plants and AM fungi are mediated by fungal endophyte infection. The implications of such modified interactions for ecosystem dynamics and functioning are considered.
Olfactory information saves venom during prey‐capture of the hunting spider Cupiennius salei (Araneae: Ctenidae)
Authors: HOSTETTLER S. , NENTWIG W. 
Published: May 2006

Summary

The Neotropical spider Cupiennius salei Keyserling (Ctenidae) selects prey in a manner consistent with the amount of venom available in its venom glands. It distinguishes the venom sensitivity of different prey species, and uses its venom economically (according to the venom‐optimization hypothesis).
A prey‐choice experiment was performed to test whether spiders use olfactory cues to detect prey and select prey items that are appropriate for their amount of available venom.
The spider could choose between two similar prey dummies made of agar. We added the odour of two prey species, either by adding minced insects to an agar block or by offering it on filter paper which had previously been exposed to the living prey. Cupiennius salei spiders had either full or emptied venom glands.
Two insects of distinctive venom sensitivity, but high acceptance, were tested: a sensitive cricket and a less sensitive cockroach.
Using video surveillance, we found an attraction effect of prey odour in the prey‐capture behaviour of C. salei. Spiders preferred agar pieces with minced insects or insect odour on filter paper over non‐smelling items. Reaction frequency and attack rates were equal for spiders with full venom glands if they had to choose between cricket and cockroach odour. When the venom glands were empty, however, C. salei significantly preferred the venom‐sensitive cricket over the venom‐insensitive cockroach.
We showed for the first time that C. salei uses its olfactory sense to detect prey items, and distinguishes between prey species with low and high sensitivity to spider venom. This study supports the venom‐optimization hypothesis.
How a mega‐grazer copes with the dry season: food and nutrient intake rates by white rhinoceros in the wild
Authors: SHRADER A. M. , OWEN‐SMITH N. , OGUTU J. O. 
Published: May 2006

SummaryFew studies have investigated how free‐ranging wild herbivores adjust their food intake rate and nutrient gains during the dry season. Our study focused on the largest extant grazer, the white rhinoceros (Ceratotherium simumBurchell 1817). Field measurements were made on changes in bite mass, bite rate and nutrient concentrations of food eaten during the dry season.As the dry season progressed, the quality and availability of food resources declined. During this time white rhinos foraged mainly in high‐quality short and woodland grasslands. Late in the dry season they also used flushes of green grass in previously burnt Themeda grasslands.Bite mass increased linearly with increasing sward height, while bite rate declined. Intake rate was determined primarily by bite mass and thus tended to increase linearly with sward height. Maximum bite mass and intake rate was obtained in swards >20 cm.White rhinos did not compensate for seasonal declines in food quality by adjusting their food intake rate or diet breadth. We suggest that white rhinos mobilize fat reserves to help meet their nutritional needs during the dry season.
Demystifying the West, Brown & Enquist model of the allometry of metabolism
Authors: ETIENNE RAMPAL S. , APOL M. EMILE F. , OLFF HAN 
Published: May 2006

Summary

The allometry of metabolic rate has long been one of the key relationships in ecology. While its existence is generally agreed on, the exact value of the scaling exponent, and the key mechanisms that determine its value, are still hotly debated.
The network model of West, Brown & Enquist (Science 276, 122–126, 1997) predicts a value of 3/4 but, although appealing, this model has not been generally accepted.
Here we reconstruct the model and derive the exponent in a clearer and much more straightforward way that requires weaker assumptions than the original model. Specifically, self‐similarity of the network is not required. Our formulation can even be used if one or several assumptions of West et al. (1997) are considered invalid.
Moreover, we provide a formula for the proportionality constant (i.e. the intercept of the allometric scaling relation) that shows explicitly where factors as temperature and stoichiometry affect metabolism.
Climate–growth relationships of tropical tree species in West Africa and their potential for climate reconstruction
Authors: SCHÖNGART JOCHEN , ORTHMANN BETTINA , HENNENBERG KLAUS JOSEF , POREMBSKI STEFAN , WORBES MARTIN 
Published: May 2006

AbstractMost tropical regions are facing historical difficulties of generating biologically reconstructed long‐term climate records. Dendrochronology (tree‐ring studies) is a powerful tool to develop high‐resolution and exactly dated proxies for climate reconstruction. Owing to the seasonal variation in rainfall we expected the formation of annual tree rings in the wood of tropical West African tree species. In the central‐western part of Benin (upper Ouémé catchment, UOC) and in northeastern Ivory Coast (Comoé National Park, CNP) we investigated the relationship between climate (precipitation, sea surface temperature (SST)) and tree rings and show their potential for climate reconstruction. Wood samples of almost 200 trees belonging to six species in the UOC and CNP served to develop climate‐sensitive ring‐width chronologies using standard dendrochronological techniques. The relationship between local precipitation, monthly SST anomalies in the Gulf of Guinea, El Niño‐ Southern Oscillation (ENSO) and ring‐width indices was performed by simple regression analyses, two sample tests and cross‐spectral analysis. A low‐pass filter was used to highlight the decadal variability in rainfall of the UOC site. All tree species showed significant relationships with annual precipitation proving the existence of annual tree rings. ENSO signals could not be detected in the ring‐width patterns. For legume tree species at the UOC site significant relationships could be found between SST anomalies in the Gulf of Guinea indicating correlations at periods of 5.1–4.1 and 2.3 years. Our findings accurately show the relationship between tree growth, local precipitation and SST anomalies in the Gulf of Guinea possibly associated with worldwide SST patterns. A master chronology enabled the reconstruction of the annual precipitation in the UOC to the year 1840. Time series analysis suggest increasing arid conditions during the last 160 years which may have large impacts on the hydrological cycles and consequently on the ecosystem dynamics and the development of socio‐economic cultures and sectors in the Guinea‐Congolian/Sudanian region.