bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biodiversity, conservation and development in Mkomazi Game Reserve, Tanzania
Authors: Homewood Katherine , Brockington Daniel 
Published: March 2003

SummarySavanna woodlands and their associated species diversity and endemism are widely seen as declining through human impacts. Alternative views suggest that savanna ecosystems vary with a large number of biophysical factors, among which human impacts may be of relatively minor importance. This paper examines the debate with respect to Mkomazi Game Reserve in Northern Tanzania, where biodiversity has been inventoried and local resource use studied. It sets out the history of land use in Mkomazi and examines the available data on the area's plant, bird and invertebrate diversity. Comparative analysis is complicated by the paucity of data for other savannas in the same biogeographic zone, and by differences in sampling effort and methodology. Conservation literature and Tanzanian government documents present Mkomazi as one of the richest savannas in Africa, as a centre of endemism, and as threatened by deleterious impacts of human land use. Available data do not substantiate such statements. The paper examines implications of those perceptions for management, particularly eviction of resident pastoralists from the Reserve in 1988, and subsequent exclusion of reserve‐adjacent dwellers. Conservation relies increasingly on reserve‐adjacent people, and on prioritizing the allocation of scarce resources. There is an urgent need for rigorous studies of the implications of human land use in savannas, for better data on biodiversity, and for rigorous standards in the way those data are applied.
Nasal challenges with recombinant derivatives of the major birch pollen allergen Bet v 1 induce fewer symptoms and lower mediator release than rBet v 1 wild‐type in patients with allergic rhinitis
Authors: Van Hage‐Hamsten M. , Johansson E. , Roquet A. , Peterson C. , Andersson M. , Greiff L. , Vrtala S. , Valenta R. , Grönneberg R. 
Published: March 2003

SummaryBackground Genetic engineering of the major birch pollen allergen (Bet v 1) has led to the generation of recombinant Bet v 1 derivatives with markedly reduced IgE‐binding capacity, but with retained T cell activating ability.Objective To compare the mucosal reactivity to rBet v 1 derivatives with rBet v 1 wild‐type as basis for new therapeutic strategies for birch pollen allergy based on mucosal tolerance induction.Methods Outside the pollen season, 10 patients with birch pollen allergic rhinitis and mild asthma underwent four nasal challenge‐sessions in a randomized, double‐blind, and cross‐over design, employing increasing doses of rBet v 1 fragment mix, rBet v 1 trimer, rBet v 1 wild‐type and diluent (albumin). Nasal lavage fluids (NAL) were collected before the challenge‐series as well as 10 min, 4 and 24 h thereafter. Nasal lavage fluid levels of tryptase as well as EPO and ECP were measured as indices of mast cell and eosinophil activity, respectively.Results All 10 patients tolerated the highest accumulated dose, 8.124 µg, when challenged with rBet v 1 trimer, eight with rBet v 1 fragments compared to one when challenged with rBet v 1 wild‐type. No late phase reactions were observed. The change in tryptase levels (pre‐challenge vs. 10 min) was significantly lower after challenges with rBet v 1 trimer and rBet v 1 fragments than with rBet v 1 wild‐type. The change in EPO/ECP concentration pre‐challenge versus 4 h post‐challenge was lower for rBet v 1 trimer and the change was significantly lower when pre‐challenge versus 24 h post‐challenge to rBet v 1 fragments and rBet v 1 wild‐type was examined.Conclusion The derivatives induced significantly fewer symptoms and lower mast cell and eosinophil activation than rBet v 1 wild‐type upon application to the nasal mucosa. They could in the future be candidates for immunotherapy based on mucosal tolerance induction.
Xeroderma pigmentosum in Libya
Authors: Khatri Mishri Lal , Bemghazil Mohammed , Shafi Mohammed , Machina Alhashmi 
Published: March 2003

Abstract Background A preliminary study of 24 cases of xeroderma pigmentosum (XP) was presented in 1990 and later published in 1992. Since then we have seen 18 further cases. Objective To study the clinical profile of Libyan cases of XP. Methods With the help of a special protocol, all 42 cases (23 girls and 19 boys from 29 families) treated and followed between 1981 and 1994 were subjected to detailed analysis. Results A history of consanguinity was present in the parents of 39 patients. XP in Libya is characterized by a relatively high incidence (approximately 15–20 per million of the population), early onset of initial manifestations (median age, 12 months) and malignant tumors (median age, 8 years), severe ocular and oral lesions in a high percentage of patients, and early death (median age, 15.5 years). The malignant skin tumors seen were squamous cell carcinoma (SCC) in 23 patients, basal cell carcinoma (BCC) in 17 patients, and basosquamous carcinoma in two patients. Malignant melanoma was not seen, but lentigo maligna was found in one case. SCC of the tongue, carcinoma of the thyroid, and lymphatic leukemia affected individual patients. Subnormal physical growth was observed in six patients, but none of the patients had significant neurologic abnormalities. The results of etretinate therapy in nine patients revealed that it is an effective preventive agent against carcinogenesis, but not a curative one. Conclusions Severe ophthalmic manifestations affected a higher percentage of patients at an early age. Malignant melanoma did not develop in any case, except for lentigo maligna in one patient.
Development of a patient decision aid for choice of surgical treatment for breast cancer
Authors: Sawka Carol A. , Goel Vivek , Mahut Catherine A. , Taylor Glen A. , Thiel Elaine C. , O'Connor Annette M. , Ackerman Ida , Burt Janet H. , Gort Elaine H. 
Published: March 2003

Purpose A patient decision aid for the surgical treatment of early stage breast cancer was developed and evaluated. The rationale for its development was the knowledge that breast conserving therapy (lumpectomy followed by breast radiation) and mastectomy produce equivalent outcomes, and the current general agreement that the decision for the type of surgery should rest with the patient.Methods A decision aid was developed and evaluated in sequential pilot studies of 18 and 10 women with newly diagnosed breast cancer who were facing a decision for breast conserving therapy or mastectomy. Both qualitative (general reaction, self‐reported anxiety, clarity, satisfaction) and quantitative (knowledge and decisional conflict) measures were assessed.Results The decision aid consists of an audiotape and workbook and takes 36 min to complete. Based on qualitative comments and satisfaction ratings, 17 of 18 women reported a positive reaction to the decision aid, and all 18 reported that it helped clarify information given by the surgeon. Women did not report an increase in anxiety and 17 of 18 women were either satisfied or very satisfied with the decision aid.Conclusion This pilot study supports the hypothesis that this decision aid may be a helpful adjunct in the decision for surgical management of early stage breast cancer. We are currently conducting a randomized trial of the decision aid versus a simple educational pamphlet to evaluate its efficacy as measured by knowledge, decisional conflict, anxiety and post‐decisional regret.
A randomized controlled trial of information‐giving to patients referred for coronary angiography: effects on outcomes of care
Authors: Bernstein Steven J. , Skarupski Kimberly A. , Grayson Carla E. , Starling Mark R. , Bates Eric R. , Eagle Kim A. 
Published: March 2003

ObjectiveTo assess the impact of providing an educational videotape, `Treatment Choices for Ischaemic Heart Disease: a Shared Decision‐Making Program Videotape,' to patients referred for coronary angiography compared with standard patient‐physician decision making (usual care). Study designRandomized controlled clinical trial. SettingUniversity Hospital and Veterans Affairs Hospital. PatientsA consecutive sample of 217 patients referred for coronary angiography were randomized to receive `usual care' or to receive the videotape in addition to standard patient physician decision making (videotape): 109 completed the study (50% completion rate). Main outcome measuresKnowledge of coronary artery disease, satisfaction, self‐reported physical and mental health functioning, and the proportion of patients who were referred for coronary revascularization. ResultsCompared with patients who received `usual care,' those who received the videotape were more knowledgeable (mean score 83 vs. 58%; P < 0.0001) but less satisfied with their treatment (79 vs. 88%; P = 0.038). There were no significant differences between the videotape and `usual care' groups with respect to satisfaction with the decision making process (mean score 73 vs. 77%; P = 0.37), satisfaction with the decision made (mean score 73 vs. 78%; P = 0.28), physical functioning (38 vs. 38%; P = 0.76), mental health functioning (49 vs. 49%; P = 0.94), or in referral for coronary revascularization (OR 0.60; 95% CI 0.22–1.65; P = 0.33). ConclusionAlthough the educational videotape increased patients' knowledge level, it was associated with a decrease in their level of satisfaction with treatment. Before there is wide‐spread dissemination of this technology, advocates should demonstrate its effectiveness in everyday practice.
Implementing shared decision‐making in routine practice: barriers and opportunities
Authors: Holmes‐Rovner Margaret , Valade Diane , Orlowski Catherine , Draus Catherine , Nabozny‐Valerio Barbara , Keiser Susan 
Published: March 2003

ObjectiveDetermine feasibility of shared decision‐making programmes in fee‐for‐service hospital systems including physicians’ offices and in‐patient facilities.DesignSurvey and participant observation. Data obtained during Phase 1 of a patient outcome study.Settings and participantsThree hospitals in Michigan: one 299‐bed rural regional hospital, one 650‐bed urban community hospital, one 459‐bed urban and suburban teaching hospital. All nurses and physicians who agreed to use the programmes participated in the evaluation (n = 34).InterventionTwo shared decision‐making® (SDP) multimedia programmes: surgical treatment choice for breast cancer and ischaemic heart disease treatment choice.Main outcome measures(1) clinicians’ evaluations of programme quality; (2) challenges in hospital settings; and (3) patient referral rates.ResultsSDP programmes were judged to be clear, accurate and about the right length and amount of information. Programmes were judged to be informative and appropriate for patients to see before making a decision. Clinicians were neutral about patients’ desire to participate in treatment decision‐making. Referral volume to SDPs was lower than expected: 24 patients in 7 months across three hospitals. Implementation challenges centred on time pressures in patient care.ConclusionsProductivity and time pressure in US health care severely constrain shared decision‐making programme implementation. Physician referral may not be a reliable mechanism for patient access. Possible innovations include: (1) incorporation into the informed consent process; (2) provider or payer negotiated requirement in the routine hospital procedure to use the SDP as a quality indicator; and (3) payer reimbursement to professional providers who make SDP programmes available to patients.
Information about screening – is it to achieve high uptake or to ensure informed choice?
Authors: Raffle Angela E. 
Published: March 2003

For many years, public information about screening has been aimed at achieving high uptake but concerns are now being raised about this approach. There are several problems that have prompted these concerns. By giving information that emphasizes only the positive aspects of screening the autonomy of individuals is ignored, individuals feel angry when they perceive that they are let down by screening, symptoms may be disregarded because of the belief that screening gives full protection, health service staff carry the blame for problems that are in fact inherent in screening, and sound debate about policy and investment in screening is hampered by misunderstanding about the benefits and costs of screening.If we adopt instead an approach that makes explicit the limitations and adverse effects then a different set of problems will be encountered. We risk a reduction in uptake of screening and thus population benefits may reduce, those most likely to be deterred from accepting screening may be the most socially disadvantaged, there will be a cost in terms of staff time to explain screening more fully to participants, and cost‐effectiveness could be reduced if uptake falls so low as to make services barely viable.In the UK current General Medical Council (GMC) advice1 to doctors about informed consent for screening makes it clear that full information should be given. The UK National Screening Committee has also signalled the need for a changed approach to information2 giving so that individuals are offered a choice based on appreciation of risks and benefits. It will take time for this approach to be fully reflected across the full range of UK screening programmes. New national information will be needed to assist staff in giving full information, and some aspects of policy, such as screening coverage targets for Health Authorities and General Practitioners, will need to be altered.There are many questions still to be answered about the kind of information needed to achieve informed participation, and about how it should be framed and communicated. These questions can begin to be addressed when there is clarity at national level about the purpose of information about screening.
Evaluation of the quality of patient information to support informed shared decision‐making
Authors: Godolphin William , Towle Angela , McKendry Rachael 
Published: March 2003

Objectives (a) To find out how much patient information material on display in family physicians’ offices refers to management choices, and hence may be useful to support informed and shared decision‐making (ISDM) by patients and (b) to evaluate the quality of print information materials exchanged during the consultation, i.e. brought in by patients or given out by family physicians. Design All print information available for patients and exchanged between physicians and patients was collected in a single complete day of the office practices of 21 family physicians. A published and validated instrument (DISCERN) was used to assess quality. Setting and participants Community office practices in the greater Vancouver area, British Columbia, Canada. The physicians were purposefully recruited by their association with the medical school Department of Family Practice, their interest in providing patients with print information and their representation of a range of practice types and location. Main variables studied The source of the pamphlets and these categories: available in the physicians’ offices; exchanged between physician and patient; and produced with the explicit or apparent intent to support evidence‐based patient choice. Main outcome measures The quality of the print information to support ISDM, as measured by DISCERN and the ease of use and reliability of the DISCERN tool. Results and conclusions Fewer than 50% of pamphlets available in these offices fulfilled our minimum criteria for ISDM (mentioned more than one management option). Offices varied widely in the proportion of pamphlets on display that supported ISDM and how particular the physician was in selecting materials. The DISCERN tool is quick, valid and reliable for the evaluation of patient information. The quality of patient information materials used in the consultation and available in these offices was below midpoint on the DISCERN score. Major deficiencies were with respect to the mention of choices, risks, effect of no treatment or uncertainty and reliability (source, evidence‐base). Good quality information can be produced; some is available locally.
Principles of distributive justice used by members of the general public in the allocation of donor liver grafts for transplantation: a qualitative study
Authors: Wilmot Stephen , Ratcliffe Julie 
Published: March 2003

AbstractObjective  To investigate the nature of public preferences in the allocation of donor liver grafts for transplantation.Design  A qualitative study based upon the transcripts of four focus groups.Setting  Derby, Derbyshire, UK.Participants  Twenty‐two members of the public in the Derby locality, recruited to one of four focus groups through local community groups.Main outcome measures  The views of focus group members as to the importance (or otherwise) of several potential discriminating factors which could be used in the prioritization of patients on the waiting list for liver transplantation were ascertained. The factors included were expected post‐transplant prognosis, the age of the patient, whether the patient was personally responsible for their illness, the time spent on the waiting list, re‐transplantation or primary transplant and the social background of the patient.Results and conclusions  Group members explored the criteria from a number of perspectives, and made some unexpected linkages between the criteria and wider moral principles. They did not come to firm conclusions about the relative desirability of the criteria, but their approach was notably flexible and thoughtful, with the exception of a few instances where they appeared to resort to arguments based on what is ‘obvious’ and ‘natural’. The results of these discussions suggest that members of the public would be able and willing to respond positively to a more open and consultative system of donor liver prioritization than exists presently within the UK.
TheN‐acetylglutamate synthase/N‐acetylglutamate kinase metabolon ofSaccharomyces cerevisiaeallows co‐ordinated feedback regulation of the first two steps in arginine biosynthesis
Authors: Pauwels Katia , Abadjieva Agnes , Hilven Pierre , Stankiewicz Anna , Crabeel Marjolaine 
Published: March 2003

InSaccharomyces cerevisiae, which uses the nonlinear pathway of arginine biosynthesis, the first two enzymes,N‐acetylglutamate synthase (NAGS) andN‐acetylglutamate kinase (NAGK), are controlled by feedback inhibition. We have previously shown that NAGS and NAGK associate in a complex, essential to synthase activity and protein level [Abadjieva, A., Pauwels, K., Hilven, P. & Crabeel, M. (2001)J. Biol. Chem.276, 42869–42880].The NAGKs of ascomycetes possess, in addition to the catalytic domain that is shared by all other NAGKs and whose structure has been determined, a C‐terminal domain of unknown function and structure. Exploring the role of these two domains in the synthase/kinase interaction, we demonstrate that the ascomycete‐specific domain is required to maintain synthase activity and protein level.Previous results had suggested a participation of the third enzyme of the pathway,N‐acetylglutamylphosphate reductase, in the metabolon. Here, genetic analyses conducted in yeast at physiological level, or in a heterologous background, clearly demonstrate that the reductase is dispensable for synthase activity and protein level.Most importantly, we show that the arginine feedback regulation of the NAGS and NAGK enzymes is mutually interdependent. First, the kinase becomes less sensitive to arginine feedback inhibition in the absence of the synthase. Second, and as inNeurospora crassa, in a yeast kinase mutant resistant to arginine feedback inhibition, the synthase becomes feedback resistant concomitantly.We conclude that the NAGS/NAGK metabolon promotes the co‐ordination of the catalytic activities and feedback regulation of the first two, flux controlling, enzymes of the arginine pathway.
Mutational analysis of disulfide bonds in the trypsin‐reactive subdomain of a Bowman‐Birk‐type inhibitor of trypsin and chymotrypsin
Authors: Philipp Sabine , Kim Young‐Mi , Dürr Ingolf , Wenzl Gabriele , Vogt Michael , Flecker Peter 
Published: March 2003

It is widely believed that protein folding is a hierarchical process proceeding from secondary structure via subdomains and domains towards the complete tertiary structure. Accordingly, protein subdomains should behave as independent folding units. However, this prediction would underestimate the well‐established structural significance of tertiary context and domain interfaces in proteins. The principal objective of this work was to distinguish between autonomous and cooperative refolding of protein subdomains by means of mutational analysis. The double‐headed Bowman‐Birk inhibitor of trypsin and chymotrypsin of known crystal structure was selected for study. The relative orientation of the two subdomains is stabilized by intramolecular and water‐mediated hydrogen bonds and close ion pairs across a polar domain interface. The binary arrangement of a trypsin‐reactive and a chymotrypsin‐reactive subdomain facilitates the distinction of local and global irregularities in the mutants of this protein by means of functional assays.The functional consequences of five replacements in the S‐S bond framework of the trypsin‐reactive subdomain are analyzed in the present report. The mutants were subjected to refolding experiments in a refolding buffer and on trypsin‐Sepharose as a template with complementary structure leading into a fully active state. The stability of the variants was assessed by means of subsequent equilibration experiments in solution. The mutants may be grouped into the following two classes : the class‐I mutations located within β‐strand A are characterized by a breakdown of the trypsin‐ and the chymotrypsin‐reactive subdomain upon refolding in solution and a complicated behavior in the equilibration experiments; by contrast, the Class‐II mutations (β‐strand B) display rather local perturbations and a reversible return to the initial ratio of the two subdomains. This points to a significance of polar interactions connecting the β‐strand A of the trypsin‐reactive with the chymotrypsin‐reactive subdomain. In conclusion, the polar domain interface appears as a major refolding unit of the Bowman‐Birk inhibitor.
Inter‐α‐trypsin inhibitor proteoglycan family
Authors: Bost Frédéric , Diarra‐Mehrpour Maryam , Martin Jean‐Pierre 
Published: March 2003

Extracellular matrix (ECM) is composed of several macromolecules associated in a complex network. This structure allows cells to adhere, migrate and interact. Hyaluronic acid (HA) is a glycosaminoglycan (GAG) and a major representative of ECM. HA‐binding proteins such as CD44, aggrecan, and versican, have been implicated in structuring the ECM by stabilizing large macromolecular aggregates. They also play an important role in tumor metastasis and cell motility.Recently, further HA‐binding proteins were identified : the inter‐α‐trypsin inhibitor(ITI)‐related proteins. ITI is a glycoprotein composed of three polypeptides : two heavy chains (HC1 and HC2) and one light chain (bikunin). Bikunin confers the protease‐inhibitor function. The heavy chains' function was unknown. Recent studies have shown that HC1 and HC2 are linked in vivo and in vitro to hyaluronic acid. This linkage greatly improves extracellular matrix stability. It also demonstrates that ITI‐related proteins might be considered as HA‐binding proteins (HABP).The ITI related proteins are composed of four polypeptides (HC1, HC2, HC3 and the bikunin) encoded by four genes H1, H2, H3 and L. Unlike the majority of plasma protein a non‐disulfide covalent linkage exists between heavy chains and bikunin.This review presents the recent progress concerning the interactions between ITI and ECM showing that ITI‐related proteins are HABP members. We will focus on the heavy chain linkage with HA, which represents the demonstration of covalent binding between proteins and HA.