Major Implications (major + implication)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

The self-efficacy model of medication adherence in chronic mental illness

Terence V McCann BA
Aim., In this position paper, the self-efficacy model of medication adherence in chronic mental illness is presented, and its application to antipsychotic medication adherence is considered. Background., Poor adherence to antipsychotic medications is common in chronic mental illness. Major implications of this are relapse and re-hospitalisation. Several conceptual frameworks have been developed about adherence and, in some instances, have been incorporated in medication taking studies, but have resulted in inconsistent outcomes. Method., This paper draws on a review of literature from databases to inform the development of the self-efficacy model of medication adherence. Inclusion and exclusion criteria were developed from primary and secondary research questions. Results., The model places the person with chronic mental illness as an active participant central to the process of medication taking. It has three components: core factors, contextual influences and a continuum. The factors comprise a central factor, self-efficacy and four interrelated supporting influences: perceived medication efficacy; access to, and relationships with, health professionals; significant other support and supported living circumstances. The factors are affected by three broad contextual influences , personal issues, medication side-effects and complexity, and social stigma , which affect the way individuals take their medications. A continuum exists between adherence and non-adherence. Conclusion., The model positions service users at the heart of adherence by giving prominence to self-efficacy, medication efficacy and to immediate social, psychological and environmental supports. Further work is needed to validate, refine and extend the model. Relevance to clinical practice., For practitioners involved in prescribing and medication management in people with chronic mental illness, the model provides a theoretical framework to strengthen adherence. It highlights the need to consider broader influences on medication taking. Moreover, it places the person with chronic mental illness as an active participant at the centre of strategies to enhance adherence. [source]

Quantifying the impact of soil water repellency on overland flow generation and erosion: a new approach using rainfall simulation and wetting agent on in situ soil

G. Leighton-Boyce
Abstract The conventional view of soil water repellency is that it promotes overland flow and soil erosion, but this is not always borne out by observations. This study aimed to isolate the effects of repellency on long-unburnt and recently burnt terrain on infiltration, overland flow and erosion at the small plot scale (0·36 m2). Rainfall simulations (30 min; intensity 100 mm h,1), using untreated water, and water treated with surfactants to eliminate repellency, were conducted on in situ repellent soils in fire-prone Eucalyptus globulus plantations, north-central Portugal at (i) a long-unburnt site with and without litter, and (ii) a recently burnt site. On long-unburnt terrain, the mean overland flow coefficient (33%) was 16 times higher and mean slopewash was 23 times higher under repellent compared with wettable conditions. On recently burnt terrain, no overland flow was recorded under wettable conditions, while under repellent conditions the mean coefficient was 70%. The water storage capacity of the litter layer under 10-year-old eucalyptus stands for dry antecedent conditions was at least 3 mm water depth per cm litter depth, implying at least a delay to the onset of overland flow. Severe repellency (36% ethanol) was found to persist through a 30-min storm (100 mm h,1) when a litter layer was present. A continuous wetting front was observed in the upper ,1 cm of exposed soil, indicating a breakdown in repellency at the time of observation. Below ,1 cm, repellent, dry soil conditions generally persisted through the simulated storm event. A major implication is that prediction of hydrological impacts of repellency must also take into account the infiltration characteristics of any litter layer and any non-repellent soils, if present. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Implications of Prognostic Factors and Risk Groups in the Management of Differentiated Thyroid Cancer,

Ashok R. Shaha MD
Abstract Objectives/Hypothesis The outcome in differentiated thyroid cancer generally depends on the stage of the disease at the time of presentation; prognostic factors such as age, grade, size, extension, or distant metastasis; and risk groups (eg, low or high risk). The author has reviewed a large number of patients with differentiated thyroid cancer to analyze their hypothesis and to confirm that various risk groups have a major implication in relation to extent of the treatment and outcome. Differentiated thyroid cancers make up 90% of all thyroid tumors. The prognostic factors are well defined, such as age, size of the tumor, extrathyroidal extension, presence of distant metastasis, histological appearance, and grade of the tumor. The author has previously divided the risk groups into low-, intermediate-, and high-risk categories based on prognostic factors. The study describes the author's treatment approach related to the extent of thyroidectomy and adjuvant therapy based on various risk groups and the long-term survival. Study Design Retrospective. Methods In a retrospective review of 1038 patients with differentiated thyroid carcinoma, various prognostic factors were studied by univariate and multivariate analysis. The significant prognostic factors were studied in detail and, based on these prognostic factors, the patients were divided into low-, intermediate- and high-risk groups. The survival curves were plotted by Kaplan-Meier method. Results The long-term survivals in low-, intermediate- and high-risk groups were 99%, 87%, and 57% respectively. Based on these risk groups, a decision tree was made regarding extent of thyroidectomy and adjuvant treatment. In the high-risk group and selected patients in the intermediate-risk group, aggressive surgery including removal of all gross disease and extrathyroidal extension with postoperative radioactive iodine ablation is recommended. In the low-risk group and selected patients in the intermediate-risk group, lobectomy appears to be satisfactory with excellent long-term outcome. The surgical treatment offers the best long-term results in low-risk patients, and the role of adjuvant treatment in this group is questionable. Conclusion The decisions in the management of well-differentiated thyroid cancer should be based on various prognostic factors and risk groups. The long-term survival in the low-risk group is excellent, and consideration should be given to conservative surgical resection depending on the extent of the disease. In the high-risk group and selected patients in the intermediate-risk group, total thyroidectomy with radioactive ablation is warranted. A consideration may be given to external-beam radiation therapy in selected high-risk patients. It is apparent, based on the author's clinical experience and critical retrospective analysis, that the author's hypothesis that risk groups are extremely important in the long-term outcome of patients with differentiated thyroid cancer is correct. Based on various risk groups, the author currently is able to guide the treatment policies for thyroid cancer. [source]

Wnt signaling in caudal dysgenesis and diabetic embryopathy

Gabriela Pavlinkova
Abstract BACKGROUND: Congenital defects are a major complication of diabetic pregnancy, and the leading cause of infant death in the first year of life. Caudal dysgenesis, occurring up to 200-fold more frequently in children born to diabetic mothers, is a hallmark of diabetic pregnancy. Given that there is also an at least threefold higher risk for heart defects and NTDs, it is important to identify the underlying molecular mechanisms for aberrant embryonic development. METHODS: We have investigated gene expression in a transgenic mouse model of caudal dysgenesis, and in a pharmacological model using situ hybridization and quantitative real-time PCR. RESULTS: We identified altered expression of several molecules that control developmental processes and embryonic growth. CONCLUSIONS: The results from our models point towards major implication of altered Wnt signaling in the pathogenesis of developmental anomalies associated with embryonic exposure to maternal diabetes. Birth Defects Research (Part A) 82:710,719, 2008. © 2008 Wiley-Liss, Inc. [source]

Hospital in-patients with diabetes: increasing prevalence and management problems

M. E. Wallymahmed
Abstract Aims To re-assess the prevalence, management problems, clinical outcomes and discharge summaries of hospital in-patients with diabetes. Methods Case records of all patients occupying in-patient beds were audited on a single weekday in 2003 in a large urban hospital and repeated after 3 months. Data was compared with an identical audit 12 years previously. Results Over 12 years the number of beds available for admission (1191) had reduced by 25% with a bed occupancy of 97%. Diabetes prevalence had increased from 7.0% to 11.1% (P < 0.01) (97% Type 2). Diabetes management was considered inappropriate in 29%, more than in 1991 (20%). After 3 months, discharge summaries had been completed on 75% of patients but diabetes was mentioned in only 53%. Conclusion The prevalence of in-patient diabetes (11.1%) was over 50% greater and diabetes management was suboptimal in more patients than in 1991. In many length of stay was prolonged and almost half of the discharge summaries did not mention diabetes. These findings have major implications for service delivery and resource planning. [source]

Long-term reproductive behaviour of woody plants across seven Bornean forest types in the Gunung Palung National Park (Indonesia): suprannual synchrony, temporal productivity and fruiting diversity

ECOLOGY LETTERS, Issue 10 2007
Charles H. Cannon
Abstract For 68 months, we observed the reproductive behaviour of 7288 woody plants (172 figs, 1457 climbers and 5659 trees) spanning major soil and elevational gradients. Two 2,3 month community-wide supra-annual fruiting events were synchronized across five forest types, coinciding with ENSO events. At least 27 genera in 24 families restricted their reproduction to these events, which involved a substantial proportion of tree diversity (> 80% of phylogenetic diversity). During these events, mean reproductive levels (8.5%) represented an almost four-fold increase compared with other months. These patterns indicate a strong behavioural advantage to this unusual reproductive behaviour. Montane forest experienced a single, separate fruiting peak while the peat swamp forest did not participate. Excluding these events, no temporal reproductive pattern was detectible, at either the landscape or forest type. These phenological patterns have major implications for the conservation of frugivore communities, with montane and swamp forests acting as ,keystone' forests. [source]

Health-related quality of life measures and psychiatric comorbidity in patients with migraine

M. Mula
Background and purpose:, The identification of factors associated to health-related quality of life (HRQoL) measures in patients with migraine has major implications in terms of prognosis and treatment. This study aimed at investigating associations between HRQoL and comorbid mood and anxiety disorders. Methods:, Consecutive adult outpatients with a diagnosis of migraine with or without aura were assessed using the Mini International Neuropsychiatric Interview (M.I.N.I.) Plus version 5.0.0 and the Migraine-Specific Quality-of-Life Questionnaire (MSQ). Results:, Data of 112 patients (82 females), 69 without aura, mean age 41.2 ± 13.3 years were analyzed. According to the M.I.N.I., 50% patients had a lifetime or current DSM-IV diagnosis of mood or anxiety disorder. There was no between-groups difference in MSQ total and subscale scores in relation to the presence/absence of psychiatric comorbidity, independently whether that was current or lifetime. In the group of subjects with psychiatric disorders, age at onset of migraine correlated with MSQ-total (rho = ,0.407 P = 0.002), and subscale scores (Role Function-Restrictive, rho = ,0.397, P = 0.002; Emotional Function, rho = ,0.487, P < 0.001). Conclusions:, Our findings suggest that current and/or lifetime psychiatric comorbidities are not associated with HRQoL measures in patients with migraine. However, patients with migraine and psychiatric comorbidities may represent a specific subgroup deserving particular attention for targeted interventions. [source]

Emergence of a subfamily of xylanase inhibitors within glycoside hydrolase family 18

FEBS JOURNAL, Issue 7 2005
Anne Durand
The xylanase inhibitor protein I (XIP-I), recently identified in wheat, inhibits xylanases belonging to glycoside hydrolase families 10 (GH10) and 11 (GH11). Sequence and structural similarities indicate that XIP-I is related to chitinases of family GH18, despite its lack of enzymatic activity. Here we report the identification and biochemical characterization of a XIP-type inhibitor from rice. Despite its initial classification as a chitinase, the rice inhibitor does not exhibit chitinolytic activity but shows specificities towards fungal GH11 xylanases similar to that of its wheat counterpart. This, together, with an analysis of approximately 150 plant members of glycosidase family GH18 provides compelling evidence that xylanase inhibitors are largely represented in this family, and that this novel function has recently emerged based on a common scaffold. The plurifunctionality of GH18 members has major implications for genomic annotations and predicted gene function. This study provides new information which will lead to a better understanding of the biological significance of a number of GH18 ,inactivated' chitinases. [source]

Probing ligand-induced conformational changes of human CD38

FEBS JOURNAL, Issue 10 2000
Valérie Berthelier
The lymphoid surface antigen CD38 is basically a NAD+glycohydrolase, which is also involved in the metabolism of cyclic ADP-ribose. Besides, this ecto-enzyme has potential signalling roles in T- and B-cells. Such multiple functions prompted us to study the molecular dynamics of the CD38 protein and especially the relationship between its ecto-enzymatic active site and its epitope, i.e. the binding site of most known anti-CD38 monoclonal antibodies. Both epitopic and enzymatic sites were shown to be degraded by proteases, such as trypsin or chymotrypsin. This sensitivity was almost entirely suppressed in the presence of substrates or inhibitors. Both sites were also degraded in the presence of reducing agents, as dithiothreitol. Inhibitory ligands induced the same resistance of both sites against reducing attack. The binding of CD38 ligands to the active site triggers therefore conformational changes that shield some backbone bonds and disulfide bridges against, respectively, proteolytic cleavage or reduction. This transconformation was found moreover to irreversibly take place after incubation with substrates such as NAD+ in the presence of dithiothreitol. The epitope remained preserved, while the enzymatic activity was lost. This inactivation probably resulted from the covalent trapping of the catalytically reactive intermediate in the active site (i.e. paracatalytic inactivation). These data have major implications in the knowledge of the CD38 structure, especially with regard to the location of disulfide bridges and their accessibility. Potential consequences of the conformational plasticity of CD38 should also be considered in its physiological functions such as signalling. [source]

Quantifying root lateral distribution and turnover using pine trees with a distinct stable carbon isotope signature

Summary 1In order to help assess spatial competition for below-ground resources, we quantified the effects of fertilization on root biomass quantity and lateral root distribution of mid-rotation Pinus taeda trees. Open-top chambers exposed trees to ambient or ambient plus 200 µmol mol,1 atmospheric CO2 for 31 months. 2Tank CO2 was depleted in atmospheric 13C; foliage of elevated CO2 trees had ,13C of ,42·9, compared with ,29·1 for ambient CO2 trees. 3Roots 1 m from the base of elevated CO2 -grown trees had more negative ,13C relative to control trees, and this difference was detected, on average, up to 5·8, 3·7 and 3·7 m away from the trees for 0,2, 2,5 and >5 mm root-size classes, respectively. Non-fertilized tree roots extended as far as fertilized trees despite the fact that their above-ground biomass was less than half that of fertilized trees. 4These results are informative with respect to root sampling intensity and protocol, and the distances required between experimental manipulations to evaluate below-ground processes of independent treatments. 5Fine-root turnover has usually been estimated to range from weeks to 3 years, representing a major avenue of carbon flux. Using a mixing model we calculated that 0,2 mm roots had a mean residence time of 4·5 years indicating relatively slow fine-root turnover, a result that has major implications in modelling C cycling. [source]

New perspectives on Holocene landscape development in the southern English chalklands: The upper Allen valley, Cranborne Chase, Dorset

C. French
A combination of on- and off-site paleoenvironmental and archaeological investigations of the upper Allen valley of Dorset, conducted from 1998,2002, has begun to indicate a different model of prehistoric landscape development to those previously put forward for this part of the southern English chalk downlands. Woodland growth in the earlier Holocene appears to have been slower and patchier than the presumed model of full climax deciduous woodland rapidly attained in a warming environment. With open areas still strongly present in the Mesolithic, the area witnessed its first exploitation, thus slowing and altering soil development. Consequently, many areas perhaps never developed thick, well-structured, brown forest earths, but more probably thin brown earths. By the later Neolithic period, these soils had become thin rendzinas, largely as a consequence of human exploitation and the predominance of pastoral land use. The early presence of thinner and less well-developed soils over large areas of downland removes the necessity for envisaging extensive soil erosion and the accumulation of thick colluvial and alluvial deposits in the dry valleys and valley floor as often postulated. If there were major changes in the vegetation and soil complexes in this area of chalk downland, these had already occurred by the Neolithic rather than the Bronze Age as often suggested, and the area has remained relatively stable ever since. This has major implications for models of prehistoric land use in the southern chalkland region, such as a much greater degree of stability in prehistoric and historic times, variability within sub-regions, and differences between different parts of the chalk downlands than had previously been envisaged. © 2005 Wiley Periodicals, Inc. [source]

Factors controlling the chemical evolution of travertine-depositing rivers of the Barkly karst, northern Australia

Russell N. Drysdale
Abstract Groundwaters feeding travertine-depositing rivers of the northeastern segment of the Barkly karst (NW Queensland, Australia) are of comparable chemical composition, allowing a detailed investigation of how the rate of downstream chemical evolution varies from river to river. The discharge, pH, temperature, conductivity and major-ion concentrations of five rivers were determined by standard field and laboratory techniques. The results show that each river experiences similar patterns of downstream chemical evolution, with CO2 outgassing driving the waters to high levels of calcite supersaturation, which in turn leads to widespread calcium carbonate deposition. However, the rate at which the waters evolve, measured as the loss of CaCO3 per kilometre, varies from river to river, and depends primarily upon discharge at the time of sampling and stream gradient. For example, Louie Creek (Q = 0·11 m3 s,1) and Carl Creek (Q = 0·50 m3 s,1) have identical stream gradients, but the loss of CaCO3 per kilometre for Louie Creek is twice that of Carl Creek. The Gregory River (Q = 3·07 m3 s,1), O'Shanassy River (Q = 0·57 m3 s,1) and Lawn Hill Creek (Q = 0·72 m3 s,1) have very similar gradients, but the rate of hydrochemical evolution of the Gregory River is significantly less than either of the other two systems. The results have major implications for travertine deposition: the stream reach required for waters to evolve to critical levels of calcite supersaturation will, all others things being equal, increase with increasing discharge, and the length of reach over which travertine is deposited will also increase with increasing discharge. This implies that fossil travertine deposits preserved well downstream of modern deposition limits are likely to have been formed under higher discharge regimes. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Drained cavity expansion in sands exhibiting particle crushing

A. R. Russell
The expansion of cylindrical and spherical cavities in sands is modelled using similarity solutions. The conventional Mohr,Coulomb failure criterion and the state parameter sand behaviour model, which enables hardening,softening, are used in the analysis. The sand state is defined in terms of a new critical state line, designed to account for the three different modes of compressive deformation observed in sands across a wide range of stresses including particle rearrangement, particle crushing and pseudoelastic deformation. Solutions are generated for cavities expanded from zero and finite radii and are compared to those solutions where a conventional critical state line has been used. It is shown that for initial states typical of real quartz sand deposits, pseudoelastic deformation does not occur around an expanding cavity. Particle crushing does occur at these states and causes a reduction in the stress surrounding the cavity. This has major implications when using cavity expansion theory to interpret the cone penetration test and pressuremeter test. Copyright © 2002 John Wiley & Sons, Ltd. [source]

European snow cover extent variability and associations with atmospheric forcings

Gina R. Henderson
Abstract Snow cover in Europe represents an important component of the region's climatic system. Variability in snow cover extent can have major implications on factors such as low-level atmospheric temperatures, soil temperatures, soil moisture, stream discharge, and energy allocation involved in the warming and melting of the snowpack. The majority of studies investigating Northern Hemisphere snow cover identify European snow cover extent as a portion of the Eurasian record, possibly masking complexities of this subset. This study explores the variability of European snow cover extent from 1967,2007, with the region in question including the area of Europe extending eastward to the Ural Mountains (60°E). Using the 89 × 89 gridded National Oceanic and Atmospheric Administration (NOAA) Northern Hemisphere weekly satellite snow cover product, area estimates of seasonal snow cover were calculated, and their relationship to gridded temperature, precipitation, and sea-level pressure data analysed. The spatial variability of snow cover extent was also explored using geographical information systems (GIS). The combined results from both surface temperature and precipitation analyses point towards snow cover extent in Europe being primarily temperature dependent. Atmospheric variables associated with extremes in snow cover extent were investigated. Large (small) European snow extent is associated with negative (positive) 850 hPa zonal wind anomalies, negative (positive) European 1000,500 hPa thickness anomalies, and generally positive (negative) Northern European precipitation anomalies. Sea-level pressure and 500 hPa results indicate strong associations between large (small) snow cover seasons and the negative (positive) phase of the North Atlantic Oscillation. Copyright © 2009 Royal Meteorological Society [source]

Comparison of suitable drought indices for climate change impacts assessment over Australia towards resource management

F. Mpelasoka
Abstract Droughts have significant environmental and socio-economic impacts in Australia. This emphasizes Australia's vulnerability to climate variability and limitations of adaptive capacity. Two drought indices are compared for their potential utility in resource management. The Rainfall Deciles-based Drought Index is a measure of rainfall deficiency while the Soil-Moisture Deciles-based Drought Index is a measure of soil-moisture deficiency attributed to rainfall and potential evaporation. Both indices were used to assess future drought events over Australia under global warming attributed to low and high greenhouse gas emission scenarios (SRES B1 and A1F1 respectively) for 30-year periods centred on 2030 and 2070. Projected consequential changes in rainfall and potential evaporation were based on results from the CCCma1 and Mk2 climate models, developed by the Canadian Climate Center and the Australian Commonwealth Scientific and Industrial Research Organisation (CSIRO) respectively. A general increase in drought frequency associated with global warming was demonstrated by both indices for both climate models, except for the western part of Australia. Increases in the frequency of soil-moisture-based droughts are greater than increases in meteorological drought frequency. By 2030, soil-moisture-based drought frequency increases 20,40% over most of Australia with respect to 1975,2004 and up to 80% over the Indian Ocean and southeast coast catchments by 2070. Such increases in drought frequency would have major implications for natural resource management, water security planning, water demand management strategies, and drought relief payments. Copyright © 2007 Royal Meteorological Society [source]

Neuropathological evidence for ischemia in the white matter of the dorsolateral prefrontal cortex in late-life depression

Alan J. Thomas
Abstract Background Signal hyperintensities on magnetic resonance imaging in late-life depression are associated with treatment resistance and poor outcome. These lesions are probably vascular in origin and proposed sites for vascular damage include the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC). Methods We therefore examined white matter in these areas for microvascular disease and evidence of ischemia using intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion molecule-1 (VCAM-1). We obtained postmortem tissue from elderly depressed (n,=,20) and control (n,=,20) subjects and blindly rated microvascular disease and ICAM-1 and VCAM-1 amount using quantitative image analysis in sections of the DLPFC, ACC and occipital cortex (OC; control area). Results We found a significant increase in ICAM-1 in the deep white matter of the DLPFC in the depressed group (p,=,0.01) and a trend towards an increase for VCAM-1 (p,=,0.10). In the gyral white matter there was a trend towards significance for both molecules (p,=,0.07 and 0.10). No differences were found in the ACC or OC or for microvascular disease in any area. Conclusions These findings are consistent with white matter ischemia in the DLPFC and lend support to the ,vascular depression' hypothesis. They implicate the DLPFC as an important site in the pathogenesis of late-life depression and have major implications for the understanding and management of late-life depression and raise the possibility of novel treatments being introduced in the future. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Screening for mental disorders in cancer patients , discriminant validity of HADS and GHQ-12 assessed by standardized clinical interview

Katrin Reuter
Abstract The detection and classification of comorbid mental disorders has major implications in cancer care. Valid screening instruments for different diagnostic specifications are therefore needed. This study investigated the discriminant validity of the German versions of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ-12). A total of 188 cancer patients participated in the examination, consisting first of the assessment of psychological distress and, second, of the diagnosis of mental disorders according to DSM-IV by clinical standardized interview (CIDI). Discriminant validity of the two instruments regarding the diagnosis of any mental disorder, anxiety, depression and multiple mental disorders was compared using ROC analysis. Overall, the total HADS scale shows a better screening performance than the GHQ-12, especially for the detection of depressive and anxiety disorders. Best results are achieved for depressive disorders with an area under the curve (AUC) of 0.80, a sensitivity of 79% and a specificity of 76% (cut-off point = 17). For the ability of the instruments to detect patients with mental disorders in general, the GHQ-12 (AUC: 0.68) shows a similar overall accuracy to the HADS (AUC: 0.70). The screening performance of both scales for comorbid mental disorders is comparable. The HADS is a valid screening instrument for depressive and anxiety disorders in cancer care. The GHQ-12 can be considered as an alternative to the HADS when diagnostic specifications are less detailed and the goal of screening procedures is to detect patients with single or multiple mental disorders in general. Limitations of conventional screening instruments are given through the differing methodological approaches of screening tests (dimensional approach) and diagnosis according to DSM-IV (categorical approach). Copyright © 2001 Whurr Publishers Ltd. [source]

Hospital Charges Attributable to a Primary Diagnosis of Infectious Diseases in Older Adults in the United States, 1998 to 2004

Aaron T. Curns MPH
OBJECTIVES: To describe total and average hospital charges associated with infectious disease (ID) hospitalizations and specific ID categories and to estimate ID hospitalization rates in adults aged 65 and older in the United States from 1998 through 2004. DESIGN: Retrospective analysis of hospital discharge data obtained from the Nationwide Inpatient Sample for 1998 through 2004. SETTING: United States. PATIENTS: Older adults hospitalized in the United States from 1998 through 2004. MEASUREMENTS: Hospital charges and hospitalization rates for IDs described according to year, age group, sex, U.S. Census region, and ID category. Charges for non-ID hospitalizations were also described. Hospital charges were adjusted for inflation. RESULTS: From 1998 through 2004, total charges for ID hospitalizations exceeded $261 billion and accounted for 13% of all hospital charges for older adults. Total charges for ID hospitalizations increased from $31.4 billion in 1998 to $45.7 billion in 2004. The average annual ID hospital charge was lower than the average annual non-ID hospital charge during the study period ($21,342 vs $22,787, P<.001). The average annual rate for ID hospitalizations was 503 per 10,000 older adults, which remained stable during the study period. CONCLUSION: The total charges for ID hospitalizations and for all hospitalizations in older adults in the United States increased 45% and nearly 40%, respectively, during the 7-year study period, whereas the population of older adults grew by only 5%. Sustained increases of such magnitude will have major implications for the U.S. healthcare system as it prepares for the more than doubling of the older U.S. adult population during the first 30 years of this century. [source]

Short-term transformation of matrix into hospitable habitat facilitates gene flow and mitigates fragmentation

Summary 1Habitat fragmentation has major implications for demography and genetic structure of natural plant and animal populations as small and isolated populations are more prone to extinction. Therefore, many recent studies focus on spatial fragmentation. 2However, the temporal configuration of suitable habitat may also influence dispersal and gene flow in fragmented landscapes. We hypothesize that short-term switching of inhospitable matrix areas into suitable habitat can mitigate effects of spatial fragmentation in natural and seminatural ecosystems. 3To test our hypothesis, we investigated the hairy-footed gerbil (Gerbillurus paeba, Smith 1836), a ground-dwelling rodent, in fragmented Kalahari savannah areas. Here, rare events of high above mean annual rainfall suggest short-term matrix suitability. 4During the field survey in ,matrix' areas in the Kalahari (shrub encroachment by heavy grazing) we never observed the hairy-footed gerbil in years of average rainfall, but observed mass occurrences of this species during rare events of exceptionally high rainfall. 5In a second step, we developed an agent-based model simulating subpopulations in two neighbouring habitats and the separating matrix. Our mechanistic model reproduces the mass occurrences as observed in the field and thus suggests the possibly underlying processes. In particular, the temporary improvement in matrix quality allows reproduction in the matrix, thereby causing a substantial increase in population size. 6The model demonstrates further how the environmental trigger (rainfall) impacts genetic connectivity of two separated subpopulations. We identified seasonality as a driver of fragmentation but stochasticity leading to higher connectivity. 7We found that our concept of temporal fragmentation can be applied to numerous other fragmented populations in various ecological systems and provide examples from recent literature. We conclude that temporal aspects of fragmentation must be considered in both ecological research and conservation management. [source]

The effects of reducing population density on contact rates between brushtail possums: implications for transmission of bovine tuberculosis

Dave Ramsey
Summary 1Interactions during mating are thought to be an important mechanism for transmission of tuberculosis (Tb) Mycobacterium bovis in the brushtail possum Trichosurus vulpecula . However, little information is available on the frequency of contacts between males and females in oestrus during the breeding season, and the relationship between mating contacts and population density. 2We used radio-telemetry to record contacts between male and oestrous and non-oestrous female possums, and determined paternity of offspring using DNA analysis. This was repeated following the removal of c . 70% of the resident possums to determine the effect of reducing density on the contact rate. 3We could not detect any significant differences in the contact rate between oestrous and non-oestrous females and males, either before or after the density reduction, even when paternity was positively identified from DNA analysis. This suggests that actual mating contacts could not be distinguished from other agonistic or affiliative contact behaviours. 4Despite this, the relationships between male,female and male,male contact rates and population density were non-linear convex-up, implying that the contact rate during the breeding season did not decrease in proportion to reductions in density. This appeared to be driven by the enlargement of male ranges and a corresponding increase in male overlap of female ranges following the density reduction. 5The form of the contact rate function will influence predictions of disease spread in epidemiological models for Tb in wildlife. This has major implications for the development of tactical approaches to disease management based on such models. [source]


Esther Blanco
Abstract New trends in studies on the governance of natural assets include substantial consideration of the role of voluntary initiatives. A traditional economic view states that there is a trade-off between being green and being competitive. According to that view, no voluntary environmental action is expected to occur. To undertake an in-depth analysis of the scope for voluntary action, this paper reviews empirical literature that analyzes the relationship between manufacturing firms' environmental initiatives or performance and economic results. This review moves beyond the general test of the ,pay to be green' hypothesis, preferring instead to systematize empirical results in more specific research questions. Empirical findings of the reviewed literature generally support that there is no penalty for being green. In addition, the typology of firms, the methods utilized for implementing environmental initiatives, the intensity of abatement efforts and stockholders' valuation of green firms have all been shown to have a sizeable influence on the actual economic results of environmental action or management. Consequently, the findings of this paper challenge the traditional strategic theory that predicts widespread free-riding; it holds major implications for environmental policy-making and environmental business decisions. [source]

Emergence and diversity of different HIV-1 subtypes in South Africa, 2000,2001

G.B. Jacobs
Abstract HIV-1 is a major health problem in South Africa with an average prevalence rate of 29.1% in pregnant women and between 4.9 and 6.1 million people infected. Using env gp120 V3 serotyping and genotyping techniques 410 patient samples were investigated. Most of the samples were obtained from different clinics in the greater Cape Town area of the Western Cape Province in South Africa. These included an academic hospital, state and private clinics, an informal settlement, sex worker cohorts, and the blood transfusion services. RNA was extracted from plasma samples followed by RT-PCR and sequencing of the env gp120 V3 region. Sequence fragments were assembled using Sequencher V4.7 and subsequently codon aligned. Distance calculation, tree construction methods, and bootstrap analysis were implemented using MEGA version 4.0. Viral load measurements indicated that HIV-1 RNA levels from 74 samples were below the assay detection limit. Three hundred thirty-six samples were used for env PCR and sequencing and 320 were assigned to subtypes. The majority of the sequences were subtyped as C (n,=,285, 89.0%). Other subtypes detected were subtype A (n,=,10, 3.1%); subtype B (n,=,22, 6.8%); one each of subtypes F1, G, U, and a CH recombinant. Whether this diversity will have major implications for HIV-1 evolution and vaccine development in this region remains undetermined. J. Med. Virol. 81:1852,1859, 2009. © 2009 Wiley-Liss, Inc. [source]

Metamorphic phase relations in orthopyroxene-bearing granitoids: implication for high-pressure metamorphism and prograde melting in the continental crust

Abstract In this work, the factors controlling the formation and preservation of high-pressure mineral assemblages in the metamorphosed orthopyroxene-bearing metagranitoids of the Sandmata Complex, Aravalli-Delhi Mobile Belt (ADMB), northwestern India have been modelled. The rocks range in composition from farsundite through quartz mangerite to opdalite, and with varying K2O, Ca/(Ca + Na)rock and FeOtot + MgO contents. A two stage metamorphic evolution has been recorded in these rocks. An early hydration event stabilized biotite with or without epidote at the expense of magmatic orthopyroxene and plagioclase. Subsequent high-pressure granulite facies metamorphism (,15 kbar, ,800 °C) of these hydrated rocks produced two rock types with contrasting mineralogy and textures. In the non-migmatitic metagranitoids, spectacular garnet ± K-feldspar ± quartz corona was formed around reacting biotite, plagioclase, quartz and/or pyroxene. In contrast, biotite ± epidote melting produced migmatites, containing porphyroblastic garnet incongruent solids and leucosomes. Applying NCKFMASHTO T,M(H2O) and P,T pseudosection modelling techniques, it is demonstrated that the differential response of these magmatic rocks to high-pressure metamorphism is primarily controlled by the scale of initial hydration. Rocks, which were pervasively hydrated, produced garnetiferous migmatites, while for limited hydration, the same metamorphism formed sub-solidus garnet-bearing coronae. Based on the sequence of mineral assemblage evolution and the mineral compositional zoning features in the two metagranitoids, a clockwise metamorphic P,T path is constrained for the high-pressure metamorphic event. The finding has major implications in formulating geodynamic model of crustal amalgamation in the ADMB. [source]

The Role of Interbank Markets in Monetary Policy: A Model with Rationing

banking; rationing; monetary policy This paper analyzes the impact of asymmetric information in the interbank market and establishes its crucial role in the microfoundations of the monetary policy transmission mechanism. We show that interbank market imperfections induce an equilibrium with rationing in the credit market. This has two major implications: first, it reconciles the irresponsiveness of business investment to the user cost of capital with the large impact of monetary policy (magnitude effect), and second, it shows that banks' liquidity positions condition their reaction to monetary policy (Kashyap and Stein liquidity effect). [source]

Buyer-Supplier Relationships and Organizational Health

Marie McHugh
SUMMARY This article examines the relationship between organizational health and buyer-supplier relationships. Contemporary research has emphasized the need for organizations to move toward closer cooperation. The decision to engage in partnership arrangements is one that has major implications for buyers and suppliers. Using evidence from an exploratory case study, the challenges presented in developing a close, cooperative, and mutually beneficial trading relationship between a buyer and a supplier, where one partner, the buyer, is in a powerful position, are investigated. It is argued that powerful buyers can seriously damage organizational health. The findings provide evidence that it is essential to promote communication structures that encourage dialogue, consultation, and employee participation in decisionmaking. This is particularly important where decisionmaking could benefit from the in-depth technical knowledge of middle and junior managers and shopfloor workers. [source]

The Future of Purchasing and Supply: A Ten-Year Forecast,

Phillip L Carter
SUMMARY The purpose of this research was the development of the 10-year forecasts for purchasing and supply based upon a close examination of key change drivers. The authors aimed at highlighting the most important areas of concern for purchasing executives. The research included trends of importance for organizations of all sizes, in all major industries , profit and nonprofit, private and public. To this end, the research team: ,,Identified the major economic, demographic, societal, competitive, and technological trends most likely to have major implications for the purchasing and supply management profession, its professionals, and organizationalprocesses ,,Projected the identified trends for 10 years (2008) ,,Determined the impact of these trends on purchasing and supply executives ,,Forecasted the environment for purchasing and supply in 10 years (2008) ,,Projected the changes to the purchasing and supply profession, its professionals, and organizational processes implied as a result of the research [source]


ABSTRACT Four thickeners (pectin, gelatin, starch and gelatin + starch) and two aroma concentrations (1.4 and 0.7 mL aroma / 1 kg candy base) were used for manufacturing high viscosity gel systems, i.e. strawberry candies. The salient texture and flavor attributes of the samples were identified and evaluated by a trained descriptive panel. The thickeners strongly affected texture and flavor attributes of the samples, while the two aroma concentrations did not differentiate between samples. Each thickener used produced its own characteristic texture. The gels with weak and fragile texture had stronger flavor intensities and tart flavor than the gels with strong and cohesive texture. Because of the strong interaction between texture and flavor, the results have major implications for the production of high viscosity gels such as candies. [source]

Cysteine-mutations in von Willebrand factor associated with increased clearance

Summary.,Background:,von Willebrand disease (VWD) is a bleeding disorder caused by the decrease of functional von Willebrand factor (VWF). Low levels of VWF can result from decreased synthesis, impaired secretion, increased clearance or combinations thereof. Several mutations lead to impaired synthesis or secretion of VWF, however, little is known about the survival of VWF in the circulation. Objectives:,To evaluate the effect of several VWF mutations on VWF clearance. Patients/methods:,The effect of three cysteine-mutations (C1130F, C1149R or C2671Y) on the in vivo survival of VWF was studied in patients carrying these mutations and in a VWF-deficient mice model. Results:,In patients carrying these mutations, we observed increased propeptide/mature VWF ratios and rapid disappearance of VWF from the circulation after desmopressin treatment. Detailed analysis of in vivo clearance of recombinant VWF in a VWF-deficient mice model revealed a fourfold increased clearance rate of the mutants. The mutations C1130F, C1149R and C2671Y are each associated with reduced survival of VWF in the circulation. Detailed analysis of the recombinant mutant VWF demonstrated that increased clearance was not due to increased proteolysis by ADAMTS-13. We did not identify functional or structural characteristics that the mutant proteins have in common and could be associated with the phenomenon of increased clearance. Conclusions:,Cysteine-mutations in VWF may result in reduced in vivo survival. The observation that various mutations are associated with increased in vivo clearance may have major implications for the therapeutic strategies that rely on the rise of endogenous VWF after desmopressin administration. [source]

Wild mammals and the human food chain

MAMMAL REVIEW, Issue 2-3 2008
ABSTRACT 1Wild mammals have a long history of association with the human food chain, with some being the source for domesticated animals and others being considered traditionally as game species. Wild mammals are of negligible importance in terms of overall energy flows in agricultural ecosystems in Britain, but some wild mammals can have detrimental effects on the human food chain through predation, competition and disease transmission. 2Understanding these ecological processes at the level of populations and individuals can assist with devising appropriate management strategies to reduce human,wildlife conflict over limited resources. There remains a dearth of reliable information on the economic impacts of wild mammals on human food production, although the available quantified evidence suggests that the impacts are generally minor and localized, and are far outweighed by the wider public benefits associated with wild mammals. 3Greater public awareness of environmental and animal welfare issues, together with changes to rural communities resulting from human population movements, are changing the social landscape of interactions between people and wild mammals in the British countryside, and leading to an increase in more ambivalent attitudes towards wild mammals than has typically been the case in the past. 4Reform of agricultural policy is placing greater emphasis on the management of the land for biodiversity and environmental protection. While the benefits deriving from many previous agri-environment schemes have been mixed, there is increasing evidence that an emphasis on targeted and coordinated management at the landscape scale can enhance success. This type of approach is essential if some of the major threats facing declining wild mammal populations, such as population fragmentation, are to be overcome. 5There is an increasing divergence between regulation of agricultural ecosystems for food production and disease minimization and regulation of the land for biodiversity production via agri-environment schemes. The resolution of these tensions at the policy level will have major implications for future interactions between wild mammals and the human food chain. [source]

Cationic antimicrobial peptides activate a two-component regulatory system, PmrA-PmrB, that regulates resistance to polymyxin B and cationic antimicrobial peptides in Pseudomonas aeruginosa

Joseph B. McPhee
Summary The two-component regulatory system PhoP-PhoQ of Pseudomonas aeruginosa regulates resistance to cationic antimicrobial peptides, polymyxin B and aminoglycosides in response to low Mg2+ conditions. We have identified a second two-component regulatory system, PmrA-PmrB, that regulates resistance to polymyxin B and cationic antimicrobial peptides. This system responds to limiting Mg2+, and is affected by a phoQ, but not a phoP mutation. Inactivation of the pmrB sensor kinase and pmrA response regulator greatly decreased the expression of the operon encoding pmrA-pmrB while expression of the response regulator pmrA in trans resulted in increased activation suggesting that the pmrA-pmrB operon is autoregulated. Interposon mutants in pmrB, pmrA, or in an intergenic region upstream of pmrA-pmrB exhibited two to 16-fold increased susceptibility to polymyxin B and cationic antimicrobial peptides. The pmrA-pmrB operon was also found to be activated by a number of cationic peptides including polymyxins B and E, cattle indolicidin and synthetic variants as well as LL-37, a component of human innate immunity, whereas peptides with the lowest minimum inhibitory concentrations tended to be the weakest inducers. Additionally, we showed that the putative LPS modification operon, PA3552-PA3559, was also induced by cationic peptides, but its expression was only partially dependent on the PmrA-PmrB system. The discovery that the PmrA-PmrB two-component system regulates resistance to cationic peptides and that both it and the putative LPS modification system are induced by cationic antimicrobial peptides has major implications for the development of these antibiotics as a therapy for P. aeruginosa infections. [source]