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Selected AbstractsUsefulness of B-Type Natriuretic Peptide as a Predictor of Treatment Outcome in Pulmonary Arterial HypertensionCONGESTIVE HEART FAILURE, Issue 5 2004Myung H. Park MD We examined the utility of early modulation B-type natriuretic peptide (BNP) levels in 20 pulmonary arterial hypertension patients as a marker of response to epoprostenol therapy. The baseline BNP level was 828±217 pg/mL. A total of 19 hospitalizations and one death occurred in nine patients during 11.0±1.8 months. At baseline, a trend toward higher BNP level was observed among the event-free (Group A) as compared with clinical event patients (Group B) (1090±372 vs. 510±235 pg/mL, respectively; p=0.08). After 3 months on epoprostenol, a significant reduction among Group A occurred while Group B demonstrated an increase (288±92 vs. 610±121 pg/mL, p=0.04). A comparison of percent reduction in BNP level demonstrated a ,70±7% change among Group A and an 11±19% increase in Group B (p=0.005). A decrease in BNP level of ,50% during the first 3 months on epoprostenol was strongly predictive of event-free survival (p=0.003). This investigation establishes the utility of BNP for predicting response to epoprostenol therapy in pulmonary arterial hypertension. [source] Adverse Event Reporting: Lessons Learned from 4 Years of Florida Office DataDERMATOLOGIC SURGERY, Issue 9 2005Brett Coldiron MD, FACP Background Patient safety regulations and medical error reporting systems have been at the forefront of current health care legislature. In 2000, Florida mandated that all physicians report, to a central collecting agency, all adverse events occurring in an office setting. Purpose To analyze the scope and incidence of adverse events and deaths resulting from office surgical procedures in Florida from 2000 to 2004. Methods We reviewed all reported adverse incidents (the death of a patient, serious injury, and subsequent hospital transfer) occurring in an office setting from March 1, 2000, through March 1, 2004, from the Florida Agency for Health Care Administration. We determined physician board certification status, hospital privileges, and office accreditation via telephone follow-up and Internet searches. Results Of 286 reported office adverse events, 77 occurred in association with an office surgical procedure (19 deaths and 58 hospital transfers). There were seven complications and five deaths associated with the use of intravenous sedation or general anesthesia. There were no adverse events associated with the use of dilute local (tumescent) anesthesia. Liposuction and/or abdominoplasty under general anesthesia or intravenous sedation were the most common surgical procedures associated with a death or complication. Fifty-three percent of offices reporting an adverse incident were accredited by the Joint Commission on Accreditation of Healthcare Organizations, American Association for Accreditation of Ambulatory Surgical Facilities, or American Association for Ambulatory Health Care. Ninety-four percent of the involved physicians were board certified, and 97% had hospital privileges. Forty-two percent of the reported deaths were delayed by several hours to weeks after uneventful discharge or after hospital transfer. Conclusions Requiring physician board certification, physician hospital privileges, or office accreditation is not likely to reduce office adverse events. Restrictions on dilute local (tumescent) anesthesia for liposuction would not reduce adverse events and could increase adverse events if patients are shifted to riskier approaches. State and/or national legislation establishing adverse event reporting systems should be supported and should require the reporting of delayed deaths. [source] Nicotinic synapses formed between chick ciliary ganglion neurons in culture resemble those present on the neurons in vivoDEVELOPMENTAL NEUROBIOLOGY, Issue 4 2001Min Chen Abstract We studied nicotinic synapses between chick ciliary ganglion neurons in culture to learn more about factors influencing their formation and receptor subtype dependence. After 4,8 days in culture, nearly all neurons displayed spontaneous excitatory postsynaptic currents (sEPSCs), which occurred at about 1 Hz. Neurons treated with tetrodotoxin displayed miniature EPSCs (mEPSCs), but these occurred at low frequency (0.1 Hz), indicating that most sEPSCs are actually impulse driven. The sEPSCs could be classified by decay kinetics as fast, slow, or biexponential and, reminiscent of the situation in vivo, were mediated by two major nicotinic acetylcholine receptor (AChR) subtypes. Fast sEPSCs were blocked by ,-bungarotoxin (,Bgt), indicating dependence on ,Bgt-AChRs, most of which are ,7 subunit homopentamers. Slow sEPSCs were unaffected by ,Bgt, and were blocked instead by the ,3/,2-selective ,-conotoxin-MII (,CTx-MII), indicating dependence on ,3*-AChRs, which lack ,7 and contain ,3 subunits. Biexponential sEPSCs were mediated by both ,Bgt- and ,3*-AChRs because they had fast and slow components qualitatively similar to those comprising simple events, and these were reduced by ,Bgt and blocked by ,CTx-MII, respectively. Fluorescence labeling experiments revealed both ,Bgt- and ,3*-AChR clusters on neuron somata and neurites. Colabeling with antisynaptic vesicle protein antibody suggested that some ,3*-AChR clusters, and a few ,Bgt-AChR clusters are associated with synaptic sites, as is the case in vivo. These findings demonstrate the utility of ciliary ganglion neuron cultures for studying the regulation of nicotinic synapses, and suggest that mixed AChR subtype synapses characteristic of the neurons in vivo can form in the absence of normal inputs or targets. © 2001 John Wiley & Sons, Inc. J Neurobiol 47: 265,279, 2001 [source] Distribution of myrmecochorous species over the landscape and their potential long-distance dispersal by emus and kangaroosDIVERSITY AND DISTRIBUTIONS, Issue 1 2008María Calviño-Cancela ABSTRACT Topographical heterogeneity can create a mosaic of substrate types leading to the formation of isolated plant populations. Seed dispersal then becomes crucial for the colonization of such suitable but remote substrate types. We surveyed the distribution of seven elaiosome-bearing species (myrmecochores) over 5 km2 of natural heathland in southwestern Australia. Ants are the standard means of dispersal of these species, which provide limited dispersal (usually of a few metres). Six species were associated with particular substrate types (dune or swale) and all occurred as discrete populations, on average 270,500 m apart, with closest dune edges 280 m apart. We evaluated the possible roles of emus and kangaroos as alternative agents of long-distance seed dispersal between substrate types. Their droppings contained viable seeds of three of the target species, as well as other myrmecochores, and were evenly distributed over the substrate types. While migration of these plant species between preferred substrate types seems unlikely when considering only their standard dispersal agents (ants), it is highly likely in the presence of emus (in particular) and kangaroos that act as non-standard dispersers. This may have important consequences for plant species conservation by increasing habitat connectivity and favouring regional persistence. [source] Testing a model for predicting the timing and location of shallow landslide initiation in soil-mantled landscapesEARTH SURFACE PROCESSES AND LANDFORMS, Issue 9 2003M. Casadei Abstract The growing availability of digital topographic data and the increased reliability of precipitation forecasts invite modelling efforts to predict the timing and location of shallow landslides in hilly and mountainous areas in order to reduce risk to an ever-expanding human population. Here, we exploit a rare data set to develop and test such a model. In a 1·7 km2 catchment a near-annual aerial photographic coverage records just three single storm events over a 45 year period that produced multiple landslides. Such data enable us to test model performance by running the entire rainfall time series and determine whether just those three storms are correctly detected. To do this, we link a dynamic and spatially distributed shallow subsurface runoff model (similar to TOPMODEL) to an in,nite slope model to predict the spatial distribution of shallow landsliding. The spatial distribution of soil depth, a strong control on local landsliding, is predicted from a process-based model. Because of its common availability, daily rainfall data were used to drive the model. Topographic data were derived from digitized 1 : 24 000 US Geological Survey contour maps. Analysis of the landslides shows that 97 occurred in 1955, 37 in 1982 and ,ve in 1998, although the heaviest rainfall was in 1982. Furthermore, intensity,duration analysis of available daily and hourly rainfall from the closest raingauges does not discriminate those three storms from others that did not generate failures. We explore the question of whether a mechanistic modelling approach is better able to identify landslide-producing storms. Landslide and soil production parameters were ,xed from studies elsewhere. Four hydrologic parameters characterizing the saturated hydraulic conductivity of the soil and underlying bedrock and its decline with depth were ,rst calibrated on the 1955 landslide record. Success was characterized as the most number of actual landslides predicted with the least amount of total area predicted to be unstable. Because landslide area was consistently overpredicted, a threshold catchment area of predicted slope instability was used to de,ne whether a rainstorm was a signi,cant landslide producer. Many combinations of the four hydrological parameters performed equally well for the 1955 event, but only one combination successfully identi,ed the 1982 storm as the only landslide-producing storm during the period 1980,86. Application of this parameter combination to the entire 45 year record successfully identi,ed the three events, but also predicted that two other landslide-producing events should have occurred. This performance is signi,cantly better than the empirical intensity,duration threshold approach, but requires considerable calibration effort. Overprediction of instability, both for storms that produced landslides and for non-producing storms, appears to arise from at least four causes: (1) coarse rainfall data time scale and inability to document short rainfall bursts and predict pressure wave response; (2) absence of local rainfall data; (3) legacy effect of previous landslides; and (4) inaccurate topographic and soil property data. Greater resolution of spatial and rainfall data, as well as topographic data, coupled with systematic documentation of landslides to create time series to test models, should lead to signi,cant improvements in shallow landslides forecasting. Copyright © 2003 John Wiley & Sons, Ltd. [source] Is there a higher risk for herbivore outhreaks after cold mast years?ECOGRAPHY, Issue 6 2000An analysis of two plant/herbivore series from southern Norway Historical data on two plant-herbivore interactions from southern Norway were used to test the hypothesis that the degree of herbivore outbreaks in post-mast years is negatively related to summer temperatures in the mast year, because plants are more depressed after a high seed production if temperatures and thus the photosynthetic activity is low. The plant species were the sessile oak Quercus petraea and the bilberry Vaceinium myrtillus. For the former species post-mast years were identified from reports given by the local forest authorities for the period 1930,48, and from acorn export curves for the period 1949,98, For the latter species, post-mast years were identified mainly from bilberry export curves for the period 1920,31, from game reports for the period 1932,78. and from diary notes for the period 1979,87. The herbivore species used were the green oak leaf roller moth Tortrix viridana and the capercaillie Tetrao urogallus. Eight moth outbreaks on oak forests were reported by the forest authorities in the period 1930,98, and they all started in a post-mast year of the sessile oak. There were however also eleven post-mast years without moth outbreaks. According to game reports, observations and autumn counts, all increases in the autumn population size of capercaillie during 1920 88 occurred in or after a year with high bilberry production. Among i8 post-mast years, there were seven with strong increase, seven with slight or moderate increase, and four with no increase. For both herbivore species, post-mast years with marked population increases had significantly lower summer temperatures in the preceding (mast) year than had post-mast years with no or slight increases. For moth populations there also was a negative effect of high temperatures in April, possibly because moth eggs tend to hatch too early relative lo budburst if spring temperatures are high. For the capercaillie, high amount of precipitation in June , July seemed to have some negative impact on the autumn population sizes, as also found in previous studies. [source] Influence of temperature on growth of Scenedesmus obliquus in diluted olive mill wastewater as culture mediumENGINEERING IN LIFE SCIENCES (ELECTRONIC), Issue 3 2010Gassan Hodaifa Abstract Scenedesmus obliquus can help to reduce the environmental impact of industrial olive mill wastewater from olive oil extraction in the three-phase system. This work examines the effect of temperature changes (288,308,K) on algal growth, culture medium, and biochemical composition of S. obliquus. The maximum specific growth rate of 0.024,h,1 occurred at an optimal temperature of 302.7,K. The apparent activation energies of cell growth and cell death were determined as 61.8 and 142.8,kJ/mol, respectively. At the end of culture the percentages of pigments, proteins, and carbohydrates were greater at the two ends of the temperature range studied, as it was also observed for the maximum elimination of biochemical oxygen demand (BOD5). The mono- and polyunsaturated fatty acid content of the biomass was greater at the lowest temperature used (288,K). [source] Opportunism of Conidiobolus obscurus stems from depression of infection in situ to progeny colonies of host alatae as disseminators of the aphid-pathogenic fungusENVIRONMENTAL MICROBIOLOGY, Issue 4 2007Guo-Zhong Zhang Summary Conidiobolus (Entomophthorales: Ancylistaceae) includes common aphid pathogens but causes sporadic mycosis worldwide. This epizootiological opportunism was explored herein by examining the potential of mycosis transmission in the progeny colonies of 513 Myzus persicae alates as disseminators of C. obscurus often infecting aphids. The alates exposed to spore showers were flown for 2.05 (0.01,8.95) km on flight mills and then reared individually on cabbage at 20,23°C for 14 day colonization. All truly infected alates were mycosed within 6 days and averagely left 3.9 (0,15) nymphs while those uninfected produced 11.6 (0,35) nymphs during the same period. Secondary and tertiary infections occurred only in 16.2% and 4.8% of the progeny colonies of the mycosed alates respectively, due to c. 60% of the cadavers forming resting spores. Most of the contagious infections appeared on days 4,8 after colonization and no more occurred from day 11 onwards. Trends of colony sizes (last-day averaging 51.5 aphids) and mycosis transmission (sixth-day maximum 6.3%) fit well to logistic (r 2 = 0.99) and Gompertz growth models (r 2 = 0.91) respectively. The results confirm that the opportunism of C. obscurus stems from depression of contagious infection after dissemination by host alates and suggest that it be overwhelmed by the prevalence of other non-resting fungal species. [source] Heart Rate Changes and ECG Abnormalities During Epileptic Seizures: Prevalence and Definition of an Objective Clinical SignEPILEPSIA, Issue 8 2002Maeike Zijlmans Summary: ,Purpose: To determine the prevalence of heart rate changes and ECG abnormalities during epileptic seizures and to determine the timing of heart rate changes compared to the first electrographic and clinical signs. To assess the risk factors for the occurrence of ECG abnormalities. Methods: We analyzed retrospectively 281 seizures in 81 patients with intractable epilepsy who had prolonged video-EEG and two-channel ECG. The nature and timing of heart rate changes compared to the electrographic and clinical seizure onset was determined. The ictal period (including one minute preictally and three minutes postictally) was analyzed for cardiac arrhythmias, conduction and repolarization abnormalities. Risk factors for cardiac abnormalities were investigated using parametric and non-parametric statistics. Results: There was an increase in heart rate of at least 10 beats/minute in 73% of seizures (93% of patients) and this occurred most often around seizure onset. In 23% of seizures (49% of patients) the rate increase preceded both the electrographic and the clinical onset. ECG abnormalities were found in 26% of seizures (44% of patients). One patient had an asystole for 30 seconds. Long seizure duration increased the occurrence of ECG abnormalities. No other risk factor was found. Conclusions: Heart rate changes occur frequently and occur around the time or even before the earliest electrographic or clinical change. The change can clarify the timing of seizure onset and the specific rate pattern may be useful for seizure diagnosis and for automatic seizure detection. ECG abnormalities occur often and repeatedly in several seizures of the same patient. [source] Trust in Financial MarketsEUROPEAN FINANCIAL MANAGEMENT, Issue 4 2008Colin Mayer O16 Abstract This paper examines contemporaneous and historical evidence on the structure of ownership and control of corporate sectors in developed countries to draw lessons for development of financial markets. It records the critical role that equity markets played in the ownership and financing of corporations at the beginning of the 20th century. It notes that this occurred in the absence of formal systems of regulation and that equity markets functioned on the basis of informal relationships of trust. These were sustained through local stock markets in the UK, banks in Germany, and business coordinators and family firms in Japan. The paper explores the concept of trust that is required to promote the development of financial markets. [source] Defining the caspase-containing apoptotic machinery contributing to cornification in human epidermal equivalentsEXPERIMENTAL DERMATOLOGY, Issue 1 2006Vijaya Chaturvedi Abstract:, Whether terminal differentiation/stratum corneum formation of keratinocytes (KCs) represents a form of programmed cell death, utilizing mediators of classical apoptosis, is unclear. Apoptosis, an evolutionarily conserved death process, is comprised of extrinsic and intrinsic pathways, which converge using caspase 3. To define upstream and downstream caspases involved in terminal differentiation, we utilized human epidermal equivalents (EEs). Using submerged cultures comprised of human KCs, EEs were sequentially analyzed before and after being raised to an air/liquid (A/L) interface at 3,24 h intervals. At each time point, EEs were analyzed morphologically and for specific enzyme activity to distinguish different initiator (caspases 1, 2, 8, 9) and effector caspases (3, 6, 7). Terminal differentiation began at 6,8 h, as defined by stratum corneum with loricirin expression and completed at 18,24 h producing an epidermis resembling normal skin. Enzyme activity for caspases 1, 2, 3, 6, 7, 8, and 9 (but not 4, 5) was enhanced (>two-fold nmol/mg/h) at 3,6 h compared with submerged cultures. Processing of caspase 14 occurred at 18 h, and cleaved caspase 14 was increased at 24 h. Activated caspase 3-positive and terminal deoxynucleotidyl transferase-mediated nick end labeling-positive KCs were identified in EEs at 3,6 h corresponding to initiation sites of terminal differentiation. Addition of caspase inhibitors reduced levels of involucrin and loricrin in EEs raised to an A/L interface. We conclude caspases function as important death effectors strategically positioned at intersection of intrinsic and extrinsic pathways in KCs undergoing stratum corneum formation. [source] Genetic variation in COL17A1 and the development of bullous pemphigoidEXPERIMENTAL DERMATOLOGY, Issue 3 2004Samantha Winsey Background: Bullous pemphigoid (BP) is an autoimmune blistering disease of the skin characterized by autoantibody attack on collagen XVII. Objectives: To characterize the genetic complexity of COL17A1, the gene which encodes for the autoantigen collagen XVII. The data will be used to determine whether there is an association between polymorphisms and haplotypes of COL17A1 and genetic susceptibility to development of BP. Methods: The genetic complexity in COL17A1 was deduced by screening and then sequencing the gene. Haplotypes were constructed from the resulting polymorphisms using the statistical programme PHASE. The linkage disequilibrium (D,) between the polymorphisms was deduced from haplotypic data using the statistical programme GOLD. Association of the polymorphisms and haplotypes was tested for, in a cohort of BP patients and controls. Results: Screening of COL17A1 for genetic variation was carried out in 29 individuals of North European caucasoid origin, and it revealed 19 single-nucleotide polymorphisms in approximately 14.7 kb of sequence. These variants resulted in 60 different haplotypes in 191 individuals, of which 13 occurred above 1% in the population. D, between the variants was found to be extensive, have a low correlation with physical distance and to extend over 33.8 kb. No association was found with any of the polymorphisms or haplotypes and development of BP, when tested for, in a cohort of patients and controls. Conclusion: This study provides an extensive description of the genetic variation in COL17A1 and shows no association of the genetic variants with susceptibility to BP. [source] Analysis of the 2002 May earthquake sequence in the central Pyrenees, consequences for the evaluation of the seismic risk at Lourdes, FranceGEOPHYSICAL JOURNAL INTERNATIONAL, Issue 3 2004Noalwenn Dubos SUMMARY Three earthquakes of magnitudes 4.6, 4.3 and 3.7 occurred in 2002 May at two locations 20 km from the pilgrimage city of Lourdes in the French Pyrenees. They were well recorded by the permanent Pyrenean seismic networks, by a temporary local network, as well as by accelerometric stations. In order to understand their tectonic contexts, and to come to a better evaluation of the seismic risk at Lourdes, a detailed analysis of these events is performed. The first two events are located south of Lourdes in an area where only a few earthquakes have occurred up to now. Their focal solutions derived from first-motion polarities indicate reverse faulting, with a N110°E strike consistent with the geological structures. 10 aftershocks were recorded and relocated with respect to the main events, benefiting from the waveform similarity of the various events. This analysis reveals that the two main events concern probably the same fault, the second rupture being in the prolongation of the first one, whereas the other small aftershocks are located on fault segments in the vicinity of the hypocentre of the second event. The third large event, located to the SE of Lourdes, involves a normal mechanism with a N120°E plane parallel to the main geological structures. It occurred in a region of intense activity, including in particular an event of maximum macroseismic intensity IX in 1660. The first two events are at the boundary of a large quiet zone. In order to understand the related structural context, a new crustal tomographic model has been computed. It reveals that this quiet zone coincides with a block of high P -velocity. In contrast, the seismicity appears to be stronger at the northern and eastern boundaries of this block. The accelerometric data of the three main events recorded at Lourdes have been used to estimate the maximum peak ground accelerations in this city if a large event occurred, similar to those which damaged the city in the seventeenth and eighteenth centuries. Horizontal accelerations of 0.25 ± 0.07 g are predicted in the frequency domain 1,5 Hz at the location of the Sanctuary for a magnitude 6 event occurring 10 km away from the city. Taking into account the error bars, these values could in some cases exceed those specified by the building codes in this region. [source] The 1994 Sefidabeh earthquakes in eastern Iran: blind thrusting and bedding-plane slip on a growing anticline, and active tectonics of the Sistan suture zoneGEOPHYSICAL JOURNAL INTERNATIONAL, Issue 2 2000M. Berberian Summary In 1994 a sequence of five earthquakes with Mw 5.5,6.2 occurred in the Sistan belt of eastern Iran, all of them involving motion on blind thrusts with centroid depths of 5,10 km. Coseismic ruptures at the surface involved bedding-plane slip on a growing hanging-wall anticline displaying geomorphological evidence of uplift and lateral propagation. The 1994 earthquakes were associated with a NW-trending thrust system that splays off the northern termination of a major N,S right-lateral strike-slip fault. Elevation changes along the anticline ridge suggest that displacement on the underlying thrust dies out to the NW, away from its intersection with the strike-slip fault. This is a common fault configuration in eastern Iran and accommodates oblique NE,SW shortening across the N,S deforming zone, probably by anticlockwise rotations about a vertical axis. This style of fault kinematics may be transitional to a more evolved state that involves partitioning of the strike-slip and convergent motion onto separate subparallel faults. [source] Fire history and the global carbon budget: a 1°× 1° fire history reconstruction for the 20th centuryGLOBAL CHANGE BIOLOGY, Issue 3 2005Florent Mouillot Abstract A yearly global fire history is a prerequisite for quantifying the contribution of previous fires to the past and present global carbon budget. Vegetation fires can have both direct (combustion) and long-term indirect effects on the carbon cycle. Every fire influences the ecosystem carbon budget for many years, as a consequence of internal reorganization, decomposition of dead biomass, and regrowth. We used a two-step process to estimate these effects. First we synthesized the available data available for the 1980s or 1990s to produce a global fire map. For regions with no data, we developed estimates based on vegetation type and history. Second, we then worked backwards to reconstruct the fire history. This reconstruction was based on published data when available. Where it was not, we extrapolated from land use practices, qualitative reports and local studies, such as tree ring analysis. The resulting product is intended as a first approximation for questions about consequences of historical changes in fire for the global carbon budget. We estimate that an average of 608 Mha yr,1 burned (not including agricultural fires) at the end of the 20th century. 86% of this occurred in tropical savannas. Fires in forests with higher carbon stocks consumed 70.7 Mha yr,1 at the beginning of the century, mostly in the boreal and temperate forests of the Northern Hemisphere. This decreased to 15.2 Mha yr,1 in the 1960s as a consequence of fire suppression policies and the development of efficient fire fighting equipment. Since then, fires in temperate and boreal forests have decreased to 11.2 Mha yr,1. At the same time, burned areas increased exponentially in tropical forests, reaching 54 Mha yr,1 in the 1990s, reflecting the use of fire in deforestation for expansion of agriculture. There is some evidence for an increase in area burned in temperate and boreal forests in the closing years of the 20th century. [source] Island biogeography and landscape ecology of mammals inhabiting fragmented, temperate rain forestsGLOBAL ECOLOGY, Issue 2 2001Mark V. Lomolino Abstract 1We expanded the island biogeography paradigm to test whether mammalian communities of the heavily fragmented temperate rain forests of the Olympic Peninsula were influenced by local environmental conditions, biogeographic factors (fragment area and isolation) and characteristics of the surrounding landscape. 2We used live-trapping, sign surveys and infra-red triggered cameras to compare distributions of non-volant mammals among fragments and between fragments and other principal landscape components (continuous old-growth, riparian corridors, second-growth forest and clearcuts). 3Of the 24 species of non-volant mammals detected during our studies, 18 occurred in at least one fragment. 4Species richness of old-growth mammals was not significantly correlated with fragment area or isolation, per se, but was significantly and positively correlated with the amount of old-growth fragments and old second-growth (41,159 years) in the surrounding landscape (r2 = 0.95, P < 0.005). 5Distributions of three old-growth dependent species [shrew-mole (Neurotrichus gibbsii), Douglas squirrel (Tamiasciurus douglasii) and Trowbridge shew (Sorex trowbridgii)] were significantly associated with local environmental conditions within the fragment, with geographical isolation from continuous old-growth and riparian corridors, and with the amount of old-growth and old second growth in the adjacent matrix. [source] Similar Ends, Differing Means: Contractualism and Civil Service Reform in Denmark and New ZealandGOVERNANCE, Issue 1 2004Robert Gregory State sector reform was an integral component of the radical economic and social policy changes enacted by New Zealand governments between 1984 and 1991. This reform replaced the traditional tenured public service with a contractual regime. Through a comparison with Denmark, it is shown that New Zealand's reforms were not unique. Similar reforms were enacted in Denmark. But contrary to what occurred in New Zealand, the Danish reforms had already begun in the 1960s, and have since been gradually expanded. The parallel contractual regimes introduced in the two countries are accounted for by an increasing demand among politicians to secure a civil service that is responsive to political executive demands. However, because of institutional differences and diverging regulatory regimes, the strategic approaches in the two countries have been different. Whereas the New Zealand approach was dominated by an appeal to a coherent and sophisticated body of theoretical knowledge, combined with strict formalization, the Danish strategy has been based on political bargaining with the civil service unions. In both cases the reforms rest on critical assumptions regarding their positive and negative implications. [source] In situ Mixing of Organic Matter Decreases Hydraulic Conductivity of Denitrification Walls in Sand AquifersGROUND WATER MONITORING & REMEDIATION, Issue 1 2008Gregory F. Barkle In a previous study, a denitrification wall was constructed in a sand aquifer using sawdust as the carbon substrate. Ground water bypassed around this sawdust wall due to reduced hydraulic conductivity. We investigated potential reasons for this by testing two new walls and conducting laboratory studies. The first wall was constructed by mixing aquifer material in situ without substrate addition to investigate the effects of the construction technique (mixed wall). A second, biochip wall, was constructed using coarse wood chips to determine the effect of size of the particles in the amendment on hydraulic conductivity. The aquifer hydraulic conductivity was 35.4 m/d, while in the mixed wall it was 2.8 m/d and in the biochip wall 3.4 m/d. This indicated that the mixing of the aquifer sands below the water table allowed the particles to re-sort themselves into a matrix with a significantly lower hydraulic conductivity than the process that originally formed the aquifer. The addition of a coarser substrate in the biochip wall significantly increased total porosity and decreased bulk density, but hydraulic conductivity remained low compared to the aquifer. Laboratory cores of aquifer sand mixed under dry and wet conditions mimicked the reduction in hydraulic conductivity observed in the field within the mixed wall. The addition of sawdust to the laboratory cores resulted in a significantly higher hydraulic conductivity when mixed dry compared to cores mixed wet. This reduction in the hydraulic conductivity of the sand/sawdust cores mixed under saturated conditions repeated what occurred in the field in the original sawdust wall. This indicated that laboratory investigations can be a useful tool to highlight potential reductions in field hydraulic conductivities that may occur when differing materials are mixed under field conditions. [source] Volume and Nature of Telephone Calls in a Specialty Headache PracticeHEADACHE, Issue 9 2002Elizabeth Loder MD Background.,No information exists regarding the contribution of patient-related telephone calls to the burden of headache practice. Objective.,To identify the nature and volume of patient-related telephone calls to a specialty headache practice over a 1-month period. Design and Methods.,The characteristics of all patient-related calls to a single headache practitioner occurring during July 2001 were documented. Information was obtained on the caller, reason for call, length of call, timing and day of call, stated importance of call, patient's principal headache diagnosis, and principal comorbid psychiatric disorder, if any. Results.,One hundred sixty-five outpatient headache-related calls were received in July 2001, 3.17 for every hour of headache clinic scheduled. A total of 65% of all calls was generated by just 36% of callers. Of the 32 patients who placed more than one call during the study period, 50% had chronic daily headache, 53% had a personality disorder, and 38% had both. Twenty-seven percent of all calls were placed by someone other than the patient, 58% involved requests for medication refills, and 17% reported a new symptom or medication side effect. Over half of all calls were placed on Mondays and Tuesdays. Relatively few occurred outside work hours; 18% of calls characterized as "emergency" and 36% of calls characterized as urgent involved requests for controlled substances. Most of these calls were placed by patients with personality disorders. None of the 11 calls characterized as emergency calls was judged so by the physician; only 19% of the urgent calls were judged so by the physician. Conclusions.,Telephone calls contribute substantially to the burden of caring for patients in a specialty headache practice. Patients with chronic daily headache and personality disorders contribute disproportionately to this telephone burden. Efforts to identify such patients at presentation and educate them regarding appropriate telephone use seem to be warranted. [source] Distinct MHC class I and II alleles are associated with hepatitis C viral clearance, originating from a single sourceHEPATOLOGY, Issue 1 2004Susan M. McKiernan The role of cytotoxic T lymphocyte responses, restricted by human leukocyte antigen (HLA) class I alleles, is recognized as highly significant in the successful clearance of hepatitis C virus (HCV). The frequency of class I alleles in females inoculated with HCV genotype 1b from a single source was examined for an association with outcome. Class I typing was performed using polymerase chain reaction sequence-specific primers in 227 female subjects: 141 had chronic infection and 86 had viral clearance. Statistical analysis included ,2 testing and multiple logistic regression analysis. A*03, B*27, and Cw*01 occurred more frequently in those with viral clearance (39.5%, 14%, and 9.3%, respectively) compared with those with chronic infection (19.1%, 2.1%, and 1.4%, respectively; P , .005). B*08 occurred more often in those with chronic infection compared with viral clearance (39.7% vs. 19.8%; P = .002). In combination with previously reported class II allele associations, over 75% that successfully eliminate HCV carry either A*03, DRB1*0101, or *0401, compared with only 37% of those with chronic infection (P < .0001). The haplotypes A*03-B*07-DRB1*15-DQB1*0602 and A*02-B*27-Cw*01-DRB1*0101-DQB1*0501 are associated with viral clearance (P = .004 and .01, respectively). By multiple logistic regression analysis, the alleles A*03, B*27, DRB1*0101, *0401, and *15 are associated with viral clearance, and B*27 has the strongest association (odds ratio [OR] 7.99). The haplotype A*01-B*08-Cw*07-DRB1*03011-DQB1*0201 is associated with chronic infection (P = .002), being independent for DQB1*0201 (OR 0.27). In conclusion, certain class I alleles are associated with outcome in this homogenous cohort. More significantly, either HLA-A*03, -DRB1*0101, or -*0401 are carried by an overwhelming majority of those subjects who successfully clear HCV. (HEPATOLOGY 2004;40:108,114.) [source] Critical Role of Reactive Oxygen Species and Mitochondrial Permeability Transition in Microcystin-Induced Rapid Apoptosis in Rat HepatocytesHEPATOLOGY, Issue 3 2000Wen-Xing Ding Microcystin-LR (M-LR) is a specific hepatotoxin. At present, the exact toxic mechanism of its action remains unclear though apoptosis is believed to be involved. This study was designed to investigate the role of reactive oxygen species (ROS) and mitochondrial permeability transition (MPT) in the M-LR,induced apoptotic process. Morphologic changes such as cell shrinkage, externalization of cell membrane phosphatidylserine, DNA fragmentation, and nuclear condensation suggest that M-LR causes rapid apoptosis in hepatocytes. Confocal microscopy revealed that M-LR exposure led to the onset of MPT and mitochondrial depolarization, evidenced by (1) redistribution of calcein fluorescence from cytosol to mitochondria, and (2) loss of mitochondrial tetramethyrhodamine methyl ester (TMRM) fluorescence; both occurred before apoptosis. Moreover, there was a significant and rapid increase of ROS level before the onset of MPT and loss of MMP, indicating a critical role of ROS in M-LR,induced apoptosis. Deferoxamine (DFO), an iron chelator, prevented the increase of ROS production, delayed the onset of MPT, and, subsequently, cell death. In addition, a specific MPT inhibitor, cyclosporin A (CsA), blocked the M-LR,induced ROS formation, onset of MPT, and mitochondrial depolarization as well as cell death. Thus, we conclude that the M-LR,induced ROS formation leads to the onset of MPT and apoptosis. [source] Spatial variability of snowmelt timing from AMSR-E and SSM/I passive microwave sensors, Pelly River, Yukon Territory, CanadaHYDROLOGICAL PROCESSES, Issue 12 2007Joan M. Ramage Abstract Spring snow melt run-off in high latitude and snow-dominated drainage basins is generally the most significant annual hydrological event. Melt timing, duration, and flow magnitude are highly variable and influence regional climate, geomorphology, and hydrology. Arctic and sub-arctic regions have sparse long-term ground observations and these snow-dominated hydrologic regimes are sensitive to the rapidly warming climate trends that characterize much of the northern latitudes. Passive microwave brightness temperatures are sensitive to changes in the liquid water content of the snow pack and make it possible to detect incipient melt, diurnal melt-refreeze cycles, and the approximate end of snow cover on the ground over large regions. Special Sensor Microwave Imager (SSM/I) and Advanced Microwave Scanning Radiometer for EOS (AMSR-E) passive microwave brightness temperatures (Tb) and diurnal amplitude variations (DAV) are used to investigate the spatial variability of snowmelt onset timing (in two stages, ,DAV onset' and ,melt onset') and duration for a complex sub-arctic landscape during 2005. The satellites are sensitive to small percentages of liquid water, and therefore represent ,incipient melt', a condition somewhat earlier than a traditional definition of a melting snowpack. Incipient melt dates and duration are compared to topography, land cover, and hydrology to investigate the strength and significance of melt timing in heterogeneous landscapes in the Pelly River, a major tributary to the Yukon River. Microwave-derived melt onset in this region in 2005 occurred from late February to late April. Upland areas melt 1,2 weeks later than lowland areas and have shorter transition periods. Melt timing and duration appear to be influenced by pixel elevation, aspect, and uniformity as well as other factors such as weather and snow mass distribution. The end of the transition season is uniform across sensors and across the basin in spite of a wide variety of pixel characteristics. Copyright © 2007 John Wiley & Sons, Ltd. [source] Prolonged exposure of naïve CD8+ T cells to interleukin-7 or interleukin-15 stimulates proliferation without differentiation or loss of telomere lengthIMMUNOLOGY, Issue 2 2006Diana L. Wallace Summary Interleukin (IL)-7 and IL-15 are cytokines implicated in homeostatic control of the peripheral CD8 T-cell pool. We compared the effects of IL-7 and IL-15 on survival and proliferation of purified human CD8+ T-cell subsets. Low concentrations of either cytokine reduced the spontaneous apoptosis of all subsets, and enhancement of survival corresponded to the extent of Bcl-2 up-regulation. Surprisingly, although minimal proliferation of naïve CD8+ T cells was observed during the first week of culture with cytokines, a marked expansion of these cells occurred at later time points, particularly in response to IL-15. This occurred largely without phenotypic change or acquisition of effector function, indicating a dissociation of differentiation from proliferation. Notably, progression of naïve CD8+ T cells through several cell divisions resulted in up-regulation of telomerase and the maintenance of telomere length. These data show that IL-7 and IL-15 induce cell proliferation and rescue from apoptosis in a concentration, time and subset-dependent manner, and have implications for the homeostatic expansion of the naïve CD8+ T-cell pool. [source] Frequent promoter hypermethylation of Wnt pathway inhibitor genes in malignant astrocytic gliomasINTERNATIONAL JOURNAL OF CANCER, Issue 11 2010Silke Götze Abstract Aberrant activation of wingless (Wnt) signaling is involved in the pathogenesis of various cancers. Recent studies suggested a role of Wnt signaling in gliomas, the most common primary brain tumors. We investigated 70 gliomas of different malignancy grades for promoter hypermethylation in 8 genes encoding members of the secreted frizzled-related protein (SFRP1, SFRP2, SFRP4, SFRP5), dickkopf (DKK1, DKK3) and naked (NKD1, NKD2) families of Wnt pathway inhibitors. All tumors were additionally analyzed for mutations in exon 3 of the ,-catenin gene (CTNNB1). While none of the tumors carried CTNNB1 mutations, we found frequent promoter hypermethylation of Wnt pathway inhibitor genes, with at least one of these genes being hypermethylated in 6 of 16 diffuse astrocytomas (38%), 4 of 14 anaplastic astrocytomas (29%), 7 of 10 secondary glioblastomas (70%) and 23 of 30 primary glioblastomas (77%). Glioblastomas often demonstrated hypermethylation of 2 or more analyzed genes. Hypermethylation of SFRP1, SFRP2 and NKD2 each occurred in more than 40% of the primary glioblastomas, while DKK1 hypermethylation was found in 50% of secondary glioblastomas. Treatment of SFRP1-, SFRP5-, DKK1-, DKK3-, NKD1- and NKD2 -hypermethylated U87-MG glioblastoma cells with 5-aza-2,-deoxycytidine and trichostatin A resulted in increased expression of each gene. Furthermore, SFRP1 -hypermethylated gliomas showed significantly lower expression of the respective transcripts when compared with unmethylated tumors. Taken together, our results suggest an important role of epigenetic silencing of Wnt pathway inhibitor genes in astrocytic gliomas, in particular, in glioblastomas, with distinct patterns of hypermethylated genes distinguishing primary from secondary glioblastomas. [source] Change in mean temperature as a predictor of extreme temperature change in the Asia,Pacific regionINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 10 2005G. M. Griffiths Abstract Trends (1961,2003) in daily maximum and minimum temperatures, extremes and variance were found to be spatially coherent across the Asia,Pacific region. The majority of stations exhibited significant trends: increases in mean maximum and mean minimum temperature, decreases in cold nights and cool days, and increases in warm nights. No station showed a significant increase in cold days or cold nights, but a few sites showed significant decreases in hot days and warm nights. Significant decreases were observed in both maximum and minimum temperature standard deviation in China, Korea and some stations in Japan (probably reflecting urbanization effects), but also for some Thailand and coastal Australian sites. The South Pacific convergence zone (SPCZ) region between Fiji and the Solomon Islands showed a significant increase in maximum temperature variability. Correlations between mean temperature and the frequency of extreme temperatures were strongest in the tropical Pacific Ocean from French Polynesia to Papua New Guinea, Malaysia, the Philippines, Thailand and southern Japan. Correlations were weaker at continental or higher latitude locations, which may partly reflect urbanization. For non-urban stations, the dominant distribution change for both maximum and minimum temperature involved a change in the mean, impacting on one or both extremes, with no change in standard deviation. This occurred from French Polynesia to Papua New Guinea (except for maximum temperature changes near the SPCZ), in Malaysia, the Philippines, and several outlying Japanese islands. For urbanized stations the dominant change was a change in the mean and variance, impacting on one or both extremes. This result was particularly evident for minimum temperature. The results presented here, for non-urban tropical and maritime locations in the Asia,Pacific region, support the hypothesis that changes in mean temperature may be used to predict changes in extreme temperatures. At urbanized or higher latitude locations, changes in variance should be incorporated. Copyright © 2005 Royal Meteorological Society. [source] Trends in indices for extremes in daily temperature and precipitation in central and western Europe, 1901,99INTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 9 2005Anders Moberg Abstract We analyse 20th century trends in six indices for precipitation extremes and four indices for temperature extremes, calculated from daily observational data for European stations. The indices chosen reflect rather moderate extremes. Most of the ,80 stations used are situated in central and western Europe; therefore, results mainly refer to this region. Trends are calculated over 1901,99, 1921,99, 1901,50 and 1946,99. Two different trend estimators are used, and significance is assessed with a bootstrap technique. We find that: Significant increasing precipitation trends over the 20th century dominate in winter for both average precipitation intensity and moderately strong events. Simultaneously, the length of dry spells generally increased insignificantly. There are few significant trends of any sign for precipitation indices in summer, but there are insignificant drying trends over Scandinavia and wetting trends over central and western Europe for 1921,99. The length of dry spells in summer generally increased insignificantly. Both the warm and cold tails of the temperature distribution in winter warmed over the entire 20th century. Notably low values in the cold tail for daily Tmax and Tmin occurred in the early 1940s, leading to strong but insignificant negative trends for 1901,50, whereas little change occurred before 1940. Warming of winters during 1946,99 occurred in both the warm and cold tails for both Tmax and Tmin, with the largest warming in the cold tail for Tmin. The warm tail of daily Tmin (and to a smaller extent Tmax) in summer warmed significantly during the past century. There is more evidence for summer warming in the first half of the century compared with the second half. During 1946,99, the warm tail of daily Tmax in summer was generally warming while the cold tail was cooling (both insignificantly). More digitized daily observational data from various European sub-regions are needed to permit a spatially more extensive analysis of changes in climate extremes over the last century. Copyright © 2005 Royal Meteorological Society [source] Current epidemiology of atopic dermatitis in south-eastern NigeriaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2004Edith N. Nnoruka MB Background, Atopic dermatitis (AD) is a common pruritic, eczematous skin disorder that runs a chronic and relapsing course. In Nigeria, it is currently on the increase, particularly amongst infants, and has created cost burdens for families. It occurs in association with a personal or family history of asthma, allergic rhinitis and conjunctivitis. Major and minor criteria exist as guidelines for arriving at a diagnosis of AD, and surveys from Western countries have shown that these features, in particular the minor features, vary with ethnicity and genetic background and can be used to aid diagnosis. African dermatologists have also voiced concern that the much used Hanifin criteria for diagnosis of AD may need some adaptation for use in Africa. Objective, To document the features and disease outcomes of AD seen amongst dermatology hospital patients in Enugu, south-eastern Nigeria, with a view to reflecting current features amongst Nigerian Blacks. Methods, A prospective study of AD patients seen over a 2-year period at a tertiary referral dermatology clinic (University of Nigeria Teaching Hospital, Enugu, Nigeria) was carried out. A total of 1019 patients aged between 4 weeks and 57 years were included in the study. Results, The prevalence of AD was 8.5%, which is much higher than the prevalence of AD reported in various parts of Nigeria 15 years ago. AD occurred before the age of 10 years in 523 (51.3%) patients, whilst 250 (24.5%) had onset after 21 years. The earliest age of onset in infants was in the first 6 weeks of life, and this was found in 129 patients (12.7%). Education and occupation of household heads were the most significant (P < 0.001) factors associated with seeking proper health care for the child's AD. Four hundred and forty-one (43.3%) patients presented with subacute atopic eczema and 326 (32%) patients with severe impeteginized eczema. Four hundred and twenty-five patients (41.7%) had at least one first-degree family member with AD (16.7%), allergic rhinitis (10.3%), asthma (14.6%) and allergic conjunctivitis (2.1%), while 55 (13.3%) of controls had a positive family history (P < 0.01) of allergy. A personal history of AD only, without concomitant respiratory allergies, was seen in 486 (47.7%) patients. The face was affected in 431 (42.3%) patients. Inverse distribution of a flexural rash was observed over the extensor aspect of the joints: the elbow in 502 patients (49.3%), the wrist joint in 183 patients (17.9%) and the knee joints in 354 patients (34.7). The commonly observed minor features included xerosis in 719 patients (71%), papular lichenoid lesions in 547 patients (54.1%), infraorbital folds in 498 patients (49.2%), palmar hyper linearity in 524 patients (51.8%) and raised peripheral blood eosinophils in 519 patients (51%), particularly for those with severe AD. Fissured heels, forehead lichenification, orbital darkening, nail pitting, sand paper-like skin lesions on the elbows/knees/lateral malleolli, knuckle dermatitis of the hands, palmar erythema and pitted keratolysis occurred more uncommonly as minor features. Infective complications were very common and included bacterial infections (folliculitis, impetiginized dermatitis and pyodermas) in 425 (41.7%) patients, fungal infections in 377 (37%) patients, parasitic infections (scabies) in 90 (8.8%) patients and viral infection (herpes simplex and molluscum contagiosum) in 29 (2.9%) patients. Thirteen of these atopics were also HIV positive. Aggravating factors most commonly reported included heat intolerance, excessive sweating, humidity, grass intolerance, thick woollen clothing and drug reactions. Only three patients had food intolerance. Three hundred and ten patients (30.4%) recalled their AD being worse in the hot humid periods and 383 (37.6%) could not recall any periods of relief or remission. Conclusions, The prevalence of AD amongst south-eastern Nigerian Blacks is on the increase, as in other areas, although it is still lower here than in other parts of the world. Many conventional minor features were found, but some occurred less frequently than in other countries, which may be attributed to ethnicity. Further studies will be required to confirm the ethnic differences in these features of AD amongst Nigerians and other Africans, to clarify the features of AD that are peculiar to Africans. [source] Is hospital admission a sufficiently sensitive outcome measure for evaluating medication review services?INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2007A descriptive analysis of admissions within a randomised controlled trial Objective The aims of the study were: to describe and assess hospital admissions occurring during a randomised controlled trial (RCT) of a pharmacist-led medication review service; to describe the admissions in terms of emergency status and main cause; to estimate the potential contribution of pharmaceutical care issues (PCIs) to admission; and to assess the proportion of admissions that could be influenced by a pharmacist intervention. Setting Within the context of a RCT of pharmacists providing medication review for 332 elderly patients living at home, taking at least four repeat medicines, carried out in one region of Scotland. Method Hospital data were obtained for all admissions occurring during the 9-month period studied, summarised and evaluated by two independent medical reviewers for the contribution of PCIs to admission. Two pharmacists assessed the extent to which PCIs were preventable by pharmacist intervention. Key findings Approximately two-thirds of the 77 admissions were unplanned, and two-thirds were to medical wards. Only 17 (22%) of all admissions were considered to be related to PCIs and 10 (13%) possibly preventable by pharmacist intervention. Although the majority of surgical admissions were considered to be unrelated to PCIs (26/29), both unplanned and planned medical admissions were related to PCIs. One of these occurred as a direct result of the pharmacist's recommendation. Conclusion The overall numbers of hospital admissions, medical admissions and unplanned admissions may not be sufficiently sensitive outcome measures for evaluating the impact of pharmacist interventions. Consideration could be given to developing categories of admission that are related to medicines or are likely to be preventable as more relevant measures. Including more details of hospital admissions in future studies may be useful. [source] One-Pot, Regioselective Synthesis of Substituted Arylglycines for Kinetic Resolution by Penicillin G AcylaseADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 11-12 2008Peter Grundmann Abstract Amido-alkylation of electron-rich arenes with phenylacetamide and glyoxylic acid offers an inexpensive route to a large variety of N -phenylacetylated arylglycines that are suited for immediate enzymatic resolution by penicillin G acylase. When performed under mild conditions at 5,°C in acetic acid/HCl, this simple one-pot operation resulted in the formation of single regioisomers only (,98%). Subsequent kinetic resolution of the amino acid derivatives by penicillin G acylase at pH,8.0 occurred generally with E values>100 and thus furnished free (S)-configurated arylglycines with high enantiomeric purity. The corresponding enantiopure (R)-substrates, easily separable by a phase-selective extraction process, provided the corresponding (R)-enantiomers upon conventional hydrolysis. This one-pot, two-step procedure for arylglycine synthesis, resolution and work-up requires a minimum of equipment and grants rapid access to both enantiopure (S)- and (R)-antipodes of non-natural ,-amino acids in small- to large-scale quantities. [source] Weight Change and Lower Body Disability in Older Mexican AmericansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2005Soham Al Snih MD Objectives: To examine the association between 2-year weight change and onset of lower body disability over time in older Mexican Americans. Design: Data were from the Hispanic Established Population for the Epidemiological Study of the Elderly (1993,2001). Weight change was examined by comparing baseline weight to weight at 2-year follow-up. Incidence of lower body disability was studied from the end of this period through an additional 5 years. Setting: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. Participants: One thousand seven hundred thirty-seven noninstitutionalized Mexican-American men and women aged 65 and older who reported no limitation in activities of daily living (ADLs) and were able to perform the walk test at 2-year follow-up. Measurements: In-home interviews assessed sociodemographic factors, self-reported physician diagnoses of medical conditions (arthritis, diabetes mellitus, heart attack, stroke, hip fracture, and cancer), self-reported ADLs, depressive symptoms, and number of hospitalizations. Cognitive function, handgrip muscle strength, and body mass index (BMI) were obtained. The outcomes were any limitation of lower body ADL (walking across a small room, bathing, transferring from a bed to a chair, and using the toilet) and limitation on the walk test over subsequent 5-year follow-up period. General Estimation Equation (GEE) was used to estimate lower body disability over time. Results: Weight change of 5% or more occurred in 42.3% of the participants; 21.7% lost weight, 20.6% gained weight, and 57.7% had stable weight. Using GEE analysis, with stable weight as the reference, weight loss of 5% or more was associated with greater risk of any lower body ADL limitation (odds ratio (OR)=1.43, 95% confidence interval (CI)=1.06,1.95) and walking limitation (OR=1.35, 95% CI=1.03,1.76) after controlling for sociodemographic variables and BMI at baseline. Weight gain of 5% or more was associated with greater risk of any lower body ADL limitation (OR=1.39, 95% CI=1.02,1.89), after controlling for sociodemographic variables and BMI at baseline. When medical conditions, handgrip muscle strength, high depressive symptomatology, cognitive function, and hospitalization were added to the equation, the relationship between 2-year weight change (>5% loss or >5% gain) and lower body disability decreased. Conclusion: Health conditions and muscle strength partially mediate the association between weight loss or gain and future loss of ability to walk and independently perform ADLs. [source] | ||||||||||||||||||||||||||||||||||||||||