FEBS JOURNAL, Issue 20 2009
Deoxyhypusine hydroxylase is an E-Z type HEAT repeat protein
In searching for new targets for antimalarials we investigated the biosynthesis of hypusine present in eukaryotic initiation factor-5A (eIF-5A) in Plasmodium. Here, we describe the cloning and expression of deoxyhypusine hydroxylase (DOHH), which completes the modification of eIF-5A through hydroxylation of deoxyhypusine. The dohh cDNA sequence revealed an ORF of 1236 bp encoding a protein of 412 amino acids with a calculated molecular mass of 46.45 kDa and an isoelectric point of 4.96. Interestingly, DOHH from Plasmodium has a FASTA SCORE of only 27 compared with its human ortholog and contains several matches similar to E-Z-type HEAT-like repeat proteins (IPR004155 (InterPro), PF03130 (Pfam), SM00567 (SMART) present in the phycocyanin lyase subunits of cyanobacteria. Purified DOHH protein displayed hydroxylase activity in a novel in vitro DOHH assay, but phycocyanin lyase activity was absent. dohh is present as a single-copy gene and is transcribed in the asexual blood stages of the parasite. A signal peptide at the N-terminus might direct the protein to a different cellular compartment. During evolution, Plasmodium falciparum acquired an apicoplast that lost its photosynthetic function. It is possible that plasmodial DOHH arose from an E/F-type phycobilin lyase that gained a new role in hydroxylation. Structured digital abstract ,,MINT-7255047: DHS (uniprotkb:P49366) enzymaticly reacts (MI:0414) with eIF-5A (uniprotkb:Q710D1) by enzymatic studies (MI:0415) ,,MINT-7255326: DOHH (uniprotkb:Q8I701) enzymaticly reacts (MI:0414) with eIF-5A (uniprotkb:Q710D1) by enzymatic studies (MI:0415) [source]

Validation of a 28-item version of the Systemic Clinical Outcome and Routine Evaluation in an Irish context: the SCORE-28

JOURNAL OF FAMILY THERAPY, Issue 3 2010
Paul Cahill
This article describes the development, in an Irish context, of a three-factor, twenty-eight-item version of the Systemic Clinical Outcome and Routine Evaluation (SCORE) questionnaire for assessing progress in family therapy. The forty- item version of the SCORE was administered to over 700 Irish participants including non-clinical adolescents and young adults, families attending family therapy, and parents of young people with physical and intellectual disabilities and cystic fibrosis. For validation purposes, data were also collected using brief measures of family and personal adjustment. A twenty-eight-item version of the SCORE (the SCORE-28) containing three factor scales that assess family strengths, difficulties and communication was identified through exploratory principal components analysis. Confirmatory factor analysis showed that the factor structure of the SCORE-28 was stable. The SCORE-28 and its three factor scales were shown to have excellent internal consistency reliability, satisfactory test-retest reliability and construct validity. The SCORE-28 scales correlated highly with the General Functioning Scale of the Family Assessment Device, and moderately with the Global Assessment of Relational Functioning Scale, the Kansas Marital and Parenting Satisfaction Scales, the Satisfaction with Life Scale, the Mental Health Inventory , 5, and the total problems scale of the Strengths and Difficulties Questionnaire. Correlational analyses also showed that the SCORE-28 scales were not strongly associated with demographic characteristics or social desirability response set. The SCORE-28 may routinely be administered to literate family members aged over 12 years before and after family therapy to evaluate therapy outcome. [source]

Beyond bone mineral density: can existing clinical risk assessment instruments identify women at increased risk of osteoporosis?

JOURNAL OF INTERNAL MEDICINE, Issue 5 2004
L. E. Wehren
Abstract. Objective., Although osteoporosis and fragility fracture are common amongst postmenopausal women, the extent of risk varies, and measurement of bone mineral density (BMD) is the standard tool used to diagnose and assess fracture risk. Rates of diagnosis remain relatively low, and several groups have developed instruments to help identify individuals who would most benefit from BMD testing. In this paper, we review and compare the performance of these instruments to identify those most useful in the primary care setting. Design., Review of screening instruments comprised osteoporosis clinical risk factors and comparison of the sensitivity and specificity of these algorithms. Results., Validated instruments have varying complexity, but similar sensitivity and specificity for identifying individuals who are likely to have low BMD. The area under the receiver operating characteristic curve ranges from 0.75 (SOFSURF) to 0.81 (SCORE). The simplest of the instruments (OST) uses only age and weight and has an AUC of 0.79. Conclusions., The Osteoporosis Self-assessment Tool, the simplest of the instruments, performs as well as more complex tools and, because of its simplicity, may be the most useful means for the busy clinician to identify postmenopausal women who would most benefit from BMD testing. [source]

SCORE ONE FOR THE CONDOM

PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 4 2005
Article first published online: 23 JAN 200
No abstract is available for this article. [source]

IS THE REVISED TRAUMA SCORE STILL USEFUL?

ANZ JOURNAL OF SURGERY, Issue 11 2003
Belinda J. Gabbe
The revised trauma score (RTS) has been embraced by the trauma community worldwide. Although originally developed as a triage tool, the use of the RTS has since been expanded to include the prediction of outcome following traumatic injury. Through a critical review of the literature, evidence for use of the RTS is discussed along with the limitations of this commonly used tool. In summary, the RTS is a well-established predictor of mortality in trauma populations, but there is a lack of definitive evidence supporting its use as a primary triage tool and as a predictor of outcomes other than mortality. Difficulty in collecting the components of the RTS creates issues for data validity and the use of the RTS as a research tool. Although the weighted RTS has been developed to improve the prediction capacity of the RTS, studies reporting its use are few and there is debate regarding the applicability of the published coefficients for broad use. Overall, further studies are warranted to clearly establish the usefulness of the RTS as a triage tool in the field, to further evaluate the weighted version of the RTS, and to determine the ability of the RTS to predict functional outcome and quality of life. In particular, future research is needed to address these issues in Australian trauma populations. [source]

THE ROLE OF NONCOGNITIVE SKILLS IN EXPLAINING COGNITIVE TEST SCORES

ECONOMIC INQUIRY, Issue 1 2008
LEX BORGHANS
This article examines whether noncognitive skills,measured both by personality traits and by economic preference parameters,influence cognitive tests' performance. The basic idea is that noncognitive skills might affect the effort people put into a test to obtain good results. We experimentally varied the rewards for questions in a cognitive test to measure to what extent people are sensitive to financial incentives. To distinguish increased mental effort from extra time investments, we also varied the questions' time constraints. Subjects with favorable personality traits such as high performance motivation and an internal locus of control perform relatively well in the absence of rewards, consistent with a model in which trying as hard as you can is the best strategy. In contrast, favorable economic preference parameters (low discount rate, low risk aversion) are associated with increases in time investments when incentives are introduced, consistent with a rational economic model in which people only invest when there are monetary returns. The main conclusion is that individual behavior at cognitive tests depends on noncognitive skills. (JEL J20, J24) [source]

THE INCREMENTAL VALIDITY OF INTERVIEW SCORES OVER AND ABOVE COGNITIVE ABILITY AND CONSCIENTIOUSNESS SCORES

PERSONNEL PSYCHOLOGY, Issue 2 2000
JOSE M. CORTINA
Recent research has suggested that scores on measures of cognitive ability, measures of Conscientiousness, and interview scores are positively correlated with job performance. There remains, however, a question of incremental validity: To what extent do interviews predict above and beyond cognitive ability and Conscientiousness? This question was addressed in this paper by (a) conducting meta-analyses of the relationships among cognitive ability, Conscientiousness, and interviews, (b) combining these results with predictive validity results from previous meta-analyses to form a "meta-correlation matrix" representing the relationships among cognitive ability, Conscientiousness, interviews, and job performance, and (c) performing 9 hierarchical regressions to examine the incremental validity of 3 levels of structured interviews in best, actual, and worst case scenarios for prediction. Results suggested that interview scores contribute to the prediction of job performance over and above cognitive ability and Conscientiousness to the extent that they are structured, with scores from highly structured interviews contributing substantially to prediction. Directions for future research are discussed. [source]

Evaluation of 6 Prognostic Models Used to Calculate Mortality Rates in Elderly Heart Failure Patients With a Fatal Heart Failure Admission

CONGESTIVE HEART FAILURE, Issue 5 2010
Andria L. Nutter
The objective was to evaluate 6 commonly used heart failure (HF) prognostic models in an elderly, fatal HF population. Predictive models have been established to quantify risk among HF patients. The validation of these models has not been adequately studied, especially in an elderly cohort. Applying a single-center, retrospective study of serially admitted HF patients who died while in the hospital or within 30 days of discharge, the authors evaluated 6 prognostic models: the Seattle Heart Failure Model (SHFM), Heywood's model, Classification and Regression Tree (CART) Analysis, the Heart Failure Survival Score (HFSS), Heart Failure Risk Scoring System, and Pocock's score. Eighty patients were included (mean age, 82.7 ± 8.2 years). Twenty-three patients (28.75%) died in the hospital. The remainder died within 30 days of discharge. The models' predictions varied considerably from one another and underestimated the patients' actual mortality. This study demonstrates that these models underestimate the mortality risk in an elderly cohort at or approaching the end of life. Moreover, the predictions made by each model vary greatly from one another. Many of the models used were not intended for calculation during hospitalization. Development of improved models for the range of patients with HF syndromes is needed. Congest Heart Fail. 2010;16:196,201. © 2010 Wiley Periodicals, Inc. [source]

The relationship between quality of life and levels of hopelessness and depression in palliative care

DEPRESSION AND ANXIETY, Issue 9 2008
Kyriaki Mystakidou M.D., Ph.D.
Abstract There is growing interest in the psychological distress and quality of life of cancer patients. The aim of this study was to compare the responses of 102 advanced cancer patients on a quality of life scale (as measured by the SF12) with the Beck Depression Inventory (BDI) and the Beck Hopelessness Scale (BHS), as well as the impact of depression and hopelessness on quality of life. Significant associations were found between gender (P=.027), performance status (P=.003), opioids (P=.002), depression (P<.0005), and hopelessness (P<.0005) with the SF12-Mental Component Score (MCS). Gender (P=.07), metastasis (P=.001), opioids (P=.0005), and education (P=.045) correlated significantly with SF12-Physical Component Score (PCS). In the prediction of MCS, the dimensions of age, hopelessness, gender, and performance status were statistically significantly high (P<.0005), explaining 48% of variance. For PCS, the predictor variables were education, metastasis, and opioids (25% of variance). Quality of life, in this patient population, was predicted by the level of hopelessness and patients' demographic and clinical characteristics. Depression and Anxiety. © 2007 Wiley-Liss, Inc. [source]

Comparison of the Medical Priority Dispatch System to an Out-of-hospital Patient Acuity Score

ACADEMIC EMERGENCY MEDICINE, Issue 9 2006
Michael J. Feldman MD
Abstract Background: Although the Medical Priority Dispatch System (MPDS) is widely used by emergency medical services (EMS) dispatchers to determine dispatch priority, there is little evidence that it reflects patient acuity. The Canadian Triage and Acuity Scale (CTAS) is a standard patient acuity scale widely used by Canadian emergency departments and EMS systems to prioritize patient care requirements. Objectives: To determine the relationship between MPDS dispatch priority and out-of-hospital CTAS. Methods: All emergency calls on a large urban EMS communications database for a one-year period were obtained. Duplicate calls, nonemergency transfers, and canceled calls were excluded. Sensitivity and specificity to detect high-acuity illness, as well as positive predictive value (PPV) and negative predictive value (NPV), were calculated for all protocols. Results: Of 197,882 calls, 102,582 met inclusion criteria. The overall sensitivity of MPDS was 68.2% (95% confidence interval [CI] = 67.8% to 68.5%), with a specificity of 66.2% (95% CI = 65.7% to 66.7%). The most sensitive protocol for detecting high acuity of illness was the breathing-problem protocol, with a sensitivity of 100.0% (95% CI = 99.9% to 100.0%), whereas the most specific protocol was the one for psychiatric problems, with a specificity of 98.1% (95% CI = 97.5% to 98.7%). The cardiac-arrest protocol had the highest PPV (92.6%, 95% CI = 90.3% to 94.3%), whereas the convulsions protocol had the highest NPV (85.9%, 95% CI = 84.5% to 87.2%). The best-performing protocol overall was the cardiac-arrest protocol, and the protocol with the overall poorest performance was the one for unknown problems. Sixteen of the 32 protocols performed no better than chance alone at identifying high-acuity patients. Conclusions: The Medical Priority Dispatch System exhibits at least moderate sensitivity and specificity for detecting high acuity of illness or injury. This performance analysis may be used to identify target protocols for future improvements. [source]

Chronic post-traumatic headache after head injuryin children and adolescents

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2008
Charlotte Kirk MBChB MRCPCH BSc
This was a prospective, observational study of children aged 3 to 15 years admitted to hospital with head injury (HI). Demographic data and information on the nature of the HI, and history of premorbid headache were collected. A structured telephone questionnaire was used to interview parents and children 2 months after injury and at 4-monthly intervals for up to 3 years, if headache was reported. One hundred and ninety children were admitted with HI. Data were available on 117 children (81 males, 36 females; mean age 8y 5mo [SD 3y 1mo]). HI was minor in 93 patients and significant in the rest. Minor HI was defined as a closed injury, no loss of consciousness, and a Glasgow Coma Score (GCS) of 13 to 15. Significant HI was associated with loss of consciousness for >30 minutes, GCS of <13, and post-traumatic amnesia for >48 hours. Eight children (five males, three females; mean age 10y 7mo [SD 2y]) reported chronic post-traumatic headache (CPTH). Five children had episodic tension-type headache and three had migraine with or without aura. Headache resolved over 3 to 27 months in all except one child who was lost to follow-up. Premorbid headache in three children transformed in frequency and type following HI. These patients were excluded from the study. CPTH is common after minor and significant HI. It has the clinical features of tension-type headache and migraine and has a good prognosis. [source]

Participation of children with cerebral palsy is influenced by where they live

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2004
Donna Hammal MSc
The study aimed to determine whether degree of participation of children with cerebral palsy (CP) is influenced by where they live, as predicted by the social model of disability. Ninety-two per cent children with CP resident in Northern England and born 1991-1996 were entered into the study. Participation was measured by the Lifestyle Assessment Score and its six component domain scores. Regression analysis was used to investigate variations in participation. There were 443 children (265 male, 178 female; mean age 4 years 8 months [SD1 year 1 month] at time of assessment) in the study. In the regression analysis the following factors remained significant with regard to level of participation: type of CP (167 with hemiplegia, and of those remaining 240 with bilateral spasticity); intellectual impairment (105 with IQ<50,113 with IQ 50 to 70, and 225 with IQ>70); presence of seizures (115 with active epilepsy); walking disability (114 unable to walk, 81 restricted and needing aids, 186 restricted but unaided, 62 unrestricted); communication problems (61 no formal communication, 51 use alternative formal methods, 126 some delay or difficulty, 205 no communication problems). After adjustment for these factors, there were significant variations with regard to level of participation in the Lifestyle Assessment Score by district of residence. The magnitude of these variations in Lifestyle Assessment Score between districts is similar to that accounted for by severe intellectual impairment. Similar models were obtained for four of the six domain scores. For one of these four, restriction of social interaction, the significant variation between districts was minimally influenced by the underlying type of CP, walking ability, or presence of seizures. Higher levels of participation among children with CP are associated with residence in certain districts. This is not attributable to variations in case-mix or functional capacity of the children. Participation of children with disability is partly a product of their environment. [source]

Timing of fetal exposure to stress hormones: Effects on newborn physical and neuromuscular maturation

DEVELOPMENTAL PSYCHOBIOLOGY, Issue 3 2008
Lauren M. Ellman
Abstract The purpose of the study was to determine the specific periods during pregnancy in which human fetal exposure to stress hormones affects newborn physical and neuromuscular maturation. Blood was collected from 158 women at 15, 19, 25, and 31 weeks' gestation. Levels of placental corticotropin-releasing hormone (CRH) and maternal cortisol were determined from plasma. Newborns were evaluated with the New Ballard Maturation Score. Results indicated that increases in maternal cortisol at 15, 19, and 25 weeks and increases in placental CRH at 31 weeks were significantly associated with decreases in infant maturation among males (even after controlling for length of gestation). Results also suggested that increases in maternal cortisol at 31 weeks were associated with increases in infant maturation among females, although these results were not significant after controlling for length of gestation. Findings suggest that stress hormones have effects on human fetal neurodevelopment that are independent of birth outcome. © 2008 Wiley Periodicals, Inc. Dev Psychobiol 50: 232,241, 2008. [source]

Elevated serum urate concentration independently predicts poor outcome following stroke in patients with diabetes

DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2006
Edward J. Newman
Abstract Background Type 2 diabetes is a risk factor for stroke and confers increased risk of poor outcome and further vascular events following stroke. Hyperuricaemia occurs commonly in patients with type 2 diabetes, but its significance as a predictor of outcome following stroke is uncertain. We sought to investigate the prognostic significance of elevated serum urate concentration in diabetic subjects following stroke. Methods We studied a cohort of type 2 diabetes patients presenting to our unit with computed tomography-confirmed acute stroke. Fasting blood samples were drawn within 24 h of admission for urate concentration and standard battery of biochemistry and hematological tests. Information on age, stroke type, prior hypertension, smoking status, resolution time of symptoms and National Institutes of Health Stroke Score was collated. The main outcome event was time to myocardial infarction, recurrent stroke or vascular death, as defined in the CAPRIE trial. Stepwise proportional hazards regression was used to estimate the effect of the above variables on event-free survival following stroke. Results One hundred and forty patients were studied. Median follow-up duration was 974 days (IQR 163 to 1830 days). Sixty-four patients suffered an outcome event. Urate levels of greater than 0.42 mmol/L (p < 0.001) and an increasing NIHSS score (p < 0.001) independently predicted increased likelihood of suffering an event. Conclusion Elevated urate concentration is significantly and independently associated with increased risk of future vascular events in diabetic stroke patients. Further studies to elucidate the mechanism of this observation are required. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Treatment of symptomatic diabetic polyneuropathy with the antioxidant ,-lipoic acid: a meta-analysis

DIABETIC MEDICINE, Issue 2 2004
D. Ziegler
Abstract Aims To determine the efficacy and safety of 600 mg of ,-lipoic acid given intravenously over 3 weeks in diabetic patients with symptomatic polyneuropathy. Methods We searched the database of VIATRIS GmbH, Frankfurt, Germany, for clinical trials of ,-lipoic acid according to the following prerequisites: randomized, double-masked, placebo-controlled, parallel-group trial using ,-lipoic acid infusions of 600 mg i.v. per day for 3 weeks, except for weekends, in diabetic patients with positive sensory symptoms of polyneuropathy which were scored by the Total Symptom Score (TSS) in the feet on a daily basis. Four trials (ALADIN I, ALADIN III, SYDNEY, NATHAN II) comprised n = 1258 patients (,-lipoic acid n = 716; placebo n = 542) met these eligibility criteria and were included in a meta-analysis based on the intention-to-treat principle. Primary analysis involved a comparison of the differences in TSS from baseline to the end of i.v. Treatment between the groups treated with ,-lipoic acid or placebo. Secondary analyses included daily changes in TSS, responder rates (, 50% improvement in TSS), individual TSS components, Neuropathy Impairment Score (NIS), NIS of the lower limbs (NIS-LL), individual NIS-LL components, and the rates of adverse events. Results After 3 weeks the relative difference in favour of ,-lipoic acid vs. placebo was 24.1% (13.5, 33.4) (geometric mean with 95% confidence interval) for TSS and 16.0% (5.7, 25.2) for NIS-LL. The responder rates were 52.7% in patients treated with ,-lipoic acid and 36.9% in those on placebo (P < 0.05). On a daily basis there was a continuous increase in the magnitude of TSS improvement in favour of ,-lipoic acid vs. placebo which was noted first after 8 days of treatment. Among the individual components of the TSS, pain, burning, and numbness decreased in favour of ,-lipoic acid compared with placebo, while among the NIS-LL components pin-prick and touch-pressure sensation as well as ankle reflexes were improved in favour of ,-lipoic acid after 3 weeks. The rates of adverse events did not differ between the groups. Conclusions The results of this meta-analysis provide evidence that treatment with ,-lipoic acid (600 mg/day i.v.) over 3 weeks is safe and significantly improves both positive neuropathic symptoms and neuropathic deficits to a clinically meaningful degree in diabetic patients with symptomatic polyneuropathy. Diabet. Med. 21, 114,121 (2004) [source]

Gastroesophageal reflux before and after Helicobacter pylori eradication.

DISEASES OF THE ESOPHAGUS, Issue 4 2003
A prospective study using ambulatory 24-h esophageal pH monitoring
SUMMARY, The aim of this study was to assess prevalence of GERD before and after Helicobacter pylori (HP) eradication utilizing 24-h esophageal pH/manometry studies. Helicobacter pylori status was confirmed by the Campylobacter like organism test. Those testing positive underwent 24-h pH/manometry followed by HP eradication therapy and urea breath test. Patients were followed up at 6 months and then at 1 year when they underwent a repeat 24-h pH/manometry. Twenty patients, 10 with non-ulcer dyspepsia (NUD) and 10 with duodenal ulcer (DU) were enrolled, though only 10 patients attended for a repeat 24-h pH/manometry study. The patients were well matched, though patients with NUD had a significantly higher symptom score at entry compared with the DU group (8.5 vs 5.7, P < 0.05). The pH and esophageal manometry data were similar in the two groups. Overall nine patients (45%; DU = 5, NUD = 4) had evidence of GERD prior to HP eradication and it persisted one year after cure of the infection. The reflux disease occurred in the presence of normal LES pressure (mean 15.6 ± 3.3 mmHg). New onset GERD was uncommon after cure of HP infection, occurring in only one patient with NUD. Overall HP eradication had no impact on percentage of time pH < 4 (4.69 ± 3 vs 4.79 ± 3), episodes > 5 min (9.8 ± 16 vs 15.5 ± 25.3) and Johnson DeMeester Score (16.8 ± 7.5 vs 26.8 ± 18). In addition successful cure of HP produced no significant changes in LES pressure (17.9 ± 3.8 mmHg vs 19.3 ± 4.6 mmHg), and other esophageal manometry data. Half of HP-positive patients with NUD and DU have evidence of GERD before HP eradication. This persists after successful cure of the infection. New onset GERD occurs very uncommonly one year after HP eradication. [source]

The Contribution of the Subjective Component of the Canadian Pulmonary Embolism Score to the Overall Score in Emergency Department Patients

ACADEMIC EMERGENCY MEDICINE, Issue 10 2005
Christopher Kabrhel MD
Abstract Background: Clinicians frequently use their experience to determine the pretest probability of pulmonary embolism (PE), although scoring systems are promoted as being more reliable. The Canadian Pulmonary Embolism Score (CPES) combines six objective questions and one subjective question. The CPES has been validated and appears to be useful for risk-stratifying patients. However, research suggests that subjective gestalt performs similarly to the CPES, and the influence of the subjective question on the predictive value of the CPES is not clear. Objectives: To determine the test characteristics of the CPES, its subjective question, and the degree to which the predictive value of the CPES is influenced by its individual questions. Methods: The authors performed a prospective observational study on a cohort of emergency department patients suspected of having PE. The authors compared patients' CPES results with the diagnosis of PE, calculated the test characteristics of the CPES, and determined the contribution of individual CPES questions to the score's overall predictive value. Results: Of 607 patients, 61 (10%) had PE. Of low-risk patients (CPES ,4), 5.54% (n= 449; 95% confidence interval [95% CI] = 3.64% to 8.11%) had PE. The sensitivity (59.0%; 95% CI = 47.4% to 69.8%) and the negative predictive value (94.4%; 95% CI = 92.8% to 95.9%) of the CPES were similar to the sensitivity (53.2%; 95% CI = 40.2% to 65.8%) and negative predictive value (93.5%; 95% CI = 90.7% to 95.5%) of the subjective question alone. In multivariable analysis, nearly all of the predictive value of the CPES was derived from the subjective question. Conclusions: The predictive value of the CPES appears to be derived primarily from its subjective component. [source]

Assessing the habitat quality of oil mallees and other planted farmland vegetation with reference to natural woodland

ECOLOGICAL MANAGEMENT & RESTORATION, Issue 3 2009
F. Patrick Smith
Summary, Much of the tree and shrub planting that has been conducted on farms in Western Australia over the past three decades has not been done with the specific intention of creating habitat or conserving biodiversity, particularly commercially oriented monocultures like oil mallee plantings. However, such plantings may nonetheless provide some habitat resources for native plants and animals. This study assessed the habitat quality of farm plantings (most of which were not planted with the primary intention of biodiversity conservation) at 72 sites across a study region in the central wheatbelt of Western Australia. Widely accepted habitat metrics were used to compare the habitat resources provided by planted farmland vegetation with those provided by remnant woodland on the same farms. The impact of adjacency of plantings to woodland and, in the case of oil mallees, the planting configuration on predicted habitat quality is assessed. Condition Benchmarks for five local native vegetation communities are proposed. Farmland plantings achieved an average Vegetation Condition Score (VCS) of 46 out of a possible 100, while remnant woodland on the same farms scored an average 72. The average scores for farm plantings ranged from 38,59 depending on which of five natural vegetation communities was used as its benchmark, but farm plantings always scored significantly less than remnant woodland (P < 0.001). Mixed species plantings on average were rated more highly than oil mallees (e.g. scores of 42 and 36 respectively using the Wandoo benchmark) and adjacency to remnant woodland improved the score for mixed plantings, but not for oil mallees. Configuration of oil mallees as blocks or belts (i.e. as an alley farming system) had no impact on the VCS. Planted farmland vegetation fell short of remnant woodland in both floristic richness (51 planted native species in total compared with a total of more than 166 naturally occurring plant species in woodland) and structural diversity (with height, multiple vegetation strata, tree hollows and woody debris all absent in the relatively young 7,15-year-old farm plantings). Nonetheless farmland plantings do have measurable habitat values and recruitment and apparent recolonization of plantings with native plant species was observed. Habitat values might be expected to increase as the plantings age. The VCS approach, including the application of locally relevant Benchmarks is considered to be valuable for assessing potential habitat quality in farmland vegetation, particularly as a tool for engaging landholders and natural resource management practitioners. [source]

Paediatric and adolescent horse-related injuries: Does the mechanism of injury justify a trauma response?

EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2008
John A Craven
Objective: To identify the frequency, variety and disposition of horse-related injury presentations to the ED and to use this information to evaluate the existing institutional trauma team activation criteria following horse-related injuries. Methods: A retrospective case analysis was performed of all horse-related injury presentations to the ED of Women's and Children's Hospital, Adelaide, Australia, in the 5 year period between January 1999 and December 2003. Results: A total of 186 children presented with horse-related injuries during the 5 year study period. The median age of injury was 9 years (range 1,17 years), with 81% of presentations female and 60% of patients hospitalized. The mechanism of injury was divided into four groups: 148 falls (79%), 28 kicks (15%), 7 tramples (4%) and 5 bites (3%). There was one death. Seven presentations rated an Injury Severity Score >15, with full trauma team activation occurring for two of these presentations. Conclusion: Although horse-related injury presentations are uncommon, severe injuries do occur. Patients presenting with severe horse-related injuries do not always activate a full trauma team response based on current trauma team activation criteria. These severe injury presentations are supported by a limited trauma team response, which activates on the mechanism of injury. The effectiveness of this as a contingency system needs to be evaluated. [source]

Patient-orientated web sites on laryngectomy: is their information readable?

EUROPEAN JOURNAL OF CANCER CARE, Issue 6 2009
L. POTHIER m, language therapist , macmillan, speech
POTHIER L. & POTHIER D.D. (2009) European Journal of Cancer Care Patient-orientated web sites on laryngectomy: is their information readable? The objective of the study was to determine levels of readability of commonly accessed websites containing patient information on laryngectomy. A Cross-sectional study of Internet websites was designed. The first 20 websites obtained from a Google® search of the word "laryngectomy" that contained a patient information section were selected. Primary outcome measures were the Flesch Readability Ease Score (FRE) and Flesch-Kincaid readability grade (FKRG) score; from these data UK reading age was calculated. The secondary outcome measure was whether or not a site was accredited by an online readability organisation. The reading ages of the 20 sites ranged from 7.8 to 14.7 years with a median of 11.7 years. Half of the Flesch Reading Ease scores were in the "Difficult" or "Fairly difficult" category with 30% falling into the "Standard" or "Fairly easy" categories. Only 20% sites fell into the "Easy" or "Very Easy" categories that are the recommended level for comprehension by the general UK population. Sites not accredited by an online healthcare quality and content control organisation had worse readability scores than those that were not (FRE: p = 0.007, FKRG: p = 0.012). The poor readability of many of the encountered sites about laryngectomy on the Internet may confuse patients who turn to the Internet for information. Methods to improve patient information websites are discussed. [source]

Bulky disease is the most important prognostic factor in Hodgkin lymphoma stage IIB

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2003
Ingrid Glimelius
Abstract: The aim of this study was to evaluate treatment results for Hodgkin lymphoma (HL) patients younger than 60 yr in stage IIB, treated according to the Swedish National Care Programme. The intention was also to identify specific subgroups depending on the number of negative prognostic factors the patients have, in order to optimise and differentiate future treatment. In total, 99 patients with HL stage IIB, diagnosed between 1985 and 1994, have been analysed. There were 47 men and 52 women and the median age was 33 yr (range 17,59). Eighty-six patients presented with supradiaphragmatic disease and 13 with infradiaphragmatic. The HL specific and overall 10-yr survival was 73 and 65%, respectively. The HL-specific survival for patients in pathological stage IIB tended to be better, although not statistically significant than for clinical stage IIB, despite less chemotherapy (P = 0.1). The patients in stage IIB who were selected for laparotomy were, however, younger and with fewer negative prognostic factors. The only significant negative prognostic factor was bulky disease (P = 0.001). The following factors also tended to have a negative influence on the prognosis although not statistically significant: the International Prognostic Score, the number of involved lymph node stations, extranodal involvement and leucocyte count >15 × 109/L. In conclusion, we suggest that bulky disease should be taken into account when treating patients with stage IIB HL. [source]

Prognostic factors in advanced stage Hodgkin's lymphoma: the significance of the number of involved anatomic sites

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5-6 2001
T.P. Vassilakopoulos
Abstract:Background: Advanced Hodgkin's lymphoma (HL) is curable by conventional chemotherapy in 60,70% of patients. The pretreatment identification of a sizeable subgroup of patients with sufficiently low failure-free survival (FFS) to be eligible for investigational treatment is necessary. Objectives: To determine the prognostic significance of the number of involved sites (NIS) in patients with advanced HL and its relationship to the International Prognostic Score (IPS). Methods: A retrospective review of patients with advanced HL, defined as Ann Arbor stage (AAS) IB, IIB, III or IV, treated with anthracycline-based regimens. The end-point was FFS. Results: We identified 277 patients with a median age of 32 yr (14,78), 57% of whom were males. AAS was I in 4% of patients, II in 29%, III in 38% and IV in 29%. B-symptoms were recorded in 81%. Most patients had nodular sclerosis (64%) and mixed cellularity (26%) histology. IPS was ,3 in 44% of 242 evaluable patients. The NIS was ,5 in 32% of the patients and 20% of all patients had both ,5 involved sites and IPS ,3. The 10-yr FFS was 67%, being 76% vs. 50% for patients with ,4 vs. ,5 involved sites (P < 0.0001). The NIS (, 5), AAS IV and anemia were independent predictors of FFS in multivariate analysis. The NIS remained significant along with IPS, when the latter was included in the analysis. Patients with ,5 involved sites and IPS ,3 had 10-yr FFS overall, and relapse-free survival of 41%, 45% and 49%, respectively. Conclusions: The NIS was associated with FFS in advanced HL, was independent of IPS, and led to the identification of a sizeable subgroup of patients with 10-yr FFS of approximately 40%. This factor should be evaluated during the development of prognostic systems. [source]

Apolipoprotein E polymorphism interacts with cigarette smoking in progression of multiple sclerosis

EUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2009
A. Sena
Background and purpose:, The influence of apolipoprotein E (ApoE) polymorphism on clinical severity of multiple sclerosis (MS) is still controversial. Cigarette smoking has been suggested to influence the progression of disability in these patients. In this study, we aimed to investigate whether an interaction of smoking with the ApoE polymorphism influences the progression of disability in MS patients. Methods:, Smoking history from 205 female patients with MS was obtained. Clinical data collected include age at onset, disease duration, annual relapse rate, the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS). ApoE polymorphism was examined in all patients and stratified according to smoking status and associations with the clinical data investigated. Results:, There were no significant associations between cigarette smoking and any of the clinical characteristics in the whole group of patients. In women carrying the ApoE E4 isoform, smokers had a lower EDSS (P = 0.033) and MSSS (P = 0.023) in comparison with non-smokers. Conclusion:, Our data suggest that in women with MS carrying the ApoE E4 isoform, cigarette smoking may have a protective influence on disease progression and accumulation of disability. These findings need to be confirmed by future large longitudinal studies. [source]

A neurological examination score for the assessment of spinocerebellar ataxia 3 (SCA3)

EUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2008
C. Kieling
Spinocerebellar ataxias (SCAs) are characterized by a heterogeneous set of clinical manifestations. Our aims were to assess the neurological features of SCA3, and to describe and test the feasibility, reliability, and validity of a comprehensive Neurological Examination Score for Spinocerebellar Ataxia (NESSCA). The NESSCA was administered to molecularly diagnosed SCA3 patients at an outpatient neurogenetics clinic. The scale, based on the standardized neurological examination, consisted of 18 items that yielded a total score ranging from 0 to 40. The score's interrater reliability and internal consistency were investigated, and a principal components analysis and a correlation with external measures were performed. Ninety-nine individuals were evaluated. Interrater reliability ranged from 0.8 to 1 across individual items (P < 0.001); internal consistency, indicated by Cronbach's alpha, was 0.77. NESSCA scores were significantly correlated with measures of disease severity: disease stage (rho = 0.76, P < 0.001), duration (rho = 0.56, P < 0.001), and length of CAG repeat (rho = 0.30, P < 0.05). NESSCA was a reliable measure for the assessment of distinct neurological deficits in SCA3 patients. Global scores correlated with all external variables tested, showing NESSCA to be a comprehensive measure of disease severity that is both clinically useful and scientifically valid. [source]

Correlation of a high D-dimer level with poor outcome in traumatic intracranial hemorrhage

EUROPEAN JOURNAL OF NEUROLOGY, Issue 10 2007
J.-R. Kuo
The correlations between D-dimer and Glasgow Coma Scale (GCS), pupillary light reflex, distance of midline shift on brain computed tomography (CT), and Glasgow Outcome Score (GOS) in patients with trauma/non-trauma intracranial hemorrhage (ICH) are not consistent in studies. Ninety-eight traumatic and 59 non-traumatic ICH patients were studied. Pre-existing venous thrombosis, recent surgery, drug use (aspirin or coumadin), or malignancy, were excluded. D-dimer level was estimated within hours after acute insult, and statistical analyses were used for comparisons between groups. Traumatic ICH patients had higher D-dimer levels than controls (2984 vs. 256 ,g/l; P = 0.001). The GCS, midline shift on brain CT, pupillary reflex, and GOS at 3 months were significantly correlated with high D-dimer value in traumatic patients (individual P < 0.001), but not in the non-traumatic group. Using receiver-operating characteristic curve (ROC), the cutoff point was 1496 ,g/l, with sensitivity and specificity of 100% and 83%, respectively. D-dimer ,1496 ,g/l predicted a poor outcome [adjusted odds ratio (OR) 14.44, 95% CI 1.16,179.27; P = 0.038]. A high D-dimer level is associated with a poor outcome in patients with traumatic ICH. It can be used in addition to neurological assessment to predict the outcome. [source]

The impact of HLA-A and -DRB1 on age at onset, disease course and severity in Scandinavian multiple sclerosis patients

EUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2007
C. Smestad
The human leucocyte antigen (HLA) class II haplotype DRB1*15,DQB1*06 (DR15,DQ6) is associated with susceptibility to multiple sclerosis (MS), and HLA class I associations in MS have also been reported. However, the influence of HLA class I and II alleles on clinical phenotypes in MS has not yet been completely studied. This study aimed at evaluating the impact of HLA-A and -DRB1 alleles on clinical variables in Scandinavian MS patients. The correlation between HLA-A or -DRB1 alleles and age at onset, disease course and Multiple Sclerosis Severity Score (MSSS) were studied in 1457 Norwegian and Swedish MS patients by regression analyses and Kruskal,Wallis rank sum test. Presence of HLA-DRB1*15 was correlated with younger age at onset of disease (corrected P = 0.009). No correlation was found between HLA-A and the variables studied. This study analysed the effect of HLA-A on clinical variables in a large Scandinavian sample set, but could not identify any significant contribution from HLA-A on the clinical phenotype in MS. However, associations between HLA-DRB1*15 and age at onset of MS were reproduced in this extended Scandinavian MS cohort. [source]

The association of post-stroke neurological improvement with risk of subsequent deterioration due to stroke events

EUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2007
S. Aslanyan
We sought to simultaneously confirm that substantial recovery at day 1 and day 7 after acute ischaemic stroke onset is associated with subsequent neurological deterioration in patients of the Acute Stroke Therapy by Inhibition of Neutrophils randomized clinical trial. Substantial recovery was assessed by improvement in the National Institutes of Health Stroke Score (NIHSS). Neurological deterioration was defined as any stroke event or NIHSS worsening from recovery assessment to day 90. After adjusting for age, t-PA and day 1 NIHSS, there was a non-significant tendency of substantial (pre-specified as 75%) recovery at day 1 to be associated with later deterioration [odds ratio (OR) 2.47; 95% CI, 0.95,6.50]. The corresponding OR for substantial (pre-defined as 65%) recovery at day 7 was 1.84 (0.85,3.96). Other thresholds for recovery were significantly associated with later deterioration: >50%, 80%, 90% and 100% for day 1 and >50%, 60%, 70%, 90% and 100% for day 7. The effect of recovery at day 1 was more important than that of later recovery. This study confirms the association between recovery and subsequent neurological deterioration and is the first to indicate the greater importance of acute recovery at day 1 in comparison with later recovery. [source]

Validation of the Pulmonary Score: An Asthma Severity Score for Children

ACADEMIC EMERGENCY MEDICINE, Issue 2 2002
Sharon R. Smith MD
Objectives: In the absence of a validated "user-friendly" method of scoring asthma severity, the authors derived the pulmonary score (PS). The purpose of this study was to begin validation trials of the PS by comparing it with the peak expiratory flow rate (PEFR). Methods: The study enrolled a convenience sample of children, aged 5-17 years, who came to the emergency department (ED) for treatment of an acute asthma exacerbation. The PEFR (best of three attempts) and the PS were measured before and after the first albuterol treatment by a physician and a nurse from a pool of 45 trained observers. The PS includes respiratory rate, wheezing, and retractions, each rated on a 0-3 scale. Decreasing PS and increasing PEFR indicate clinical improvement. Pre- and post-treatment PEFRs and PSs were compared using paired t-tests to establish construct validity. Correlation of pre- and post-treatment PSs with PEFRs was measured to establish criterion validity. Results: Forty-six subjects completed the study. Mean percent predicted PEFR improved after treatment by 20.7% (p = 0.0001), and mean PS by 1.5 for nursing-obtained scores (p < 0.0001) and 1.9 for physician-obtained scores (p < 0.0001). Pre- and post-treatment PSs were significantly correlated with PEFRs. Correlations for the nursing-obtained scores were pre-treatment r = -0.57 (p = 0.0003) and post-treatment r = -0.67 (p = 0.0001), and for the physician-obtained scores were pre-treatment r = -0.44 (p = 0.003) and post-treatment r = -0.56 (p = 0.0001). The pre-treatment interrater reliability was 0.62 and the post-treatment was 0.53. Conclusions: These data support the construct and criterion validities of the PS as a measure of asthma severity among children in the ED. The PS is a practical substitute to estimate airway obstruction in children who are too young or too sick to obtain PEFRs. [source]

Prospective Validation of a Modified Thrombolysis In Myocardial Infarction Risk Score in Emergency Department Patients With Chest Pain and Possible Acute Coronary Syndrome

ACADEMIC EMERGENCY MEDICINE, Issue 4 2010
Erik P. Hess MD
Abstract Objectives:, This study attempted to prospectively validate a modified Thrombolysis In Myocardial Infarction (TIMI) risk score that classifies patients with either ST-segment deviation or cardiac troponin elevation as high risk. The objectives were to determine the ability of the modified score to risk-stratify emergency department (ED) patients with chest pain and to identify patients safe for early discharge. Methods:, This was a prospective cohort study in an urban academic ED over a 9-month period. Patients over 24 years of age with a primary complaint of chest pain were enrolled. On-duty physicians completed standardized data collection forms prior to diagnostic testing. Cardiac troponin T-values of >99th percentile (,0.01 ng/mL) were considered elevated. The primary outcome was acute myocardial infarction (AMI), revascularization, or death within 30 days. The overall diagnostic accuracy of the risk scores was compared by generating receiver operating characteristic (ROC) curves and comparing the area under the curve. The performance of the risk scores at potential decision thresholds was assessed by calculating the sensitivity and specificity at each potential cut-point. Results:, The study enrolled 1,017 patients with the following characteristics: mean (±SD) age 59.3 (±13.8) years, 60.6% male, 17.9% with a history of diabetes, and 22.4% with a history of myocardial infarction. A total of 117 (11.5%) experienced a cardiac event within 30 days (6.6% AMI, 8.9% revascularization, 0.2% death of cardiac or unknown cause). The modified TIMI risk score outperformed the original with regard to overall diagnostic accuracy (area under the ROC curve = 0.83 vs. 0.79; p = 0.030; absolute difference 0.037; 95% confidence interval [CI] = 0.004 to 0.071). The specificity of the modified score was lower at all cut-points of >0. Sensitivity and specificity at potential decision thresholds were: >0 = sensitivity 96.6%, specificity 23.7%; >1 = sensitivity 91.5%, specificity 54.2%; and >2 = sensitivity 80.3%, specificity 73.4%. The lowest cut-point (TIMI/modified TIMI >0) was the only cut-point to predict cardiac events with sufficient sensitivity to consider early discharge. The sensitivity and specificity of the modified and original TIMI risk scores at this cut-point were identical. Conclusions:, The modified TIMI risk score outperformed the original with regard to overall diagnostic accuracy. However, it had lower specificity at all cut-points of >0, suggesting suboptimal risk stratification in high-risk patients. It also lacked sufficient sensitivity and specificity to safely guide patient disposition. Both scores are insufficiently sensitive and specific to recommend as the sole means of determining disposition in ED chest pain patients. ACADEMIC EMERGENCY MEDICINE,2010; 17:368,375 © 2010 by the Society for Academic Emergency Medicine [source]

Combined homology modelling and evolutionary significance evaluation of missense mutations in blood clotting factor VIII to highlight aspects of structure and function

HAEMOPHILIA, Issue 4 2009
A. MARKOFF
Summary., Most small lesions in the factor VIII (FVIII) gene that cause haemophilia A (HA) are single nucleotide substitutions resulting in amino acid replacing (missense) mutations and leading to various phenotypes, ranging from mild to severe. We took a combined approach of homology modelling and quantitative evaluation of evolutionary significance of amino acid replacing alterations using the Grantham Matrix Score (GMS) to assess their structural effects and significance of pathological expression. Comparative homology models of all amino acid substitutions summarized in the FVIII mutations database plus these identified and reported lately by us or by our collaborators were evaluated. Altogether 640 amino acid replacing mutations were scored for potential distant or local conformation changes, influence on the molecular stability and predicted contact residues, using available FVIII domain models. The average propensity to substitute amino acid residues by mutation was found comparable to the overall probability of de novo mutations. Missense changes reported with various HA phenotypes were all confirmed significant using GMS. The fraction of these, comprising residues apparently involved in intermolecular interactions, exceeds the average proportion of such residues for FVIII. Predicted contact residues changed through mutation were visualized on the surface of FVIII domains and their possible functional implications were verified from the literature and are discussed considering available structural information. Our predictive modelling adds on the current view of domain interface molecular contacts. This structural insight could aid in part to the design of engineered FVIII constructs for therapy, to possibly enhance their stability and prolong circulating lifetime. [source]