Use of stress echocardiography to predict mortality in patients with diabetes and known or suspected coronary artery disease

OBJECTIVE - This study sought to determine whether stress echocardiography using exercise (when feasible) or dobutamine echo could be used to predict mortality in patients with diabetes. RESEARCH DESIGN AND METHODS - Stress echo was performed in 937 patients with diabetes (aged 59 +/- 13 years, 529 men) for symptom evaluation (42%) and follow-up of known coronary artery disease (CAD) (58%). Stress echocardiography using exercise was performed in 333 patients able to exercise maximally, and dobutamine echo using a standard dobutamine stress was used in 604 patients. Patients were followed for less than or equal to9 years (mean 3.9 +/- 2.3) for all-cause mortality. RESULTS - Normal studies were obtained in 567 (60%) patients; 29% had resting left ventricular (LV) dysfunction, and 25% had ischemia. Abnormalities were confined to one territory in 183 (20%) patients and to multiple territories in 187 (20%) patients. Death (in 275 [29%] patients) was predicted by referral for pharmacologic stress (hazard ratio [HR] 3.94, P < 0.0001), ischemia (1.77, P <0.0001), age (1.02, P = 0.002), and heart failure (1.54, P = 0.01). The risk of death in patients With a normal scan was 4% per year, and this was associated with age and selection for pharmacologic stress testing. In stepwise models replicating the sequence of clinical evaluation, the predictive power of independent clinical predictors (age, selection for pharmacologic stress, previous infarction, and heart failure; model chi(2) = 104.8) was significantly enhanced by addition of stress echo data (model chi(2) = 122.9). CONCLUSIONS - The results of stress echo are independent predictors of death in diabetic patients with known or suspected CAD.. Ischemia adds risk that is incremental to clinical risks and LV dysfunction.

CDT, GGT, and AST as markers of alcohol use: The WHO/ISBRA Collaborative Project

Background: Estimates of the performance of carbohydrate deficient transferrin (CDT) and gamma glutamyltransferase (GGT) as markers of alcohol consumption have varied widely. Studies have differed in design and subject characteristics. The WHO/ISBRA Collaborative Study allows assessment and comparison of CDT, GGT, and aspartate aminotransferase (AST) as markers of drinking in a large, well-characterized, multicenter sample. Methods: A total of 1863 subjects were recruited from five countries (Australia, Brazil, Canada, Finland, and Japan). Recruitment was stratified by alcohol use, age, and sex. Demographic characteristics, alcohol consumption, and presence of ICD-10 dependence were recorded using an interview schedule based on the AUDADIS, CDT was assayed using CDTect(TM) and GGT and AST by standard methods. Statistical techniques included receiver operating characteristic (ROC) analysis. Multiple regression was used to measure the impact of factors other than alcohol on test performance. Results: CDT and GGT had comparable performance on ROC analysis, with AST performing slightly less well. CDT was a slightly but significantly better marker of high-risk consumption in men. All were more effective for detection of high-risk rather than intermediate-risk drinking. CDT and GGT levels were influenced by body mass index, sex, age, and smoking status. Conclusions: CDT was little better than GGT in detecting high- or intermediate-risk alcohol consumption in this large, multicenter, predominantly community-based sample. As the two tests are relatively independent of each other, their combination is likely to provide better performance than either test alone, Test interpretation should take account sex, age. and body mass index.

Physiological profiles of restricted endemic plants and their widespread congenors in the North Queensland wet tropics, Australia

Little is known about causes of endemic rarity in plants. This study pioneered an approach that determined environmental variables in the rainforest habitat and generated physiological profiles for light, water, and nutrient relations for three endemically restricted versus widespread congeneric species' pairs. We found no overall consistent differences in the physiological variables between the group of restricted species and the group of widespread species, and congeneric species pairs were therefore examined individually. Availability of soil nutrients did not differ between restricted-widespread species sites suggesting that species grow under comparable nutrient conditions. Under ambient and manipulated higher light conditions, widespread Gardenia ovularis had a greater photosynthetic activity than restricted Gardenia actinocarpa suggesting that the two species differ in their photosynthetic abilities. Differences between Xanthostemon species included lower photosynthetic activity, higher transpiration rate, and a higher foliar manganese concentration in restricted Xanthostemon formosus compared to widespread Xanthostemon chrysanthus. It is suggested that X. formosus is restricted by its high water use to its current rainforest creek edge habitat, while X. chrysanthus grows in a range of environments, although naturally found in riparian rainforest. Restricted Archidendron kanisii had higher electron transport rates, greater dissipative capacity for removal of excess light, and more efficient investment of nitrogen into photosynthetic components, than its widespread relative Archidendron whitei. These observations and previous research suggest that restricted Archidendron kanisii is in the process of expanding its range. Physiological profiles suggest a different cause of rarity for each species. This has implications for the conservation strategies required for each species. (C) 2002 Elsevier Science Ltd. All rights reserved.

An investigation into the possible inhibitory effects of white cypress pine (Callitris glaucophylla) litter on the germination and growth of associated ground cover species

White cypress-pine stands typically support sparse densities of shrubs and grasses. The commonly held opinion is that leaching of allelopathic chemical compounds from cypress-pine litter partly facilitates this exclusion. Germination and growth of cypress pine seedlings do not appear to be similarly affected. This study set out to determine whether cypress litter had a differential effect on germination and growth of cypress-pine seedlings and on associated ground-cover species. Glasshouse trials comparing seedling emergence under cypress- and artificial-litter layers were undertaken. Cypress-pine litter did not have an inhibitory effect on the germination or growth of ground-cover species. In most cases, seedling emergence was facilitated by the application of cypress-pine litter due to its ability to increase the water holding capacity of the underlying soil. Cypress litter did not promote growth of its own seedlings over its competitors except on coarse-textured soils where it provided an ameliorative function to water stress due to the soil's reduced water holding capacity. The inhibition of ground-cover species' germination and growth in pure cypress stands was suggested to be the result of high below-ground resource competition due to the pine's expansive root morphology.

Play Preferences and Behavior of Preschool Children with Autistic Spectrum Disorder in the Clinical Environment

The play of children with autistic spectrum disorder (ASD) is a valuable medium for assessment and intervention, and its analysis has the potential to aid diagnosis. This study investigated spontaneous play behavior and play object preferences for 24 preschool children with ASD in a typical occupational therapy clinical environment. Play behavior was rated and choice of play object noted at 10-second intervals from a 15-minute video recording of unstructured play. Statistical analyses indicated that play behavior was consistent with descriptions in the literature. In addition, the children demonstrated clear preferences for play objects in the form of popular characters (e.g., Thomas the Tank Engine) and those with sensorimotor properties. We propose that the inclusion of preferred play objects in a clinical environment may increase intrinsic motivation to play, and thereby enhance assessment and intervention.

Occupational therapy assessment of self-awareness following traumatic brain injury

Impaired self-awareness is a common problem following traumatic brain injury. Without adequate self-awareness, a person's motivation to participate in rehabilitation may be limited, which in turn can have an adverse effect on his or her functional outcome. For this reason, it is important that brain injury rehabilitation professionals, including occupational therapists, both understand this phenomenon and use assessment and treatment approaches aimed at improving clients' self-awareness. This article provides an overview of self-awareness, reviewing the distinction between intellectual and online awareness. The current role of occupational therapy in the assessment of self-awareness is highlighted and the guidelines for new assessments of self-awareness suitable for use in occupational therapy are explored.

Climate of fear in organisational settings: Construct definition, measurement and a test of theory

This paper reports a study that explored a new construct: climate of fear. We hypothesised that climate of fear would vary across work sites within organisations, but not across organisations. This is in contrast a to measures of organisational culture, which were expected to vary both within and across organisations. To test our hypotheses, we developed a new 13-item measure of perceived fear in organisations and tested it in 20 sites across two organisations (N = 209). Culture variables measured were innovative leadership culture, and communication culture. Results were that climate of fear did vary across sites in both organisations, while differences across organisations were not significant, as we anticipated. Organisational culture, however, varied between the organisations, and within one of the organisations. The climate of fear scale exhibited acceptable psychometric properties.

Use of web-based formative assessment to support student learning in metabolism/nutrition unit

In 2002, an integrated basic science course was introduced into the Bachelor of Dental Sciences programme at the University of Queensland, Australia. Learning activities for the Metabolism and Nutrition unit within this integrated course included lectures, problem-based learning tutorials, computer-based self-directed learning exercises and practicals. To support student learning and assist students to develop the skills necessary to become lifelong learners, an extensive bank of formative assessment questions was set up using the commercially available package, WebCT®. Questions included short-answer, multiple-choice and extended matching questions. As significant staff time was involved in setting up the question database, the extent to which students used the formative assessment and their perceptions of its usefulness to their learning were evaluated to determine whether formative assessment should be extended to other units within the course. More than 90% of the class completed formative assessment tasks associated with learning activities scheduled in the first two weeks of the block, but this declined to less than 50% by the fourth and final week of the block. Patterns of usage of the formative assessment were also compared in students who scored in the top 10% for all assessment for the semester with those who scored in the lowest 10%. High-performing students accessed the Web-based formative assessment about twice as often as those who scored in the lowest band. However, marks for the formative assessment tests did not differ significantly between the two groups. In a questionnaire that was administered at the completion of the block, students rated the formative assessment highly, with 80% regarding it as being helpful for their learning. In conclusion, although substantial staff time was required to set up the question database, this appeared to be justified by the positive responses of the students.

Effect of time of harvest of budded virus on the selection of baculovirus FP mutants in cell culture

Rapid formation and selection of FP (few polyhedra) mutants occurs during serial passaging of Helicoverpa armigera nucleopolyhedrovirus (HaSNPV) in insect cell culture. The production of HaSNPV for use as biopesticides requires the passaging of the virus over a number of passages to produce enough virus inoculum for large-scale fermentation. During serial passaging in cell culture, FP mutants were rapidly selected, resulting in declined productivity and reduced potency of virus. Budded virus (BV) is usually harvested between 72 and 96 h postinfection (hpi) in order to obtain a high titer virus stock. In this study, the effect of tine of harvest (TOH) for BV on the selection rate of HaSNPV FP mutants during serial passaging was investigated. BV were harvested at different times postinfection, and each series was serially passaged for six passages. The productivity and percentage of FP mutants at each passage were determined. It was found that the selection of FP mutants can he reduced by employing an earlier TOH for BV. Serial passaging with BV harvested at 48 hpi showed a slower accumulation of FP mutants compared to that of BV harvested after 48 hpi. Higher cell specific yields were also maintained when BV were harvested at 48 hpi. When BV that were formed between 48 and 96 hpi were harvested and serially passaged, FP mutants quickly dominated the virus population. This suggests that the V formed and released between 48 and 96 hpi are most likely from FP mutant infected cells.