A prospective randomised trial of a "test and treat" policy versus endoscopy based management in young Helicobacter pylori positive patients with ulcer-like dyspepsia, referred to a hospital clinic

Management of dyspepsia remains a controversial area. Although the European Helicobacter pylori study group has advised empirical eradication therapy without oesophagogastroduodenoscopy (OGD) in young H pylori positive dyspeptic patients who do not exhibit alarm symptoms, this strategy has not been subjected to clinical trial.

A millennial record of environmental change in peat deposits from the Misten bog (East Belgium)

In this study, palaeoenvironmental changes recorded in the top metre of a peat profile (Misten bog, East Belgium) were investigated using a multiproxy approach. Proxies include bulk density, Ti and Si content, pollen, macrofossils, d13C on specific Sphagnum stems, and d13C–d18O on Sphagnum leaves. A high-resolution chronology was generated using 210Pb measurements and 22 14C AMS dates on carefully selected Sphagnum macrofossils. d13C only records large change in mire surface wetness. This is partly due to the fact that the core was taken from the edge of a hummock, which may make it difficult to track small isotopic changes. The d13C signal seems to be dependent upon the Sphagnum species composition. For example, a change between Sphagnum section Cuspidata towards Sphagnum imbricatum causes a significant drop in the d13C values. On the whole, the C and O isotopes record two shallow pool phases during the 8th–9th and the 13th centuries. Pollen and atmospheric soil dust (ASD) fluxes records increased human occupation in the area. There may be some climatic signals in the ASD flux, but they are difficult to decipher from the increasing human impact (land clearance, agriculture) during the last millennium. The variations in the proxies are not always synchronous, suggesting different triggering factors (temperature, wetness, windiness) for each proxy. This study also emphasizes that, compared to studies dealing with pollution using geochemical proxies, palaeoclimatic inferences from peat bogs need as many proxies as possible, together with highly accurate and precise age-models, in order to better understand climate variability and their consequences during the Holocene.

Possible interactions between environmental factors in determining species optima

Questions: 1. Indicator values, such as those of Ellenberg, for different environmental factors are seen as independent. We tested for the presence of interactions between environmental factors ( soil moisture and reaction) to see if this assumption is simplistic. 2. How close are Ellenberg indicator values (IVs) related to the observed optima of species response curves in an area peripheral to those where they have been previously employed and 3. Can the inclusion of bryophytes add to the utility of IVs?

Location: South Uist, Outer Hebrides, Scotland, UK.

Methods: Two grids (ca. 2000 m x 2000 m) were sampled at 50-m intervals across the transition from machair to upland communities covering an orthogonal gradient of both soil pH ( reaction) and soil moisture content. Percentage cover data for vascular plants, bryophytes and lichens were recorded, along with pH and moisture content of the underlying sand/soil/peat. Reaction optima, derived from species response curves calculated using HOF models, were compared between wet and dry sites, and moisture optima between acidic and basic samples. Optima for the whole data set were compared to Ellenberg IVs to assess their performance in this area, with and without the inclusion of bryophytes.

Results: A number of species showed substantially different pH optima at high and low soil moisture contents (18% of those tested) and different soil moisture optima at high and low pH (49%). For a number of species the IVs were poor predictors of their actual distribution across the sampled area. Bryophytes were poor at explaining local variation in the environmental factors and also their inclusion with vascular plants negatively affected the strength of relationships.

Conclusions: A substantial number of species showed an interaction between soil moisture and reaction in determining their optima on the two respective gradients. It should be borne in mind that IVs such as Ellenberg's may not be independent of one another.

Holocene environmental changes in northeast Thailand as reconstructed from a tropical wetland

Geochemical variables (TOC, C/N, TS, delta C-13) and diatom assemblages were analyzed in a lake sediment sequence from Nong (Lake) Han Kumphawapi in northeast Thailand to reconstruct regional climatic and environmental history during the Holocene. By around c. 10,000-9400 cal yr BP, a large shallow freshwater lake had formed in the Kumphawapi basin. Oxygenated bottom waters and a well-mixed water column were characteristic of this early lake stage, which was probably initiated by higher effective moisture and a stronger summer monsoon. Decreased run-off after c. 6700 cal yr BP favored increased aquatic productivity in the shallow lake. Multiple proxies indicate a marked lowering of the lake level around 5900 cal yr BP, the development of an extensive wetland around 5400 cal yr BP, and the subsequent transition to a peatland. The shift from shallow lake to wetland and later to a peatland is interpreted as a response to lower effective moisture. A hiatus at the transition from wetland to peatland suggests very low accumulation rates, which may result from very dry climatic conditions. A rise in groundwater and lake level around 3200 cal yr BP allowed the re-establishment of a wetland in the Kumphawapi basin. However, the sediments deposited between c. 3200 and 1600 cal yr BP provide evidence for at least two hiatuses at c. 2700-2500 cal yr BP, and at c. 1900-1600 cal yr BP, which would suggest surface dryness and consequently periods of low effective moisture. Around 1600 cal yr BP a new shallow lake became re-established in the basin. Although the underlying causes for this new lake phase remain unclear, we hypothesize that higher effective moisture was the main driving force. This shallow lake phase continued up to the present but was interrupted by higher nutrient fluxes to the lake around 1000-600 cal yr BP. Whether this was caused by intensified human impact in the catchment or, whether this signals a lowering of the lake level due to reduced effective moisture, needs to be corroborated by further studies in the region. The multi-proxy study of Kumphawapi's sediment core CP3A clearly shows that Kumphawapi is a sensitive archive for recording past shifts in effective moisture, and as such in the intensity of the Asian summer monsoon. Many more continental paleorecords, however, will be needed to fully understand the spatial and temporal patterns of past changes in Asian monsoon intensity and its ecosystem impacts. (C) 2012 Elsevier B.V. All rights reserved.

Perceptions of resident behavior problems and their clinical management in Long Term Care facilities

The objective of this study was to describe the perceptions of Long Term Care (LTC) service providers in urban Canadian care facilities regarding the prevalence and nature of resident behavior problems and how staff manage these problems. Key informants from 15 LTC facilities housing 1,928 residents, participated in a cross sectional survey which employed semi-structured telephone interviews. Respondents estimated that on average 61% (n = 1,176) of residents had some type of mental health/behavioral problem, with facility estimates ranging from 20% to 90%. The most frequently reported problem behaviors included: general agitation and restlessness (36%); pacing and aimless wandering (28%); hoarding things (24%); hitting either self or others (23%); and verbal aggression (22%). Behaviors reported by respondents as "disruptive" or "very disruptive" were screaming (13%), sexual disinhibition (10%), and hitting either self or others (10%). The most common interventions used by staff were behavioral interventions followed by the use of medications. Low levels of staffing and educational training of staff were among the most common factors recognized as contributing to the difficulty in caring for residents with mental health needs.

Diabetes management in patients receiving palliative care

A literature review revealed no evidence-based guidelines specific to managing diabetes in the context of palliative care. The purpose of the current project was to describe the management practices of doctors and nurses caring for people with diabetes and advanced disease. Palliative care doctors, palliative care nurses, endocrinologists, and diabetes nurse educators participated in this study. A two-phase project was undertaken: 1) two focus groups, and 2) a cross-sectional survey using a self-completed questionnaire. The focus group and questionnaire data identified that doctors and nurses used a range of practices and blood glucose testing frequencies to control blood glucose based on experience and not according to a robust evidence base. Implications for practice include the importance of collaboration between diabetes and palliative care specialists, and the need to develop clinical management guidelines.

Biomonitoring aquatic environmental quality in a marine protected area: A biomarker approach

The main aims of the present study, conducted in the framework of the MONIQUA-Egadi Scientific Project, were twofold: first, to make the first step in the development and validation of an ecotoxicological approach for the assessment of marine pollution in coastal environments on the basis of a set of biomarker responses in new sentinel species; and second, to obtain preliminary information on environmental quality in an Italian marine protected area, the Egadi Islands (Sicily). Several cytochrome P450-dependent mixed-function oxidase activities were measured in the following sentinel species: rainbow wrasse Coris julis, gastropod limpet Patella caerulea, and sea urchin Paracentrotus lividus. The results suggest that specimens from the Favignana Harbor may be exposed to P450 inducers, whereas most of the other sites seem to share similar environmental quality. The proposed approach has potential for assessment of environmental quality in marine protected areas.

Developing tomorrow's leaders-Evidence of global talent management in multinational enterprises

Organizations are becoming relentless in managing and developing their key talent. This is a view, however, largely based on anecdote rather than reliable empirical evidence. Utilizing data from 260 multinational enterprises (MNEs), this paper helps redress this deficit. Specifically, this paper explores the extent to which MNEs engage in global talent management (GTM) and deciphers some of the factors which may explain the use and non-use of GTM practices. In so doing, we find that although a significant number of MNEs have systems and mechanisms in place to strategically identify and develop their talent many more seemingly adopt an ad hoc or haphazard approach. For instance, less than half of all MNEs have both global succession planning and formal management development programs for their high-potentials. Consequently it seems that there is a considerable distance yet to be travelled to arrive at a universal appreciation of the need to strategically manage one's key employees. We find the size of the MNE has a significant effect on GTM system usage-larger MNEs are more likely to undertake GTM. Other significant, positive influences include whether products or services are standardized regionally or globally, and if the MNE has a global human resources policy formation body. Of considerable interest is the finding that MNEs operating in the low-tech/low-cost sectors are significantly more likely to have formal global systems to identify and develop high-potentials. © 2009 Elsevier Inc. All rights reserved.