Evaluation of a brief child-focused group-based intervention for anxiety-disordered children

This paper presents a pilot study of a brief, group-based, cognitive-behavioural intervention for anxiety-disordered children. Five children (aged 7 to 13 years) diagnosed with a clinically significant anxiety disorder were treated with a recently developed 6-session, child-focused, cognitive-behavioural intervention that was evaluated using multiple measures (including structured diagnostic interview, self-report questionnaires and behaviour rating scales completed by parents) over four follow-up occasions (posttreatment, 3-month follow-up, 6-month follow-up and 12-month follow-up). This trial aimed to (a) evaluate the conclusion suggested by the research of Cobham, Dadds, and Spence (1998) that anxious children with non-anxious parents require a child-focused intervention only in order to demonstrate sustained clinical gains; and (b) to evaluate a new and more cost-effective child-focused cognitive-behavioural intervention. Unfortunately, the return rate of the questionnaires was poor, rendering this data source of questionable value. However, diagnostic interviews (traditionally the gold standard in terms of outcome in this research area) were completed for all children at all follow-up points. Changes in diagnostic status indicated that meaningful treatment-related gains had been achieved and were maintained over the full follow-up period. The results would thus seem to support the principle of participant-intervention matching proposed by Cobham et al. (1998), as well as the utility of the more brief intervention evaluated.

High-Risk Merkel Cell Carcinoma of the Skin Treated With Synchronous Carboplatin/Etoposide and Radiation: A Trans-Tasman Radiation Oncology Group Study-TROG 96:07

Purpose: The effectiveness of synchronous carboplatin, etoposide, and radiation therapy was prospectively assessed in a group of patients with high-risk Merkel cell carcinoma (MCC) of the skin. Patients and Methods: Patients were eligible if they had disease localized to the primary site and nodes, and were required to have at least one of the following high risk features: recurrence after initial therapy, involved nodes, primary tumor size greater than 1 cm, gross residual disease after surgery, or occult primary with nodes. Radiation was delivered to the primary site and nodes to a dose of 50 Gy in 25 fractions over 5 weeks and synchronous carboplatin (area under the curve, 4.5) and intravenous etoposide 80 mg/m(2) days 1 to 3 was given in weeks 1, 4, 7, and 10. The median age of the group was 67 (range, 43-86) years, and there were 39 males and 14 females. Involved nodes (stage II) were present in 33 cases (62%). The sites involved were head and neck (22 patients), occult primary (13 patients), upper limb (eight patients), lower limb (eight patients), and trunk (two patients). Results: Fifty-three patients were entered between 1996 and 2001. The median potential follow-up was 48 months. There were no treatment related deaths. The 3-year overall survival, locoregional control, and distant control were 76%, 75%, and 76%, respectively. Tumor site and the presence of nodes were factors that were predictive for local control and survival. Multivariate analysis indicated that the major factor influencing survival was the presence of nodes; however, this was not a significant factor in locoregional control. Conclusion: High levels of locoregional control and survival have been achieved with the addition of chemotherapy to radiation treatment for high-risk MCC of the skin. The role of chemoradiotherapy for high-risk MCC warrants further investigation. (C) 2003 by American Society of Clinical Oncology.

Quantitative trends in airborne loads of Celtis sinensis pollen and associations with meteorological variables in a subtropical Australian environment

Celtis sinensis is an introduced plant species to the southeastern region of Queensland that has had a destructive affect on indigenous plant Communities and its pollen has been identified as an allergen Source. Pollen belonging to C. sinensis was sampled during a 5-year (June 1994-May 1999) atmospheric pollen-monitoring programme in Brisbane, Australia, using a Burkard 7-day spore trap. The seasonal incidence of airborne C. sinensis pollen (CsP) in Brisbane occurred over a brief period each year during spring (August-September), while peak concentrations were restricted to the beginning of September. individual CsP seasons were heterogeneous with daily counts within the range 1-10 grains m(-3) on no more than 60 sampling days; however, smaller airborne concentrations of CsP were recorded out of each season. Correlation co-efficients were significant each year for temperature (p0.05) and relative humidity (p>0.05). A significant relationship (r(2)=0.81, p=0.036) was established between the total CsP count and pre-seasonal average maximum temperature; however, periods of precipitation (>2mm) were demonstrated to significantly lower the daily concentrations of CsP from the atmosphere. Given the environmental and clinical significance of CsP and its prevalence in the atmosphere of Brisbane, a Clinical population-based Study is required to further understand the pollen's importance as a seasonal sensitizing source in this region.

A double blind, randomized, multicenter, parallel group study of the effectiveness and tolerance of intraarticular hyaluronan in osteoarthritis of the knee

Objective. To investigate the efficacy and tolerability of a course of 5 injections of hyaluronan (HA) given at intervals of one week in patients with symptomatic, mild to moderate osteoarthritis (OA) of the knee. Methods: A double blind, randomized, parallel group, multicenter (17 centers), saline vehicle-controlled study was conducted over 18 weeks. Patients received either 25 mg (2.5 ml) HA in a phosphate buffered solution or 2.5 ml vehicle containing only the buffer by intraarticular injection. Five injections were given at one week intervals and the patients were followed for a further 13 weeks. The Western Ontario McMaster (WOMAC) OA instrument was used as the primary efficacy variable and repeated measures analysis of covariance was used to compare the 2 treatments over Weeks 6, 10, 14, and 18. Results. Of 240 patients randomized for inclusion in the study, 223 were evaluable for the modified intention to treat analysis. The active treatment and control groups were comparable for demographic details, OA history, and previous treatments. Scores for the pain and stiffness subscales of the WOMAC were modestly but significantly lower in the HA-treated group overall (Weeks 6 to 18; p < 0.05) and the statistically significant difference from the control was not apparent until after the series of injections was complete. The physical function subscale did not reach statistical significance (p = 0.064). Tolerability of the procedure was good and there were no serious adverse events that were considered to have a possible causal relationship with the study treatment. Conclusion. Intraarticular HA treatment was significantly more effective than saline vehicle in mild to moderate OA of the knee for the 13 week postinjection period of the study.

Promising results of a cooperative group phase II trial of preoperative chemoradiation for locally advanced rectal cancer (TROG 9801)

PURPOSE: This article reports the overall survival, failure-free survival, local failure, and late radiation toxicity of a phase II trial of preoperative radiotherapy with continuous infusion 5-fluorouracil for rectal cancer after a minimum 3.5 years of follow-up. METHODS: Eligible patients were those with newly diagnosed localized adenocarcinoma of the rectum, within 12 cm of the anal verge, staged T3-T4 and deemed suitable for curative resection. Radiotherapy (50.4 Gy in 28 fractions in five weeks and three days) was given with continuous infusion 5-fluorouracil throughout the course of radiotherapy. RESULTS: A total of 82 patients were accrued in 13 months. The median follow-up time was 4.1 (range, 2.3-4.5) years. There were 55 males (67 percent) and the median age was 59 (range, 27-87) years. Patients were staged pretreatment as T3 (89 percent) and resectable T4 (11 percent). Endorectal ultrasound was performed in 70 percent and magnetic resonance imaging in another 5 percent. The four-year overall and failure-free survival rates were 82 percent (95 percent Cl: 72-89) and 69 percent (95 percent Cl: 58-78), respectively. The cumulative incidence of local failure at four years was 3.9 percent (95 percent CI: 1.3-11). Risk of failures, local and distant, has not reached a plateau phase. CONCLUSION: This regimen can be delivered safely and without leading to a significant increase in late toxicity. It provides excellent local control and favorable overall survival. There is a need for longer follow-up than has commonly been used for the proper evaluation of failures after an effective regimen of preoperative chemoradiation.

Genetic resource impacts of habitat loss and degradation; reconciling empirical evidence and predicted theory for neotropical trees

The theoretical impacts of anthropogenic habitat degradation on genetic resources have been well articulated. Here we use a simulation approach to assess the magnitude of expected genetic change, and review 31 studies of 23 neotropical tree species to assess whether empirical case studies conform to theory. Major differences in the sensitivity of measures to detect the genetic health of degraded populations were obvious. Most studies employing genetic diversity (nine out of 13) found no significant consequences, yet most that assessed progeny inbreeding (six out of eight), reproductive output (seven out of 10) and fitness (all six) highlighted significant impacts. These observations are in line with theory, where inbreeding is observed immediately following impact, but genetic diversity is lost slowly over subsequent generations, which for trees may take decades. Studies also highlight the ecological, not just genetic, consequences of habitat degradation that can cause reduced seed set and progeny fitness. Unexpectedly, two studies examining pollen flow using paternity analysis highlight an extensive network of gene flow at smaller spatial scales (less than 10 km). Gene flow can thus mitigate against loss of genetic diversity and assist in long-term population viability, even in degraded landscapes. Unfortunately, the surveyed studies were too few and heterogeneous to examine concepts of population size thresholds and genetic resilience in relation to life history. Future suggested research priorities include undertaking integrated studies on a range of species in the same landscapes; better documentation of the extent and duration of impact; and most importantly, combining neutral marker, pollination dynamics, ecological consequences, and progeny fitness assessment within single studies.

To self, or not to self ... A review of outcrossing and pollen-mediated gene flow in neotropical trees

Despite the typically low population densities and animal-mediated pollination of tropical forest trees, outcrossing and long-distance pollen dispersal are the norm. We reviewed the genetic literature on mating systems and pollen dispersal for neotropical trees to identify the ecological and phylogenetic correlates. The 36 studies surveyed found >90% outcrossed mating for 45 hermaphroditic or monoecious species. Self-fertilization rates varied inversely with population density and showed phylogenetic and geographic trends. The few direct measures of pollen flow (N = 11 studies) suggest that pollen dispersal is widespread among low-density tropical trees, ranging from a mean of 200 m to over 19 km for species pollinated by small insects or bats. Future research needs to examine (1) the effect of inbreeding depression on observed outcrossing rates, (2) pollen dispersal in a wide range of pollination syndromes and ecological classes, (3) and the range of variation of mating system expression at different hierarchical levels, including individual, seasonal, population, ecological, landscape and range wide.

Transcription factor Tfec contributes to the IL-4-inducible expression of a small group of genes in mouse macrophages including the granulocyte colony-stimulating factor receptor

Expression of the mouse transcription factor EC (Tfec) is restricted to the myeloid compartment, suggesting a function for Tfec in the development or function of these cells. However, mice lacking Tfec develop normally, indicating a redundant role for Tfec in myeloid cell development. We now report that Tfec is specifically induced in bone marrow-derived macrophages upon stimulation with the Th2 cytokines, IL-4 and IL-13, or LPS. LPS induced a rapid and transient up-regulation of Tfec mRNA expression and promoter activity, which was dependent on a functional NF-kappa B site. IL-4, however, induced a rapid, but long-lasting, increase in Tfec mRNA, which, in contrast to LPS stimulation, also resulted in detectable levels of Tfec protein. IL-4-induced transcription of Tfec was absent in macrophages lacking Stat6, and its promoter depended on two functional Stat6-binding sites. A global comparison of IL-4-induced genes in both wild-type and Tfec mutant macrophages revealed a surprisingly mild phenotype with only a few genes affected by Tfec deficiency. These included the G-CSFR (Csf3r) gene that was strongly up-regulated by IL-4 in wild-type macrophages and, to a lesser extent, in Tfec mutant macrophages. Our study also provides a general definition of the transcriptome in alternatively activated mouse macrophages and identifies a large number of novel genes characterizing this cell type.

Does health assessment improve health outcomes in Indigenous people? An RCT with 13 years of follow-up

Objective: To examine the impact of a multi-component health assessment on mortality and morbidity in Kimberley Aboriginal residents during a 13-year follow-up. Method. A population-based randomised controlled trial using linked hospital, cancer and death records to evaluate outcomes in 620 intervention and 6,736 control subjects. Results: The intervention group had a higher rate of first-time hospitalisation for any reason (IRR = 1.37; 95 % Cl 1.25-1.50), a higher rate of injury-related hospital episodes (IRR = 1.31; 95 % Cl 1.15-1.48) and a higher notification rate of alcohol-related cancers. There was a smaller difference in the rates of multiple hospitalisations (IRR = 1.14; 95 % Cl 0.751.74) and no improvement in overall mortality compared with controls (IRR = 1.08; 95 % Cl 0.91-1.29). Conclusions: There was no overall mortality benefit despite increased health service contact associated with the intervention. Implications: Although not influencing mortality rates, multi-component health assessment may result in a period of increased health service use in Aboriginal and Torres Strait Islander populations, thus constituting an 'intervention'. However, this should not be confused with systematic and sustained interventions and investment in community development to achieve better health outcomes.

Analysis of plant microfossils in archaeological deposits from two remote archipelagos: The Marshall Islands, Eastern Micronesia, and the Pitcairn Group, Southeast Polynesia

Pollen and starch residue analyses were conducted on 24 sediment samples from archaeological sites on Maloelap and Ebon Atolls in the Marshall Islands, eastern Micronesia, and Henderson and Pitcairn Islands in the Pitcairn Group, Southeast Polynesia. The sampled islands, two of which are mystery islands (Henderson and Pitcairn), previously occupied and abandoned before European contact, comprise three types of Pacific islands: low coral atolls, raised atolls, and volcanic islands. Pollen, starch grains, calcium oxylate crystals, and xylem cells of introduced non-Colocasia Araceae (aroids) were identified in the Marshalls and Henderson (ca. 1,900 yr B.P. and 1,200 yr B.P. at the earliest, respectively). The data provide direct evidence of prehistoric horticulture in those islands and initial fossil pollen sequences from Pitcairn Island. Combined with previous studies, the data also indicate a horticultural system on Henderson comprising both field and tree crops, with seven different cultigens, including at least two species of the Araceae. Starch grains and xylem cells of Ipomoea sp., possibly introduced 1. batatas, were identified in Pitcairn Island deposits dated to the last few centuries before European contact in 1790.

LUCAS 13,1-5 MEMÓRIA PERIGOSA DAS VÍTIMAS

O seguinte trabalho desenvolve o tema da violência contra o movimento popular na Galiléia, segundo o texto de Lucas 13,1-5. Esse texto não tem paralelo nas outras duas fontes sinóticas, nem em João, nem em Tomé, nem no grupo Galileu que escreveu a fonte Q; quanto a esses eventos históricos que narra o texto, não há referência nem em Flávio Josefo, nem em outros historiadores da época. Isso quer dizer, que estes versículos são uma fonte própria de Lucas, uma fonte autônoma, chamada por alguns como fonte L (ou fonte S). A abordagem deste texto de Lucas, feita por grande parte de pesquisadores na área bíblica, preocupa-se com os temas de pecado e arrependimento, deixando na margem a situação das vítimas e as ameaças de Jesus para seus ouvintes. Neste sentido, este trecho de Lucas é de grande importância. Estes versículos expressam a realidade sócio -política. Seu conteúdo é um sinal de conflito e de denúncia contra o sistema imperial romano que não passou desapercebido para o redator do texto e nem para o seu auditório. Trata-se, portanto, da memória das vítimas da opressão. Apresentamos a seguir, a pesquisa em três capítulos esboçados brevemente. O primeiro descreve o agir específico dos procuradores ou governadores romanos, nas províncias comandadas por eles; ao mesmo tempo, a reação do povo e os seus protestos. A nossa ênfase recairá sobre o procurador romano Pôncio Pilatos. Nos valeremos das fontes bíblicas, extra-bíblicas e pseudo-epígrafas. No final, destacaremos a relevância e o papel central do texto Lucas 13,1-5. No segundo capítulo, o centro será a exegese de Lucas 13,1-5, relacionando-o com o contexto maior que, em nosso caso, é chamado itinerário de viagem para Jerusalém , e com um contexto imediato que é o capitulo 13 de Lucas. No final, perguntaremos pelo grupo ou grupos que podem estar por trás destes versículos, e a importância da fonte L, como fonte primeira que se insere no Evangelho de Lucas. O texto de Lucas 13,1-5 aparece como texto autônomo, memória das vítimas; ele contrasta com a visão moderada dos relatos da Paixão nos sinóticos, frente a uma realidade de opressão. O terceiro capítulo constitui-se num ensaio de articulação destes dois capítulos com a realidade atual, especificamente com a situação de guerra, violência e morte na Colômbia, junto aos esforços atuais por reconstruir a memória das vítimas do povo colombiano, memória que dá sentido e dignifica a oferenda de suas vidas.(AU)

Diagenesis and aquifer characteristics of the Sherwood Sandstone Group in North Nottinghamshire

The Sherwood Sandstone Group forms an important aquifer in Eastern England, which in North Nottinghamshire comprises the Nottingham Castle and Lenton Sandstone Formations. The aquifer is formed by an alluvial red-bed sequence dominated by medium-coarse grained sandstones which are texturally immature to submature and have only been subjected to shallow burial diagenesis. These sandstones reached the mature stage of the meso diagenetic regime, and four stages are recognized in their diagenetic history depending upon the physical/chemical processes prevailing and the subsequent effect on porosity and permeability. Stage "One" represents changes including dissolution of unstable silicates, clay replacement, red colouration and precipitation of authigenic minerals (quartz, feldspar, illite, l/S, kaolinite, dolomite, ferroan calcite, calcite). The net result of these changes was porosity reduction. Stage "Two" included changes due to mechanical compaction which resulted in minor porosity reduction. Stage "Three" was the main phase of secondary porosity enhancement. Stage "Four" represents changes taking place in the present groundwater where porosity and permeability may have been increased by dissolution and partly reduced by kaolinite precipitation. Porosity measured by water-resaturation and Hg-injection gave average values of 25.63% and 24.85% respectively. The results are comparable and showed marked correlation especially in highly porous/permeable rocks. Porosity measurements from photomicrographs were markedly offset from laboratory results. Horizontal Kw ranged between 1.43 x 10-5 and 1.13 x 10-1 mm/sec, with an average of  1.68 x 10-2 mm/sec. The estimated KHg ranged between 7.29 x 10-6 and 6.99 x 10-2 mm/sec with an average of 1.47 x 10-2 mm/sec. Both results are significantly correlated for highly porous/permeable rocks. The hydraulic properties are highly dependent upon the diagenetic properties (as most of the pores present are of secondary origin) as well as the pore size distribution. The chemistry of these groundwaters indicates that they are under-saturated with respect to dolomite, calcite, K-feldspar, l/S clay, and montmorillonite. The precipitation of kaolinite,and to a lesser extent illite, is favoured in the present groundwater regime.