Increase in skin cancer screening during a community-based randomized intervention trial

Survival from cutaneous melanoma is mainly dependent on the thickness of the lesion at diagnosis. Skin screening may increase detection of thin lesions and hence improve survival. Within a community-based randomized controlled trial of a population screening program for melanoma in Queensland, Australia, 9 communities were randomly assigned to the 3-year intervention and 9 communities to the control group. Skin screening prevalence was monitored by cross-sectional surveys at baseline, 1, 2 and 3 years into the intervention and 2 years later. At baseline, prevalence of whole-body clinical skin examination was similar in intervention and control communities. In intervention communities, the prevalence of whole-body skin examinations increased to 29.2%, an absolute difference of 18% from baseline, with a peak of 34.8% 2 years after baseline, and began to decline again at the end of the intervention period. The largest increases were seen in men and women ≥50 years. Uptake of screening did not differ according to melanoma risk factors; however, the decline in screening was less in participants who reported a number of melanoma risk factors. The prevalence of skin self-examination remained stable during the intervention program. No changes were observed in the control communities. These results indicate that the intervention program significantly increased the prevalence of whole-body clinical skin examinations in intervention communities. Once the intervention program ceased, and particularly after skin clinics ceased, levels of skin screening began to decline. The provision of specialized skin screening clinics may be needed to achieve sufficient screening rates should population based screening for skin cancer be considered. © 2005 Wiley-Liss, Inc.

Is mortality from heart failure increasing in Australia? An analysis of official data on mortality for 1997-2003

Objective To assess whether trends in mortality from heart failure(HF) in Australia are due to a change in awareness of the condition or real changes in its epidemiology. Methods We carried out a retrospective analysis of official data on national mortality data between 1997 and 2003. A death was attributed to HF if the death certificate mentioned HF as either the underlying cause of death (UCD) or among the contributory factors. Findings From a total of 907 242 deaths, heart failure was coded as the UCD for 29 341 (3.2%) and was mentioned anywhere on the death certificate in 135 268 (14.9%). Between 1997 and 2003, there were decreases in the absolute numbers of deaths and in the age-specific and age-standardized mortality rates for HF either as UCD or mentioned anywhere for both sexes. HF was mentioned for 24.6% and 17.8% of deaths attributed to ischaemic heart disease and circulatory disease, respectively, and these proportions remained unchanged over the period of study. In addition, HF as UCD accounted for 8.3% of deaths attributed to circulatory disease and this did not change materially from 1997 to 2003. Conclusion The decline in mortality from HF measured as either number of deaths or rate probably reflects a real change in the epidemiology of HF. Population-based studies are required to determine accurately the contributions of changes in incidence, survival and demographic factors to the evolving epidemiology of HF.

Summer dormancy in Dactylis glomerata L.: the influence of season of sowing and a simulated mid-summer storm on two contrasting cultivars

A series of trials to increase understanding of the summer dormancy trait in Dactylis glomerata was conducted. Autumn-sown reproductive and younger, spring-sown plants of 2 drought-resistant cultivars, contrasting for summer dormancy, were established and then tested in summer 2002 under long drought, drought + midsummer storm, or full irrigation. The autumn-sown reproductive plants of cv. Kasbah were summer dormant under all moisture regimes and exhibited the characteristic traits including growth cessation, rapid herbage senescence, and dehydration of surviving organs (-6.7MPa). Cultivar Kasbah used 8% less soil water over the summer and also began to rehydrate its leaf bases from conserved soil water before the drought broke. The non-dormant cv. Medly grew for 10 days longer under drought and whenever moisture was applied; Medly also responded to the storm with a decline in dehydrin expression in leaf bases, whereas no decline occurred in Kasbah, presumably because it remained dormant and therefore much drier. The irrigated, younger, spring-sown swards of cv. Kasbah had restrained growth and produced only about 25% of the herbage of cv. Medly. Drought reduced activity and growth of young plants of both cultivars, but whereas Medly regrew in response to the storm, cv. Kasbah did not, indicating that dormancy, although only partially expressed after spring sowing, was reinforced by summer drought. A longer drought in 2003 caused a 22% loss of the basal cover in cv. Medly, whereas Kasbah fully maintained its sward and therefore produced a higher post-drought autumn yield. This work confirms summer dormancy as a powerful trait for improving persistence over long, dry summers.

Summer dormancy in Festuca arundinacea Schreb.; the influence of season of sowing and a simulated mid-summer storm on two contrasting cultivars

Due to the shortage of information on summer dormancy in tall fescue (Festuca arundinacea, syn. Lolium arundinaceum), we tested the response of 2 cultivars of differing dormancy expression and growth stage to a range of summer moisture conditions, including full irrigation, drought, and a simulated mid-summer storm and analysed whether traits associated with summer dormancy conferred better survival under severe field drought. Autumn-sown reproductive and younger, spring-sown plants of 2 cultivars, claimed to exhibit contrasting summer dormancy, were established and then tested in summer 2002 under either long drought, drought+ simulated mid-summer storm, or full irrigation. The autumn-sown reproductive plants of cv. Flecha exhibited traits that can be associated with partial summer dormancy since under summer irrigation they reduced aerial growth significantly and exhibited earlier herbage senescence. Moreover, cv. Flecha used 35% less soil water over the first summer. However, the water status of leaf bases of young vegetative tillers of both cultivars was similar under irrigation and also throughout most of the drought (leaf potential and water content maintained over -4MPa and at approx. 1 g H2O/g DM, respectively). The summer-active cv. Demeter did not stop leaf elongation even in drought and produced twice as much biomass as Flecha under irrigation. Cultivar Demeter responded to the simulated storm with a decline in dehydrin expression in leaf bases, whereas no decline occurred in Flecha, presumably because it remained partially dormant. The younger, spring-sown swards of both cultivars had similar biomass production under summer irrigation but whereas Demeter regrew in response to the simulated storm, cv. Flecha did not, indicating that dormancy, although only partially expressed, was reinforced by summer drought. In all trials, cv. Flecha out-yielded Demeter in autumn regrowth. In particular, the severe drought in 2003 caused a 25% loss of the basal cover in cv. Demeter, whereas Flecha fully maintained its sward allowing it to produce a higher post-drought autumn yield. This work links summer dormancy with higher persistence over long, dry summers.

Stem End blockaged in Cut grevillea 'Crimson Yul-lo' inflorescences

Grevillea 'Crimson Yul-lo' inflorescences have cut flower potential, but their vase life is short. End of vase life is characterized by early wilting. The possibility of physiologically mediated stem end blockage was investigated. Hydraulic conductance of 2 cm long stem end segments declined rapidly and remained lower throughout vase life than that of 2 cm long stem segments from immediately above. Recutting daily to remove basal 2 cm stem ends increased solution uptake, delayed declines in inflorescence water potential and water content, and improved inflorescence vase life. S-carvone is a potential inhibitor of wound related suberin formation, via inhibition of phenylalanine ammonia-lyase. Vase solution treatments with S-carvone (0.318 and 0.636 mM) delayed the decline in hydraulic conductance of basal 2 cm long stem end segments and decreases in vase solution uptake and relative fresh weight of cut stems, and extended vase life. Treatments with the catechol oxidase inhibitor 4-hexylresorcinol (2.5-10 mM) also delayed stem end blockage. These findings suggest that stem end blockage in cut G. 'Crimson Yul-lo' stems is physiologically mediated. (C) 2006 Elsevier B.V. All rights reserved.

Using nitrogen stable isotope ratios ( d15N) of macroalgae to monitor changes in the extent of sewage impacts in Moreton Bay, Australia

During the past decade the use of stable isotopes to investigate transport pathways of nutrients in aquatic ecosystems has contributed new understanding and knowledge to many aspects of ecology; from the trophic structure of food webs to the spatial extent of nutrient discharges. At the same time aquatic monitoring programs around the world have become more interested in quantifying ecosystem health rather than simply measuring the physical and chemical properties of water (nutrients, pH, temperature and turbidity). A novel technique was initiated in 1998 as part of the development of the Ecosystem Health Monitoring Program in S.E. Queensland Australia (EHMP) using changes in the 15N value of the red macroalgae Catenella nipae, to indicate regions impacted by sewage nitrogen. Sewage plume mapping, using the 15N of C. nipae, has demonstrated that over the past 5 years there has been a large reduction in the magnitude and spatial extent of 15N enrichment at sites close to sewage treatment plants (STPs) discharging into Moreton Bay. This presentation will discuss how the 15N signatures of the C. nipae in the plume at the mouth of the Brisbane River have declined since it was first sampled in 1998 and will evaluate causes that may be responsible for these variations. A series of laboratory experiments were conducted to investigate how environmental conditions influence the 15N signature of C, nipae over the incubation period. These data will be used to discuss the observed in situ decline in 15N in an attempt to determine if the reduction can be attributed solely to improvements in the wastewater discharge.

Self-reported risk perception, mood and risk behaviour across the human menstrual cycle

Normally ovulating women exhibit a decline in risk behaviours that may lead to sexual assault during the fertile phase of the menstrual cycle, whereas women using the Pill do not. The current study tests two explanatory models: the mood and fertility models. Self-reported risk and non-risk behaviours, mood, and risk perception in sexual assault and physical risk domains were assessed by testing fiftyone women at menstruation and during their fertile period. Based on the decline in risk behaviours shown in past research, the fertility model predicts that normally ovulating women will display greater risk perception during the fertile phase of their cycle. The mood model predicts that at menstruation, when negative mood is highest, risk perception will be increased and risk behaviours correspondingly reduced. Risk behaviours did not vary over the cycle or between groups. Overall, results support the mood model. Negative mood was greater at menstruation and positive mood during the fertile period for both groups, rational risk perception was correspondingly greater at menstruation. The fertility model was not supported as risk perception ratings did not vary in the expected direction and ratings were not specific to the sexual assault domain.

Bernstein's theory of pedagogic discourse: linguistics, educational policy and practice in the UK English/literacy classroom

In “The English Patient: English Grammar and teaching in the Twentieth Century”, Hudson and Walmsley (2005) contens that the decline of grammar in schools was linked to a similar decline in English universities, where no serious research or teaching on English grammar took place. This article argues that such a decline was due not only to a lack of research, but also because it suited educational policies of the time. It applies Bernstein’s theory of pedagogic discourse (1990 & 1996) to the case study of the debate surrounding the introduction of a national curriculum in English in England in the late 1980s and the National Literacy Strategy in the 1990s, to demonstrate the links between academic theory and educational policy.

On the decline of 1st and 2nd order sensitivity with eccentricity

We studied the relationship between the decline in sensitivity that occurs with eccentricity for stimuli of different spatial scale defined by either luminance (LM) or contrast (CM) modulation. We show that the detectability of CM stimuli declines with eccentricity in a spatial frequency-dependent manner, and that the rate of sensitivity decline for CM stimuli is roughly that expected from their 1st order carriers, except, possibly, at finer scales. Using an equivalent noise paradigm, we investigated the possible reasons for why the foveal sensitivity for detecting LM and CM stimuli differs as well as the reason why the detectability of 1st order stimuli declines with eccentricity. We show the former can be modeled by an increase in internal noise whereas the latter involves both an increase in internal noise and a loss of efficiency. To encompass both the threshold and suprathreshold transfer properties of peripheral vision, we propose a model in terms of the contrast gain of the underlying mechanisms.

The National Literacy Strategy and knowledge about language in the English school curriculum

In “The English Patient: English Grammar and teaching in the Twentieth Century”, Hudson and Walmsley (2005) contend that the decline of grammar in schools was linked to a similar decline in English universities, where no serious research or teaching on English grammar took place. This article argues that such a decline was due not only to a lack of research, but also because it suited educational policies of the time. It applies Bernstein’s theory of pedagogic discourse (1990 & 1996) to the case study of the debate surrounding the introduction of a national curriculum in English in England in the late 1980s and the National Literacy Strategy in the 1990s, to demonstrate the links between academic theory and educational policy.

The effect of ageing on macrophage Toll-like receptor-mediated responses in the fight against pathogens

The cellular changes during ageing are incompletely understood yet immune system dysfunction is implicated in the age-related decline in health. The acquired immune system shows a functional decline in ability to respond to new pathogens whereas serum levels of cytokines are elevated with age. Despite these age-associated increases in circulating cytokines, the function of aged macrophages is decreased. Pathogen-associated molecular pattern receptors such as Toll-like receptors (TLRs) are vital in the response of macrophages to pathological stimuli. Here we review the evidence for defective TLR signalling in normal ageing. Gene transcription, protein expression and cell surface expression of members of the TLR family of receptors and co-effector molecules do not show a consistent age-dependent change across model systems. However, there is evidence for impaired downstream signalling events, including inhibition of positive and activation of negative modulators of TLR induced signalling events. In this paper we hypothesize that despite a poor inflammatory response via TLR activation, the ineffective clearance of pathogens by macrophages increases the duration of their activation and contributes to perpetuation of inflammatory responses and ageing.

Visual field and structural alterations in age-related macular degeneration

The thesis investigated progression of the central 10° visual field with structural changes at the macula in a cross-section of patients with varying degrees of agerelated macular degeneration (AMD). The relationships between structure and function were investigated for both standard and short-wavelength automated perimetry (SWAP). Factors known to influence the measure of visual field progression were considered, including the accuracy of the refractive correction on SWAP thresholds and the learning effect. Techniques of assessing the structure to function relationships between fundus images and the visual field were developed with computer programming and evaluated for repeatability. Drusen quantification of fundus photographs and retro-mode scanning laser ophthalmoscopic images was performed. Visual field progression was related to structural changes derived from both manual and automated methods. Principal Findings: • Visual field sensitivity declined with advancing stage of AMD. SWAP showed greater sensitivity to progressive changes than standard perimetry. • Defects were confined to the central 5°. SWAP defects occurred at similar locations but were deeper and wider than corresponding standard perimetry defects. • The central field became less uniform as severity of AMD increased. SWAP visual field indices of focal loss were of more importance when detecting early change in AMD, than indices of diffuse loss. • The decline in visual field sensitivity over stage of severity of AMD was not uniform, whereas a linear relationship was found between the automated measure of drusen area and visual field parameters. • Perimetry exhibited a stronger relationship with drusen area than other measures of visual function. • Overcorrection of the refraction for the working distance in SWAP should be avoided in subjects with insufficient accommodative facility. • The perimetric learning effect in the 10° field did not differ significantly between normal subjects and AMD patients. • Subretinal deposits appeared more numerous in retro-mode imaging than in fundus photography.

Mild cognitive decline. A position statement of the Cognitive Decline Group of the European Innovation Partnership for Active and Healthy Ageing (EIPAHA)

Introduction Mild cognitive impairment (MCI) is a term used to describe a level of decline in cognition which is seen as an intermediate stage between normal ageing and dementia, and which many consider to be a prodromal stage of neurodegeneration that may become dementia. That is, it is perceived as a high risk level of cognitive change. The increasing burden of dementia in our society, but also our increasing understanding of its risk factors and potential interventions, require diligent management of MCI in order to find strategies that produce effective prevention of dementia. Aim To update knowledge regarding mild cognitive impairment, and to bring together and appraise evidence about the main features of clinical interest: definitions, prevalence and stability, risk factors, screening, and management and intervention. Methods Literature review and consensus of expert opinion. Results and conclusion MCI describes a level of impairment in which deteriorating cognitive functions still allow for reasonable independent living, including some compensatory strategies. While there is evidence for some early risk factors, there is still a need to more precisely delineate and distinguish early manifestations of frank dementia from cognitive impairment that is less likely to progress to dementia, and furthermore to develop improved prospective evidence for positive response to intervention. An important limitation derives from the scarcity of studies that take MCI as an endpoint. Strategies for effective management suffer from the same limitation, since most studies have focused on dementia. Behavioural changes may represent the most cost-effective approach.

Impact of liberalization on efficiency and productivity of sugar industry in Kenya

Purpose – The data used in this study is for the period 1980-2000. Almost midway through this period (in 1992), the Kenyan government liberalized the sugar industry and the role of the market increased, while the government's role with respect to control of prices, imports and other aspects in the sector declined. This exposed the local sugar manufacturers to external competition from other sugar producers, especially from the COMESA region. This study aims to find whether there were any changes in efficiency of production between the two periods (pre and post-liberalization). Design/methodology/approach – The study utilized two methodologies to efficiency estimation: data envelopment analysis (DEA) and the stochastic frontier. DEA uses mathematical programming techniques and does not impose any functional form on the data. However, it attributes all deviation from the mean function to inefficiencies. The stochastic frontier utilizes econometric techniques. Findings – The test for structural differences in the two periods does not show any statistically significant differences between the two periods. However, both methodologies show a decline in efficiency levels from 1992, with the lowest period experienced in 1998. From then on, efficiency levels began to increase. Originality/value – To the best of the authors' knowledge, this is the first paper to use both methodologies in the sugar industry in Kenya. It is shown that in industries where the noise (error) term is minimal (such as manufacturing), the DEA and stochastic frontier give similar results.

Midterm to long-term longitudinal outcome of autologous chondrocyte implantation in the knee joint:a multilevel analysis

Background Autologous chondrocyte implantation is a cell therapeutic approach for the treatment of chondral and osteochondral defects in the knee joint. The authors previously reported on the histologic and radiologic outcome of autologous chondrocyte implantation in the short- to midterm, which yields mixed results. Purpose The objective is to report on the clinical outcome of autologous chondrocyte implantation for the knee in the midterm to long term. Study Design Cohort study; Level of evidence, 3. Methods Eighty patients who had undergone autologous chondrocyte implantation of the knee with mid- to long-term follow-up were analyzed. The mean patient age was 34.6 years (standard deviation, 9.1 years), with 63 men and 17 women. Seventy-one patients presented with a focal chondral defect, with a median defect area of 4.1 cm2 and a maximum defect area of 20 cm2. The modified Lysholm score was used as a self-reporting clinical outcome measure to determine the following: (1) What is the typical pattern over time of clinical outcome after autologous chondrocyte implantation; and (2) Which patient-related predictors for the clinical outcome pattern can be used to improve patient selection for autologous chondrocyte implantation? Results The average follow-up time was 5 years (range, 2.7–9.3). Improvement in clinical outcome was found in 65 patients (81%), while 15 patients (19%) showed a decline in outcome. The median preoperative Lysholm score of 54 increased to a median of 78 points. The most rapid improvement in Lysholm score was over the 15-month period after operation, after which the Lysholm score remained constant for up to 9 years. The authors were unable to identify any patient-specific factors (ie, age, gender, defect size, defect location, number of previous operations, preoperative Lysholm score) that could predict the change in clinical outcome in the first 15 months. Conclusion Autologous chondrocyte implantation seems to provide a durable clinical outcome in those patients demonstrating success at 15 months after operation. Comparisons between other outcome measures of autologous chondrocyte implantation should be focused on the clinical status at 15 months after surgery. The patient-reported clinical outcome at 15 months is a major predictor of the mid- to long-term success of autologous chondrocyte implantation.