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Ecosystem-based management of marine fisheries requires the use of simulation modelling to investigate the system-level impact of candidate fisheries management strategies. However, testing of fundamental assumptions such as system structure or process formulations is rarely done. In this study, we compare the output of three different ecosystem models (Atlantis, Ecopath with Ecosim, and OSMOSE) applied to the same ecosystem (the southern Benguela), to explore which ecosystem effects of fishing are most sensitive to model uncertainty. We subjected the models to two contrasting fishing pressure scenarios, applying high fishing pressure to either small pelagic fish or to adult hake. We compared the resulting model behaviour at a system level, and also at the level of model groups. We analysed the outputs in terms of various commonly used ecosystem indicators, and found some similarities in the overall behaviour of the models, despite major differences in model formulation and assumptions. Direction of change in system-level indicators was consistent for all models under the hake pressure scenario, although discrepancies emerged under the small-pelagic-fish scenario. Studying biomass response of individual model groups was key to understanding more integrated system-level metrics. All three models are based on existing knowledge of the system, and the convergence of model results increases confidence in the robustness of the model outputs. Points of divergence in the model results suggest important areas of future study. The use of feeding guilds to provide indicators for fish species at an aggregated level was explored, and proved to be an interesting alternative to aggregation by trophic level. [ABSTRACT FROM AUTHOR]

Background: The assessment of social anxiety in late life has been examined in few studies (e.g. Gretarsdottir et al., 2004; Ciliberti et al., 2011). The present study describes the creation and initial psychometric evaluation of a new, content valid measure of social anxiety for older adults, the Older Adult Social-Evaluative Situations Questionnaire (OASES).Methods: Psychometric properties of the OASES were evaluated in a community dwelling sample of older adults (N = 137; 70.8% female). Convergent validity was established by examining the relation between the OASES and the Liebowitz Social Anxiety Scale (LSAS), Social Phobia and Anxiety Inventory (SPAI), and Beck Anxiety Inventory (BAI). Discriminant validity was established by examining the relation between the OASES and measures of depression (Geriatric Depression Scale, GDS), perceived health status (Short Form Health Survey, SF-12), and demographic variables. The validity analyses of the OASES were based on a smaller sample with n values ranging from 98 to 137 depending on missing data on each questionnaire.Results: Internal consistency, measured by Cronbach's α, for the OASES total score was 0.96. All items on the OASES were endorsed by participants. Convergent validity was demonstrated by medium to large correlations with the SPAI, LSAS, and BAI. Support for discriminant validity was evidenced by small to medium correlations between the OASES and GDS, SF-12, and demographic variables.Conclusions: Evidence in support of convergent and discriminant validity of the OASES is discussed. Although the results from the present study suggest that this measure may assess anxiety in and avoidance of social situations salient to older adults, future studies are needed to further examine the psychometric properties of the OASES and replicate these results in both clinical and more diverse samples of older adults. [ABSTRACT FROM AUTHOR]

This study explores the usefulness of a frame-based modelling approach in the southern Benguela upwelling ecosystem, with four frames describing observed small pelagic fish dominance patterns. We modelled the dynamics of sardine Sardinops sagax and anchovy Engraulis encrasicolus populations under the influence of the small pelagic fishery and climate variability, performed extensive sensitivity analyses and exercised the model prototype in scenarios based on realistic management objectives. Model outputs were seen to roughly parallel observed dynamics. Frame dynamics were reasonably sensitive to frame switching rules. Reduced sardine recruitment in the 'low' frames had a strong negative impact on stock recovery, and bycatch of juvenile sardine from the modelled anchovy fishery could also greatly impair sardine recovery. Specific tests included exploring the robustness of fisheries management strategies under highly stochastic recruitment and uncertainty around long-term environmental forcing. The respective frame of the model is suggested as a composite indicator of ecosystem state. The model approach shows promise for evaluating small pelagic fisheries management strategies in an ecosystem context incorporating long-term environmental variability. [ABSTRACT FROM AUTHOR]

Introduction of pneumococcal conjugate and polysaccharide vaccines into the United Kingdom's routine immunization programmes is expected to change the epidemiology of invasive pneumococcal disease (IPD). We have documented the epidemiology of IPD in an English region (South West) with high-quality surveillance data before these programmes were established. We analysed data on isolates of Streptococcus pneumoniae from blood and CSF between 1996 and 2005 from microbiology laboratories in the South West that were reported and/or referred for serotyping to the Health Protection Agency Centre for Infections. The mean annual incidence of IPD increased from 11.2/100 000 in 1996 to 13.6/100 000 in 2005 (P<0.04). After adjusting for annual blood-culture sampling rates in hospitals serving the same catchment populations, an increase in annual incidence of IPD was no longer observed (P=1.0). Variation in overall incidence between laboratories could also be explained by variation in blood culture rates. The proportion of disease caused by serotypes 6B, 9V and 14 decreased significantly (P=0.001, P=0.007, and P=0.027 respectively) whereas that caused by serotype 4, 7F and 1 increased (P=0.001, P=0.003, and P<0.001 respectively) between 2000 and 2005. The level of penicillin non-susceptibility and resistance to erythromycin remained stable (2% and 12% respectively). This study provides an important baseline to assess the impact of changing vaccination programmes on the epidemiology of IPD, thus informing future use of pneumococcal vaccines. [ABSTRACT FROM AUTHOR]

OBJECTIVE: CCR2 is a chemokine receptor expressed by monocytes, macrophages, and a subset of T cells. Its ligand, CCL2 (monocyte chemotactic protein 1), is abundantly present in the synovium of patients with rheumatoid arthritis (RA). Blocking CCR2 prevents CCL2-mediated chemotaxis in vitro and modulates arthritis in animal models of RA. In this study we examined the effects of CCR2 blockade on synovial inflammation in RA. METHODS: The study was designed as a phase IIa clinical trial with a human CCR2 blocking antibody (MLN1202) in patients with active RA. Thirty-two patients received 3 infusions, over a period of 6 weeks, with either placebo (n = 9) or anti-CCR2 monoclonal antibody at 0.5 mg/kg (n = 7), 1.5 mg/kg (n = 7), or 4.0 mg/kg (n = 9). Safety was monitored with laboratory tests, immunotoxicity assessments, and documenting of adverse events, and European League Against Rheumatism and American College of Rheumatology response criteria were used to assess clinical improvement. Synovial tissue was obtained at baseline and after 43 days of treatment, for pharmacodynamic analysis using immunohistochemistry and digital image analysis. The Kruskal-Wallis test was used to compare groups, and the Wilcoxon signed rank test was used to assess changes within the groups. RESULTS: All patients completed the study. Treatment with CCR2 blocking antibody reduced the levels of free CCR2 on CD14+ monocytes by at least 57% and up to 94% (P < 0.001), demonstrating the biologic activity of the compound. However, there was no reduction in the levels or expression of any of the synovial biomarkers. Accordingly, no clinical improvement was observed. CONCLUSION: Treatment with anti-CCR2 blocking antibody did not result in amelioration of synovial inflammation in active RA. The results do not support the notion that blockade of CCR2 may be sufficient to induce clinical improvement in RA. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The transforming growth factor beta superfamily member macrophage inhibitory cytokine 1 (MIC-1) is expressed upon macrophage activation, regulated by the p53 pathway, and linked to clinical events in atherosclerosis and cancer. Since rheumatoid arthritis (RA) shares similar etiopathologic mechanisms with the above diseases, we sought to determine the clinical utility of determining MIC-1 serum levels and MIC-1 genotype in the management of RA. METHODS: Ninety-one RA patients were recruited. Serum was collected from 83 of these patients and synovial biopsy samples were collected from the remaining 8 patients. Of the 83 patients from whom serum was collected, 61 were treated on an outpatient basis (defined as having nonsevere disease), and 22 patients went on to undergo hemopoietic stem cell transplantation (HSCT) (defined as having severe disease). RESULTS: Serum levels of MIC-1 were higher in RA patients and reflected disease severity independently of classic disease markers. MIC-1 was detected in rheumatoid synovial specimens, and allelic variation of MIC-1 was associated with earlier erosive disease and severe treatment-resistant chronic RA. Additionally, algorithms including serum and/or allelic variation in MIC-1 predicted response to HSCT, the presence of severe disease, and joint erosions. CONCLUSION: Determination of serum levels of MIC-1 and MIC-1 genotype may be clinically useful in the management of RA as well as in selection of patients for HSCT, since they predict disease course and response to therapy. The data indicate a potential role for MIC-1 in RA pathogenesis. These results warrant larger prospective studies to fully delineate and confirm a role for MIC-1 genotyping and serum estimation in patient selection for HSCT and in the management of RA. [ABSTRACT FROM AUTHOR]

Background: Historically, medical students learned the art and science of medicine from the patients they encountered. While students were highly motivated to learn through this approach, the serendipitous nature of real practice and the variability in the skills of their teachers proved to be liabilities for learning. This apprenticeship-style education was replaced by a more formal didactic curriculum during the twentieth century. Description: The power of computer technology enables medical educators to recapture the authenticity of patient-centred learning (PCL) through the creation of a virtual practice populated by a panel of virtual patients. In contrast to traditional problem-based learning cases, PCL virtual patients return for multiple visits with their student-doctors, demonstrating how diseases change over time, interact with other diseases and risk factors, and are influenced by psychosocial factors. Conclusions: New approaches to pedagogy embodied in patient-centred learning allow the curriculum to be organized around the patients, both real and simulated. [ABSTRACT FROM AUTHOR]

OBJECTIVE. Following the demonstration that the stress protein, BiP, prevented induction of collagen-induced arthritis (CIA) in HLA-DRB*0101(+/+) (HLA-DR1(+/+)) mice, we investigated the immunotherapeutic ability of BiP to suppress disease during the active phase of CIA in HLA-DR1(+/+) and DBA/1 mice. METHODS: BiP was administered either subcutaneously or intravenously to DBA/1, HLA-DR1(+/+), or interleukin-4 (IL-4)-knockout mice at the onset of arthritis. Immune cells were used in adoptive transfer studies or were restimulated in culture with BiP or type II collagen (CII). Proliferation and cytokine release were measured. In addition, serum anti-CII antibodies were measured by enzyme-linked immunosorbent assay. Disease progression was scored using a visual analog scale. RESULTS: BiP was successful in suppressing established CIA in HLA-DR1(+/+) and DBA/1 mice. Serum levels of anticollagen IgG antibodies were reduced in BiP-treated mice. T cells from BiP-immunized mice produced Th2 cytokines, in particular, IL-4. Treatment with BiP was also shown to increase the production of CII-specific IL-5, IL-10, and interferon-gamma at the termination of the study. Development of severe CIA was prevented by the intravenous transfer of BiP-specific cells at the time of CIA induction in HLA-DR1(+/+) mice or by transferring BiP-specific cells to DBA/1 mice at the onset of disease. BiP failed to ameliorate the development of CIA in IL-4(-/-), HLA-DR1(+/+) mice. CONCLUSION: These novel results show that BiP can suppress active CIA by the induction of regulatory cells that act predominantly via IL-4. Thus, BiP is a potential immunotherapeutic agent for the treatment of patients with rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

The removal of heavy metals from storm and surface waters by slow sand filtration is described. The importance of speciation as a technique for exploring and improving the mechanisms of removal is identified. Laboratory-scale slow sand filters operating at conventional flow rate and depth were shown to be able to reduce concentrations of selected heavy metals (Cu, Cr, Pb and Cd) found in road runoff, surface water and sewage effluents to drinking water standard. Nitrogen, volatile solids and modified Stover speciation were used to differentiate between the potential mechanisms of removal, i.e. active biomass, organic adsorption and simple adsorption or precipitation on the surface of the sand. The data presented show that adsorption via organic ligands was the predominant mechanism for metal removal at the surface of the filter but chemical adsorption was the more important deeper in the filter. In the lower layers the adsorbed metals were more easily exchanged than the organically bound metals. The precise chemical ligands were not identified and varied from metal to metal. The most important operational factors affecting performance were therefore the concentration of organic matter, filter depth and the flow velocity. [ABSTRACT FROM AUTHOR]

An HIV knowledge survey and qualitative interview were administered to 20 case managers in community-based programs for troubled youth to assess HIV knowledge and their perception of client HIV risk behaviors. Participants had good HIV knowledge. Case managers perceived client youth to be at high risk for HIV infection due to unsafe sexual practices, survival sex, vulnerability to victimization, and homelessness. Teenaged girls were seen as being at higher risk than teenage boys. Clients with stable placements and involved caregivers were deemed at lower risk due to increased emotional and behavioral support. Few case managers provided HIV prevention services due to strained resources, insufficient training, and difficulty talking about sexuality. Implications for prevention are discussed. [ABSTRACT FROM AUTHOR]

Parent training is often used to treat non-compliance and social problems in Attention Deficit Hyperactivity Disorder. Smith and Barrett (2000) found that a parent training intervention led to improved compliance and core ADHD symptoms in 3 school-aged girls. The current study extended findings from Smith and Barrett (2000) by directly examining changes in hyperactivity and inattentiveness in the same 3 girls. Five child behaviors indexing inattention and hyperactivity were assessed from home observations of parent-child interactions made before, during, and after the parent training program. Body Fidgeting (gross motor movements and leaving one's seat) declined significantly. It was the only child behavior variable correlated with parent reports of attention, behavior, and emotional problems on the Child Behavior Checklist. Off-Task behaviors grew worse over the course of parent training. Such findings suggest that parent training programs may narrowly focus on overt behaviors at the expense of other symptoms. Further, it may be that increasing parent intervention with some child behaviors (e.g., fidgeting) reduces the family's ability to manage other ADHD-related problems (e.g., inattention). [ABSTRACT FROM AUTHOR]

Despite improvements in hemodialyzers with respect to their clearance of middle and high molecular mass molecules, accumulation of specific solutes in the circulation of dialysis patients continues to be a medical problem. A new membrane material, polyester-polymer alloy (PEPA) which has been developed to have a filtration profile akin to that of the natural kidney, is now being used in hemodialyzers. This study evaluates the performance of a PEPA-based hemodialyzer alongside a selection of available competing high-flux dialyzers using official standardized methods. The new membrane material appears to be a viable alternative which offers performance at least as good as that of the competition. The promising results obtained with the PEPA membrane suggest that a detailed clinical performance study should be undertaken. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: A multicenter, randomized, double-blind, placebo-controlled, flexible-dose, two-way crossover study conducted June 1996 through January 1997. OBJECTIVES: To evaluate the effect of sildenafil citrate (VIAGRA(R)) on the quality of life (QoL) of men with erectile dysfunction (ED) caused by spinal cord injury (SCI). SETTING: Study centers in Australia, Belgium, France, Germany, Norway, Sweden and the United Kingdom. METHODS: Questions 13 and 14 of the 15-item International Index of Erectile Function (IIEF) addressed QoL issues directly related to ED in 178 men with SCI. A 5-item questionnaire addressing concerns that men had about their erection problems was also used to evaluate the impact of ED on QoL. Several commonly used psychometric instruments, including the Medical Outcomes Survey (MOS) Short Form-12, Psychological General Well-Being Index, and MOS Family Survey, assessed general QoL issues. RESULTS: Significant improvements were seen for overall satisfaction with sex life (IIEF Q13), sexual relationship with partner (IIEF Q14), and concerns about erectile problems (P<0.0001). Improvements were reported in scores for the generic QoL parameters of mental health, well-being, depression, and anxiety (P<0.05 sildenafil versus placebo). CONCLUSION: Treatment with sildenafil can significantly improve key QoL parameters in men with ED caused by SCI. Sponsorship: This study was funded by Pfizer Inc. [ABSTRACT FROM AUTHOR]

Context: Erectile dysfunction is common in men with diabetes.Objective: To assess the efficacy and safety of oral sildenafil citrate in the treatment of erectile dysfunction in men with diabetes.Design: A multicenter, randomized, double-blind, placebo-controlled, flexible dose-escalation study conducted May through November 1996.Setting: Patients' homes and 19 clinical practice centers in the United States.Patients: A total of 268 men (mean age, 57 years) with erectile dysfunction (mean duration, 5.6 years) and diabetes (mean duration, 12 years).Interventions: Patients were randomized to receive sildenafil (n = 136) or placebo (n = 132) as needed, but not more than once daily, for 12 weeks. Patients took the study drug or placebo 1 hour before anticipated sexual activity. The starting dose of sildenafil citrate was 50 mg, with the option to adjust the dose to 100 mg or 25 mg based on efficacy and tolerability, to be taken as needed.Main Outcome Measures: Self-reported ability to achieve and maintain an erection for sexual intercourse according to the International Index of Erectile Function and adverse events.Results: Two hundred fifty-two patients (94%) completed the study (131/136 in the sildenafil group, 121/132 in the placebo group). By intention-to-treat analysis, at 12 weeks, 74 (56%) of 131 patients in the sildenafil group reported improved erections compared with 13 (10%) of 127 patients in the placebo group (P<.001). The proportion of men with at least 1 successful attempt at sexual intercourse was 61 % (71/ 117) for the sildenafil group vs 22% (25/114) for the placebo group (P<.001). Adverse events related to treatment were reported for 22 (16%) of 136 patients taking sildenafil and 1 (1%) of 132 patients receiving placebo. The most common adverse events were headache (11% sildenafil, 2% placebo), dyspepsia (9% sildenafil, 0% placebo), and respiratory tract disorder (6% sildenafil, 2% placebo), predominantly sinus congestion or drainage. The incidence of cardiovascular adverse events was comparable for both groups (3% sildenafil, 5% placebo).Conclusion: Oral sildenafil is an effective and well-tolerated treatment for erectile dysfunction in men with diabetes. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: This was a two-part pilot study in men with erectile dysfunction (ED) due to spinal cord injury (SCI: cord level range T6-L5). Part I was a randomised, double-blind, two-way cross-over study comparing a single dose of sildenafil 50 mg or placebo. Part II was a randomised, double-blind, parallel-group evaluation of sildenafil 50 mg or placebo, taken as required (not more than once daily) approximately 1 h prior to sexual activity, over a period of 28 days. OBJECTIVES: To assay the efficacy and safety of sildenafil 50 mg and placebo. SETTING: Clinic- and home-based assessments in the United Kingdom. METHODS: A total of 27 subjects who were able to achieve at least a grade 2 erection (hard, but not hard enough for penetration) in response to penile vibratory stimulation (PVS) were recruited. In Part I, the reflexogenic response of the penis to PVS was evaluated in the clinic while in Part II, the response to treatment was assessed in the home (global efficacy. questionniare, diary). RESULTS: In Part I, 17/26 (65%) subjects had erections of >60% rigidity at the penile base (median duration 3.5 min) after sildenafil compared with 2/26 (8%) (median duration 0 min) alter placebo (P=0.0003). In Part II, 9/12 (75%) subjects on sildenafil and 1/14 (7%) subjects on placebo reported that the treatment had improved their erections (P<0.005), and 8/12 (67%) and 2/13 (15%) men, respectively, indicated that they wished to continue treatment (P<0.02). An analysis of diary data showed no difference between the groups with respect to the mean number of erections hard enough for penetration (P = 0.08). The mean proportion of attempts at sexual intercourse that were successful was 30 and 15%, respectively (P=0.21). Similarly, responses to the end-of-treatment questionnaire indicated that there were no significant differences between the groups with respect to the frequency of erections hard enough for sexual intercourse (P=0.47) or that lasted as long as the subject would have liked (P=0.11). No subject discontinued sildenafil due to adverse events. CONCLUSION: Sildenafil is an effective, well-tolerated oral treatment for ED in SCI subjects. [ABSTRACT FROM AUTHOR]

Percutaneous large core needle biopsy of the breast is recognized as an important tool in the current management of breast disease. This technique is safe, accurate, and has a very low complication rate. We present a rare complication of a pseudoaneurysm after large core needle biospy of the breast, diagnosed by means of ultrasound and color Doppler examination. Pathophysiologic characterestics, diagnosis, treatment options, and potential prevention of this complication are discussed. [ABSTRACT FROM AUTHOR]

Investigated facilitated communication with 10 adults with autism, and specifically examined the effects of facilitator influence and level of assistance as a function of facilitator knowledge of experimental stimuli. Six men and four women with autism served as subjects, ranging in age from 14 years to 51 years of age. Each subject had 6 experimental sessions, 2 with no help, 2 with partial assistance, and 2 with full assistance. Within each session, the facilitator had knowledge of the experimental stimuli in one half of the trials. Results revealed no cases of correct responding independent of facilitator knowledge of correct answers. Additionally, facilitator control was apparent in numerous cases in which typed output matched stimuli to which the facilitator, not the subject, had been exposed. Results suggest that clinical and educational use of the procedure should be curtailed pending further experimental investigation. [ABSTRACT FROM AUTHOR]

The article offers information on the 7th International Symposium on Pediatric Pain (ISPP) to be held in Vancouver, Canada during June 25-29, 2006, the Canadian Pain Society Conference to be held during June 14-17, 2006 and the 48th Annual Scientific Meeting to be held in Los Angeles, California during June 22-25, 2006.

A 56-year-old man with a history of rheumatoid arthritis presented with a 2-day history of worsening pain in his left foot. Treatment with high-dose steroids was of no benefit, hence a diagnosis of septic arthritis was considered. However, the patient's condition deteriorated despite empirical antibiotic therapy. Following persistent investigation, the cause was identified as a fastidious Legionella longbeachae infection, and appropriate antibiotic therapy led to complete resolution of the sepsis. This emphasises the importance of considering infections with atypical organisms in patients on immunosuppressive therapy. [ABSTRACT FROM AUTHOR]