Search

Self-care is essential in the long-term management of chronic heart failure. Heart failure guidelines stress the importance of patient education on treatment adherence, lifestyle changes, symptom monitoring and adequate response to possible deterioration. Self-care is related to medical and person-centred outcomes in patients with heart failure such as better quality of life as well as lower mortality and readmission rates. Although guidelines give general direction for self-care advice, health care professionals working with patients with heart failure need more specific recommendations. The aim of the management recommendations in this paper is to provide practical advice for health professionals delivering care to patients with heart failure. Recommendations for nutrition, physical activity, medication adherence, psychological status, sleep, leisure and travel, smoking, immunization and preventing infections, symptom monitoring, and symptom management are consistent with information from guidelines, expert consensus documents, recent evidence and expert opinion. Jaarsma, T (corresponding author), Univ Linkoping, Fac Hlth Sci, Kungsgatan 40, S-60174 Norrkoping, Sweden. tiny.jaarsma@liu.se

The co‐occurrence of cancer and heart failure (HF) represents a significant clinical drawback as each disease interferes with the treatment of the other. In addition to shared risk factors, a growing body of experimental and clinical evidence reveals numerous commonalities in the biology underlying both pathologies. Inflammation emerges as a common hallmark for both diseases as it contributes to the initiation and progression of both HF and cancer. Under stress, malignant and cardiac cells change their metabolic preferences to survive, which makes these metabolic derangements a great basis to develop intersection strategies and therapies to combat both diseases. Furthermore, genetic predisposition and clonal haematopoiesis are common drivers for both conditions and they hold great clinical relevance in the context of personalized medicine. Additionally, altered angiogenesis is a common hallmark for failing hearts and tumours and represents a promising substrate to target in both diseases. Cardiac cells and malignant cells interact with their surrounding environment called stroma. This interaction mediates the progression of the two pathologies and understanding the structure and function of each stromal component may pave the way for innovative therapeutic strategies and improved outcomes in patients. The interdisciplinary collaboration between cardiologists and oncologists is essential to establish unified guidelines. To this aim, pre‐clinical models that mimic the human situation, where both pathologies coexist, are needed to understand all the aspects of the bidirectional relationship between cancer and HF. Finally, adequately powered clinical studies, including patients from all ages, and men and women, with proper adjudication of both cancer and cardiovascular endpoints, are essential to accurately study these two pathologies at the same time., We describe the co‐occurrence of cancer and heart failure (HF), their potential shared risk factors, and their pathophysiological mechanisms. We advocate intense interaction between cardiologists and oncologists to achieve unifying hypotheses and collaborative pre‐clinical and clinical studies.

Diabetes and metabolic syndrome are associated with the typical American high glycemia diet and result in accumulation of high levels of advanced glycation end products (AGEs), particularly upon aging. AGEs form when sugars or their metabolites react with proteins. Associated with a myriad of age‐related diseases, AGEs accumulate in many tissues and are cytotoxic. To date, efforts to limit glycation pharmacologically have failed in human trials. Thus, it is crucial to identify systems that remove AGEs, but such research is scanty. Here, we determined if and how AGEs might be cleared by autophagy. Our in vivo mouse and C. elegans models, in which we altered proteolysis or glycative burden, as well as experiments in five types of cells, revealed more than six criteria indicating that p62‐dependent autophagy is a conserved pathway that plays a critical role in the removal of AGEs. Activation of autophagic removal of AGEs requires p62, and blocking this pathway results in accumulation of AGEs and compromised viability. Deficiency of p62 accelerates accumulation of AGEs in soluble and insoluble fractions. p62 itself is subject to glycative inactivation and accumulates as high mass species. Accumulation of p62 in retinal pigment epithelium is reversed by switching to a lower glycemia diet. Since diminution of glycative damage is associated with reduced risk for age‐related diseases, including age‐related macular degeneration, cardiovascular disease, diabetes, Alzheimer's, and Parkinson's, discovery of methods to limit AGEs or enhance p62‐dependent autophagy offers novel potential therapeutic targets to treat AGEs‐related pathologies., AGEs are toxic compounds formed by non‐enzymatic reactions between sugars and proteins. AGEs are prone to aggregate. Insoluble AGEs are efficiently removed via p62‐selective autophagy. The autophagic removal of AGEs is a conserved pathway, and the lack of p62 leads to accumulation of toxic AGEs in mouse and worms. Enhanced autophagy is protective against glycation‐derived damage. p62‐dependent autophagy offers novel potential therapeutic targets to treat AGEs‐related pathologies.

Purpose To explore the strategies used by older people living in Ireland to obtain information about community health and social services. Methods A qualitative exploratory design was used. Focus groups (n = 3) were conducted with community dwelling older people (n = 17). A series of vignettes were used to guide discussion regarding hypothetical situations that approximated real-life scenarios for older people. Data were transcribed verbatim and analysed using content analysis. Results Obtaining information about community health and social services is an ongoing process that requires continuous commitment by older adults. Key strategies which emerged from the data included (i) taking a proactive stance towards accessing health information, (ii) making use of personal networks in your community and (iii) developing ‘insider’ knowledge. Conclusion Older people in this study had a proactive approach to obtaining health information and identified the importance of taking responsibility for managing their own needs. Despite this, obtaining basic information about community health and social services was a challenging and time-consuming process. Future research should focus on developing health literacy interventions that build upon and expand the strategies currently used by older people.

In the crystal structure of the title compound, [WCl(2)(NO)(C(6)H(16)P(2))(2)]Cl, the seven-coordinated tungsten(II) center displays a distorted penta-gonal-bipyramidal geometry with trans nitrosyl and chloride ligands. The NO and Cl ligands are disordered over two positions; the site occupancy factors are 0.6 and 0.4.

An evidence-based (EB) approach has been a significant driver in reforming healthcare over the past two decades. This change has extended across a broad range of health professions, including oral healthcare. A key element in achieving an EB approach to oral healthcare is educating our practitioners, both current and future. This involves providing opportunities integrated within simulated and actual clinical settings for practitioners to learn and apply the principles and processes of evidence-based oral healthcare (EBOHC). Therefore, the focus of this discussion will be on ways in which EBOHC and associated research activities can be implemented into curricula, with the aim of improving patient care. This paper will initially define the scope of EBOHC and research, what these involve, why they are important, and issues that we need to manage when implementing EBOHC. This will be followed by a discussion of factors that enable successful implementation of EBOHC and research into curricula. The paper concludes with suggestions on the future of EBOHC and research in curricula.Key recommendations related to curricula include strengthening of the culture of a scientific approach to education and oral healthcare provision; complete integration of EBOHC into the curriculum at all levels; and faculty development to implement EBOHC based on their needs and evidence of effective approaches. Key recommendations to support implementation and maintenance of EBOHC include recognition and funding for high-quality systematic reviews and development of associated methodologies relevant for global environments; building global capacity of EBOHC researchers; research into improving translation of effective interventions into education and healthcare practice, including patient-reported outcomes, safety and harms, understanding and incorporation of patient values into EB decision-making, economic evaluation research specific to oral healthcare and effective methods for changing practitioner (faculty) behaviours; and extend access to synthesized research in 'user friendly' formats and languages tailored to meet users' needs. Realizing these recommendations may help to improve access to effective healthcare as a basic human right.

The aim of this paper is thus to identify, evluate, and summarize in a systematic fashion all the epidemiological studies that have analyzed the association between exposure to specific indoor air pollutants and respiratory disease among children under the age of five. A search was carried out in the main biomedical bibliographica sources in December 2006 and updated in February 2008. The study period covered 12 years (1996-2007). All the selected papers were carefully read. We focused on studies that analyzed at least one indicator of respiratory health and which included one or more indoor air pollutants in relation to the respiratory health of children under the age of 5. Studies that analyzed passive smoking as the sole source of indoor air pollution were not included. Fourteen studies were considered to be relevant. The most analyzed pollutant was nitrogen dioxide, followed by volative organic compounds, airborne particulates and other pollutants; phthalates and CO2. The literature reviewed within our criteria seems to indicate that several indoor pollutants, even at the moderate levels found in the developed countries, could be harmful to the respiratory health of very young children. Future research should focus on conducting more studies, preferably making use of cohorts, with adequate techniques for measuring indooor pollution levels. Pediatr Pulmonol. 2009; 44:231-243. (C) 2009 Wiley-Liss, Inc.

The US Community Mental Health Act of 1963 led to a deinstitutionalization process which proved to be a mixed failure, particularly when community ser- vices were not available in the catchment areas. Ten years later, John Talbott 1 reported that hospital readmission or “revolving door” was a significant problem and that nearly half of it could be prevented with minor improvements of existing services. In spite of this early evidence, “revolving door” effects followed psychiatric reforms in many countries. Thirty years later, Talbott published the “ten commandments” of community mental health care, and summarized the reasons for the problems created by deinstitutionalization in four main factors: lack of consensus about the movement, no real testing of its philosophic bases, the lack of planning for alternative facil- ities and services, and the inadequacies of the mental health delivery system 2. The paper by Thornicroft et al uses an expert knowledge approach to frame community care on common sense and to describe ten key challenges to implement it and to improve balance of care. The paper is mainly focused on the challenges of care reform at individual ser- vices (microlevel). A number of comments may be added to better understand the current trends of decision making and planning at the upper side of the Thornicroft and Tansella matrix 3: the regio- nal or national care system (macro-level). Mental health care in the real world performs as a complex environmental system characterized by multidisciplinarity, high dimensionality with ill-structured and nonlinear domains, and high uncertainty with heterogeneity of data and imprecise information 4,5. Complex care systems demonstrate other identifiable characteristics such as embeddedness, self-organization, or unpredictability. Under these conditions, evidence cannot be generated using the designs and statistical methods of evidence-based medicine. New health technology assessment tools include outcomes management, decision support systems and knowledge discovery from data (KDD). KDD is a hybrid of statistics and artificial intelligence which incorporates implicit expert knowledge into the data analysis. In the analysis of complex systems, expert opinion is not a source of bias but a key component of the knowledge management and the development of mathematical models. Thus, experience is incorporated into evidence-base mental health care planning 5. The classical debate between hospital and community psychiatry is already closed. Todaýs mounting evidence delivers a simple and clear message: traditional psychiatric hospitals are part of an outdated system of service provision which should be abandoned or entirely transformed. Although failures exist and they replicate at a stubborn pace, psychiatric hospitals have been successfully closed in several countries or regions, whilst in other areas these services have been changed into integrated health care systems 6. On the other hand, the closure of a psychiatric hospital produces similar social resistance and unrest as any other service in obsolete economic sectors, particularly when the hospital is a major source of employment in what are often isolated communities 7. Surprisingly the staffs needs and the social dynamics are not handled in a similar way to other economic sectors. Involving other ministries or national agencies may favour deinstitutionalization in middle income countries. As Thornicroft et al put it forward, the reform of psychiatric hospitals should be led by experience and common sense as much as by values. Bulgaria and other Eastern European countries provide a good example of the complexities of hospital reform. Criticism raised against the World Bank policy to fund “improvement” of the Bulgarian psychiatric hospitals confronts the reality of emergency crisis and human rights of people living in these institutions. The balance of care approach may facilitate a better appreciation of these problems. Classical community psychiatry put major emphasis on closing psychiatric hospitals and on developing specialized community services, mainly residential and intermediate care for severe mental illness. During the last years, a new balance of care model is providing a broader view of the mental health system. Person-centered approaches and longitudinal perspectives are key to this new framework. It takes into consideration the equilibrium between residential and community care, primary and specialized care, or health, social and forensic care within an integrated (multi-sectoral) approach to the delivery of services 7. A special focus is provided on the transitional arrangements needed during the process of re-balancing care for people with mental health problems, or on the outputs at later stages of this process. For example, re-institutionalization has been identified as a worrying trend of well developed community care systems in Western Europe 8. To date, mental health systems have been extensively described by system characteristics, macro indicators of system development and the specific focus on deinstitutionalization and community psychiatry. However, little information has been provided on the financing of mental health systems until very recently. Care financing studies are concerned with the flow of expenditure throughout the care system. The Mental Health Economics European Network has described the financing systems of 17 European countries and identified commonalities and differences 9. A thorough information on the financing system of a number of these countries have been published separately 10,11. Assessing and comparing financing systems represents a “follow the money” approach which may provide a more accurate information on the care system than other traditional description methods. The World Health Organization has also provided a framework to produce standard reports on mental health financing (including pooling, context, mapping, resource base, allocation, budgeting, purchasing, and financing analysis). Financing is a main policy tool to lead mental health reforms 12,13.

While some papers report an increased risk of COVID-19 and worse outcomes1 in oncological patients, others have found no differences2 . We are not aware of studies assessing risk for COVID-19 and clinical outcomes of patients with Primary Cutaneous Lymphomas (PCL).

Vascular malformations (VMs) of the central nervous system (CNS) include a wide range of pathological conditions related to intra and extracranial vessel abnormalities. Although some VMs show typical neuroimaging features, other VMs share and overlap pathological and neuroimaging features that hinder an accurate differentiation between them. Hence, it is not uncommon to misclassify different types of VMs under the general heading of arteriovenous malformations. Thorough knowledge of the imaging findings of each type of VM is mandatory to avoid these inaccuracies. Conventional MRI sequences, including MR angiography, have allowed the evaluation of CNS VMs without using ionizing radiation. Newer MRI techniques, such as susceptibility-weighted imaging, black blood sequences, arterial spin labeling, and 4D flow imaging, have an added value of providing physiopathological data in real time regarding the hemodynamics of VMs. Beyond MR images, new insights using 3D printed models are being incorporated as part of the armamentarium for a noninvasive evaluation of VMs. In this paper, we briefly review the pathophysiology of CNS VMs, focusing on the MRI findings that may be helpful to differentiate them. We discuss the role of each conventional and advanced MRI sequence for VMs assessment and provide some insights about the value of structured reports of 3D printing to evaluate VMs.

INTRODUCTION: This systematic review examines whether individualised gonadotropin dosing in in-vitro fertilisation (IVF) leads to better outcomes with respect to safety, costs and live birth rates compared to standard dosing. MATERIAL AND METHODS: Electronic databases searched were PubMed, Embase and Cochrane. The primary outcome was live birth rate. The secondary outcomes included pregnancy rate, costs and safety. Papers were critically appraised by two reviewers. RESULTS: A total of 7,022 articles were retrieved and assessed for eligibility, of which seven randomised controlled trials were selected. All studies used gonadotropin releasing hormone agonist co-treatment. Clinical and methodological heterogeneity was present, so data could not be pooled for meta-analysis. Only one study, that mainly included women with a good prognosis, revealed an increased chance of ongoing pregnancy in the individualised dosing group compared to standard treatment. With respect to safety, individualised dosing might reduce the occurrence of hyper response and ovarian hyperstimulation syndrome, without affecting the outcome of pregnancy. In predicted poor responders higher than standard dosages do not reduce the incidence of poor response. A cost-efficacy analysis was not performed in any of the studies included. CONCLUSION: It is currently not possible to conclude whether individualised dosing leads to higher pregnancy or live birth rates as compared to standard dosing, since evidence from well-designed studies that are adequately powered for one of these outcomes is lacking. So, large well-designed studies that evaluate the impact of individualised dosing on live birth rates are needed to assess whether individualised dosing should become the standard in IVF practice. This article is protected by copyright. All rights reserved.

Between January and June 2013, nine stillborn bovine foetuses with congenital malformations from nine cattle herds located in Salamanca (central Spain) were detected. Necropsy was performed on two calves. Pathological lesions together with molecular genetics and serological results allowed a definitive diagnosis: first confirmation of Schmallenberg virus (SBV) infection in cattle in Spain. SBV was detected in different tissues and organic fluids in both animals including blood, suggesting a possible viraemia. The umbilical cord was also positive for the presence of SBV in both animals. The former tissue provides an easy to obtain sample and might be a sample of choice when necropsy is carried out in the field., This paper was partially funded by a Grant from INIA-RTA2011-00010-00-00 (FEDER-Cofinantiated). We would like to thank G. Belver and S. Morales for their kind help and support. We also thank Dr. Kevin Dalton for critically reviewing the manuscript. A. Balseiro is a recipient of a 'Contrato de Investigacion para Doctores' from INIA (Spain).

Key termsequine; immunophenotype; ISCTmarkersThere has been growing interest in recent years in the use ofmesenchymal stem cells (MSCs) as a potential treatment fora number of important diseases. MSCs were first describedas colony-forming units consisting of fibroblast-like cellsderived from bone marrow (1). Since then they have beenisolated from many different tissues such as adipose, muscle,synovium, dental pulp, tendon, peripheral blood, Wharton’sjelly, and umbilical cord blood (2–4). The biological charac-teristics of MSCs that contribute to their therapeutic activityand the mechanisms of action continue to be studied.Despite many advances in MSC therapy, a specific markerthat defines cultured MSCs and identifies them within theirtissue niche has remained elusive. As a consequence, theInternational Society of Cell Therapy (ISCT) proposed a setof minimal test criteria for human MSCs as a first attempt atstandardization for laboratory and preclinical research. Thesecriteria include plastic adherence, trilineage differentiation toosteoblast, adipocyte, and chondrocyte lineages, and a phe-notype relating to surface marker expression. This latter stip-ulates that MSCs, measured by flow cytometry, must show 95% positivity for CD73, CD90, and CD105 antigens and 2% for CD45, CD34, CD14 or CD11b, CD79a or CD19,and HLA class II (5).These criteria were established only for human MSCresearch. However, the study of MSCs is not limited to humanapplications: many animal models are routinely used in pre-clinical investigation and in veterinary applications. There isan urgent need for a universal marker(s) to define and identifyMSCs from all tissues of origin, which will apply across allspecies.There has been an interest in equine MSC therapy formore than 10 years, especially in the treatment of musculo-skeletal disorders such as tendon or joint disease. In addition,because of similarities in terms of structure and biomechanics,the horse is accepted by the US Food and Drug Administra-tion as an animal model suitable for the investigation of carti-lage and tendon repair therapies for human use. In recentyears, several equine trials have been carried out using MSCsfrom different sources. Most of these reported a positive out-come (6) although the mechanism of action remains unclear.It can be argued that failure to understand the biologicalmechanism of repair hinders development of optimized thera-pies. It can also be argued that the lack of meaningful potencytests will hamper the development of standardized cell prepa-rations. The most important identifying characteristics ofequine MSCs have been plastic adhesion and trilineage poten-tial. The use of cell surface markers has been limited due tothe lack of commercial antibodies that cross-react with equineantigens (7).The paper published in this issue (p. XXX) by Paebstet al. is the first to analyze the complete panel of human MSCmarkers established by the ISCT in equine MSCs derived fromfive different tissue sources (marrow, adipose, tendon, umbili-cal cord tissue, and umbilical cord blood).

Objectives: The Stress Thermometer is an easily accessible Internet-based instrument for feedback on work stress and burnout. The aim of this paper is to describe the development of this instrument and to determine its applicability within the dental practice. Methods: The Stress Thermometer was made accessible to all members of the Dutch Dental Association, of which 77% of all Dutch dentists are members. Frequency of use was determined, and descriptive data was collected. Results: During an evaluation period of 5 months at least 12% of all possible respondents made use of the Stress Thermometer. Descriptive characteristics of the response group, as well as levels of burnout and work stress, corresponded with those found in the Dutch dentist population. However, some deviations were also present. Conclusions: Results indicate the applicability of the Stress Thermometer to a representative variety of dentists. Although the deviations found should not be ignored in future use, the Stress Thermometer was successful in reaching a population that is difficult to reach. It effectively calls attention to sensitive personal issues concerning work-related stress and burnout.

Tuberculosis (TB), a chronic disease caused by infection with the Mycobacterium tuberculosis complex, is endemic in wild boar (Sus scrofa) and red deer (Cervus elaphus) in south-central Spain. Understanding the temporal dynamics of this chronic infection requires long time series data collection over large areas. The aim of this paper was to identify the determinants of TB prevalence and severity in both species in Ciudad Real province, Spain, from 2000 to 2012. Study variables included management, population dynamics, and a range of geographical and climatological factors. The prevalence of TB in wild boar increased from 50% to 63% since the study commenced. This may be due to an increased hunting bag (a proxy for population abundance), which was correlated with TB infection rates. Low rainfall (a stochastic factor) was associated with higher individual risk of TB presence and progression, resulting in an increased proportion of severe cases of wild boar TB in dry years. This was probably a result of increased food restriction leading to a higher susceptibility to TB. In contrast, red deer TB showed an apparent stable trend, which may be a consequence of the species' higher and stable population size. Hunting management, characterized by fencing, was associated with a higher risk of TB in both wild boar and red deer, suggesting that intensive hunting management may have contributed to exacerbated TB figures. This difference was more marked in red deer than in wild boar, probably because fencing imposes less restriction on movement, population mixing and TB spread to wild boar than to deer. Our findings on TB dynamics are fundamental for assessing the impact of future disease-control actions (e.g. field vaccination). Moreover, such control plans must operate in the long term and cover large areas., This study was funded by the MINECO research project AGL2010-20730-C02-01 and JCCM PPEII 10-0262-7673.This is also a contribution to EU FP7 EMIDA (ERA-NET) Grant APHAEA on wildlife disease surveillance in Europeand to FP7 Grants ANTIGONE (project number 278976) and WildTBVac. Jose Angel Barasona enjoyed a scholarshipfrom JCCM and a contract through MINECO Grant AGL2011-30041. We thank the Agriculture Department of JCCM and its Delegation in Ciudad Real for providing data on hunting statistics and sanitary campaigns. Pelayo Acevedo was supported by a Beatriu de Pinòs fellowship funded y ‘Comissionat per a Universitats i Recerca del Departament d’Innovaciò, Universitats i Empresa’ of the Generalitat de Catalunya, and the COFUND Programme–MarieCurie Actions under 7th Framework Programme of the European Community. He is currently funded from the SFRH/BPD/90320/2012 post-doctoral grant provided bythe Portuguese Fundaçao para a Ciencia e a Tecnologia (FCT) and the European Social Fund.

10 páginas, 3 figuras, 3 tablas., In the present paper, we have used 2-DE coupled to MS analysis to examine the molecular variability of the Ole e 1 allergen in three olive cultivars (cvs). Our results confirmed that the predicted polymorphism of Ole e 1 at cDNA level is extended to the expressed protein. The profiles of both the Ole e 1 peptides and the N-glycan variants significantly changed among cvs. We observed that Picual and Arbequina cvs presented the highest and lowest degree of Ole e 1 polymorphism, respectively. Some of these peptides and N-glycans were distributed in a cv-specific manner. The putative implications of this molecular polymorphism in the development of the allergy symptoms are discussed., This work was supported by projects BFU2004-00601/BFI and P06-AGR-01791 from the MEC and the Junta de Andalucía, respectively.

This paper is interested in the relationship between evolutionary thinking and moral behavior and commitments, ethics. There is a traditional way of forging or conceiving of the relationship. This is traditional evolutionary ethics, known as Social Darwinism. Many think that this position is morally pernicious, a redescription of the worst aspects of modern, laissez-faire capitalism in fancy biological language. It is argued that, in fact, there is much more to be said for Social Darwinism than many think. In respects, it could be and was an enlightened position to take; but it flounders on the matter of justification. Universally, the appeal is to progress—evolution is progressive and, hence, morally we should aid its success. I argue, however, that this progressive nature of evolution is far from obvious and, hence, traditional social Darwinism fails. There is another way to do things. This is to argue that the search for justification is mistaken. Ethics just is. It is an adaptation for humans living socially and has exactly the same status as other adaptations, like hands and teeth and genitalia. As such, ethics is something with no standing beyond what it is. However, if we all thought that this was so, we would stop being moral. So part of the experience of ethics is that it is more than it is. We think that it has an objective referent. In short, ethics is an illusion put in place by our genes to make us good social cooperators.

Harold Shipman was an English doctor who killed approximately 15 patients while working as a junior hospital doctor in the 1970s, and another 235 or so when working subsequently as a general practitioner.1 Is it possible to learn general lessons to improve patient safety from such extraordinary events? In this paper we argue that it is not possible fully to understand how Shipman came to be such a successful and prolific serial killer, nor to learn how the safety of healthcare systems can be improved, unless his diabolical activities are studied using approaches developed to investigate patient safety. The World Health Organization (WHO) defines a patient safety occurrence as ‘an event which resulted in, or could have resulted in, unintended harm to a patient by an act of commission or omission, not due to the underlying medical condition of the patient’.2 Whatever the complexity of his actual motives3 when Shipman administered massive doses of diamorphine he clearly intended harm. But on the WHO's definition Shipman's practice falls outside questions about patient safety. We argue on the contrary that Shipman's case precisely requires to be understood within a patient safety framework (in addition to relevant legal and criminal frameworks).

Bioprocesses have been developed as relatively recent alternatives to conventional, non-biological technologies, for waste gas treatment and air pollution control in general. This paper reviews major biodegradation processes relevant in this field as well as both accepted and major innovative bioreactor configurations studied or used nowadays for the treatment of polluted air, i.e. biofilters, one- and two-liquid phase biotrickling filters, bioscrubbers, membrane bioreactors, rotating biodiscs and biodrums, one- and two-liquid phase suspended growth bioreactors, as well as hybrid reactor configurations. Some of these bioreactors are being used at full-scale for solving air pollution problems, while others are still at the research and development stage at laboratory- or pilot-scale.

Objective: An intervention to structure patient-key worker communication has been tested in a randomized controlled trial. The aim of this paper was to investigate effectiveness of the intervention in terms of moderators of effectiveness.Method: A total of 507 patients with schizophrenia were included. Moderators of effectiveness were investigated using two-way ANOVAS.Results: Patients with a better relationship with their key worker and a shorter duration of illness at baseline benefited more from the intervention in terms of quality of life. Patients who received the intervention who were in competitive employment or had a shorter duration of illness showed greater reduction of unmet needs. Older patients receiving the intervention had better treatment satisfaction.Conclusion: Outcome of the intervention was moderated by patient characteristics. Moreover, the moderating characteristics varied depending on the specific outcome. Evidence on moderators is very limited, even though, they are significant for understanding, targeting and implementing complex interventions.

The rational management of patients recovering from posttraumatic coma has been plagued by a paucity of hard data addressing the role of different physical interventions. In this paper, Oh and Seo present some useful and thorough research in a clinical area that is critically under-researched. As technology, knowledge and understanding advances, the number of patients surviving severe brain injury is increasing. Although the majority make a good recovery, a minority remain in coma, the minimally conscious state or the vegetative state. It has been estimated that as many as six to eight in 100 000 people each year sustain a moderate or severe head injury, with long-term consequences. Unfortunately, this is not reflected in the provision of health care or research effort in this field. These patients are often ignored by modern health care. While billions of research pounds and dollars have been spent on the investigation of (mainly ineffective) acute neuroprotective interventions, little research effort has been directed at dealing with the clinical reality of patients who are left severely disabled following brain injury. There should no longer be any doubt that early rehabilitation is essential to the effective care and long-term recovery of patients who have sustained a brain injury. As a result, the interface of clinical responsibility between acute care and rehabilitation has become increasingly blurred, with acute care teams taking greater responsibility for early rehabilitation (Von Wild, 2001). It is no longer appropriate to initiate rehabilitation only after acute care has come to an end, not only for self-evident logistic and clinical reasons, but also because the biology of acute inflammation following brain injury imperceptibly merges into processes involved in repair Correspondence: Leslie Gelling, Research Officer, School of Community Health and Social Studies, Anglia Polytechnic University, East Road, Cambridge, CB1 1PT, UK, E-mail: leslie.gelling@ntlworld.com

Representing motions as linear sums of principal components has become a widely accepted animation technique. While powerful, the simplest version of this approach is not particularly well suited to modeling the specific style of an individual whose motion had not yet been recorded when building the database: it would take an expert to adjust the PCA weights to obtain a motion style that is indistinguishable from his. Consequently, when realism is required, the current practice is to perform a full motion capture session each time a new person must be considered. In this paper, we extend the PCA approach so that this requirement can be drastically reduced: for whole classes of cyclic and noncyclic motions such as walking, running or jumping, it is enough to observe the newcomer moving only once at a particular speed or jumping a particular distance using either an optical motion capture system or a simple pair of synchronized video cameras. This one observation is used to compute a set of principal component weights that best approximates the motion and to extrapolate in real-time realistic animations of the same person walking or running at different speeds, and jumping a different distance