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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.

The solution of a structure of human Rab27a suffering from severe anisotropy and translational noncrystallographic symmetry was aided by identifying diffraction measurements with low information content., Data pathologies caused by effects such as diffraction anisotropy and translational noncrystallographic symmetry (tNCS) can dramatically complicate the solution of the crystal structures of macromolecules. Such problems were encountered in determining the structure of a mutant form of Rab27a, a member of the Rab GTPases. Mutant Rab27a constructs that crystallize in the free form were designed for use in the discovery of drugs to reduce primary tumour invasiveness and metastasis. One construct, hRab27aMut, crystallized within 24 h and diffracted to 2.82 Å resolution, with a unit cell possessing room for a large number of protein copies. Initial efforts to solve the structure using molecular replacement by Phaser were not successful. Analysis of the data set revealed that the crystals suffered from both extreme anisotropy and strong tNCS. As a result, large numbers of reflections had estimated standard deviations that were much larger than their measured intensities and their expected intensities, revealing problems with the use of such data at the time in Phaser. By eliminating extremely weak reflections with the largest combined effects of anisotropy and tNCS, these problems could be avoided, allowing a molecular-replacement solution to be found. The lessons that were learned in solving this structure have guided improvements in the numerical analysis used in Phaser, particularly in identifying diffraction measurements that convey very little information content. The calculation of information content could also be applied as an alternative to ellipsoidal truncation. The post-mortem analysis also revealed an oversight in accounting for measurement errors in the fast rotation function. While the crystal of mutant Rab27a is not amenable to drug screening, the structure can guide new modifications to obtain more suitable crystal forms.

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.

Over two decades, the checklist has risen to prominence in healthcare improvement. This paper contributes to the debate between its proponents and critics, making the case for an STS-informed understanding of the checklist that demonstrates the limitations of both the ‘checklist-as-panacea’ and ‘checklist-as-socially-determined’ positions. Attending to the checklist as a socio-material object endowed with affordances that call upon clinicians to act (Hutchby 2001, Allen 2012), the study revisits the efforts of a recent improvement initiative, the Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial. Rather than a singularised simple tool, this study discusses four different and relationally enacted logics of the checklist as a stop and check tool, a clinical prompt, an audit tool, and a clinical record. Each logic is associated with specific temporality, beneficiaries, relationship to material forms, and interpellates (Law 2002) clinicians to initiate specific actions which can conflict. The paper seeks to make the case for intervention to improve such tools and consciously account for the consequences of their design and materiality and calls for supporting such settings and arrangements in which incoherences collected in tools can be locally negotiated.

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.

Bleeding and thrombosis are major clinical problems with high morbidity and mortality. Treatment modalities for these diseases have improved in recent years, but there are many clinical questions remaining and a need to advance diagnosis, management, and therapeutic options. Basic research plays a fundamental role in understanding normal and disease processes, yet this sector has observed a steady decline in funding prospects thereby hindering support for studies of mechanisms of disease and therapeutic development opportunities. With the financial constraints faced by basic scientists, the ISTH organized a basic science task force (BSTF), comprising Scientific and Standardization Committee subcommittee chairs and co-chairs, to identify research opportunities for basic science in hemostasis and thrombosis. The goal of the BSTF was to develop a set of recommended priorities to build support in the thrombosis and hemostasis community and to inform ISTH basic science programs and policy making. The BSTF identified three principal opportunity areas that were of significant overarching relevance: mechanisms causing bleeding, innate immunity and thrombosis, and venous thrombosis. Within these, five fundamental research areas were highlighted: blood rheology, platelet biogenesis, cellular contributions to thrombosis and hemostasis, structure-function protein analyses, and visualization of hemostasis. This position paper discusses the importance and relevance of these opportunities and research areas, and the rationale for their inclusion. These findings have implications for the future of fundamental research in thrombosis and hemostasis to make transformative scientific discoveries and tackle key clinical questions. This will permit better understanding, prevention, diagnosis, and treatment of hemostatic and thrombotic conditions. ispartof: JOURNAL OF THROMBOSIS AND HAEMOSTASIS vol:20 issue:6 pages:1496-1506 ispartof: location:England status: published

The terms ‘quality of life’ (QoL) and ‘health related quality of life’ (HRQoL) are fraught with preconceptions, misconceptions and, frequently, confusion: How are these terms best defined? What are the best ways to measure them? These challenges, which are present even in the relatively well-studied fields of adult physical health, are magnified considerably when considered in the context of child and adolescent mental health. They are, however, concepts that are being increasingly discussed by child and adolescent mental health clinicians, researchers and service planners. The purpose of this review is to analyse and discuss the concept of QoL and HRQoL (for simplicity we will use the umbrella term QoL in this paper except when there is a need to draw more fine-grain distinctions) as they relate to child and adolescent mental health, and review the various reasons for measuring QoL in this population. The paper is divided into three main sections. First, we introduce the concept of QoL and draw out the issues raised with regard to the field of childhood mental health research and practice. Second, we discuss the range of challenges raised as we move from concept to measurement. Third, we review and contrast some of the many different measurement tools currently available.

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.

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.

Horizontal gene transfer (HGT) is widespread among prokaryotes driving their evolution. In this paper, we review the potential impact in humans of the HGT between prokaryotes living in close association with humans in two scenarios: horizontal transfer in human microbiomes and transfer between microbes living in human managed environments. Although our vision is focused on the possible impact of these transfers in the propagation of antibiotic resistance genes or pathogenicity determinants, we also discuss possible human physiological adaptations via gene transfer between resident and occasional bacteria in the human microbiome., The authors thank the two anonymous referees for their valuable comments. LB is supported by the grant CGL2016-75262-P of Spain DGI. RP is supported by a postdoctoral contract (Submodality 5.2.A) funded by the Research Plan of the University of Cordoba.

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.

Based on fieldwork material from Lao People's Democratic Republic, this paper introduces an analytical framework that transcends compartmentalized approaches towards migration involving young people. The notions of fluid and institutionalized forms of migration illuminate key differences and commonalities in the relational fabric underpinning empirically diverse migration scenarios. Applying this framework to the role of networks in becoming a young migrant, this chapter sheds light on young migrants' differential scope for exercising agency. This redirects concerns about young migrants away from descriptive and static factors towards their relational position in the process of migration, which shapes their agency and vulnerability.

Correspondence analysis ( CA) is a popular method that can be used to analyse relationships between categorical variables. It is closely related to several popular multivariate analysis methods such as canonical correlation analysis and principal component analysis. Like principal component analysis, CA solutions can be rotated orthogonally as well as obliquely into a simple structure without affecting the total amount of explained inertia. However, some specific aspects of CA prevent standard rotation procedures from being applied in a straightforward fashion. In particular, the role played by weights assigned to points and dimensions and the duality of CA solutions are unique to CA. For orthogonal simple structure rotation, procedures recently have been proposed. In this paper, we construct oblique rotation methods for CA that take into account these specific difficulties. We illustrate the benefits of our oblique rotation procedure by means of two illustrative examples.

Aim: To evaluate oral environmental changes in cannabis users.Material and Methods: The MEDLINE and Cochrane Central register of controlled trails (CENTRAL) were searched up to April 2007 to identify appropriate studies.Results: Independent screening of 982 titles and abstracts (MEDLINE-Pubmed) and (Cochrane) papers resulted in seven eligible publications.Conclusion: Based on the limited data, it seems justified to conclude that with increasing prevalence of cannabis use, oral health care providers should be aware of cannabis-associated oral side effects, such as xerostemia, leukoedema and an increased prevalence and density of Candida albicans.

Objective: To review the literature on whether a hand-held triangular woodstick, as compared with no adjunct or other interdental cleaning device in addition to daily toothbrushing, can improve clinical parameters of gingival inflammation.Material and Methods: MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched through February 2008 to identify appropriate studies. Plaque and gingivitis were selected as outcome variables.Results: Independent screening of the titles and abstracts of 181 MEDLINE and 65 CENTRAL papers yielded seven publications with eight clinical experiments that met the eligibility criteria. The improvement in gingival health, as observed in seven studies, represents a significant incremental benefit realized by the use of triangular woodsticks. None of the studies that scored plaque demonstrated any significant advantage to the use of woodsticks, as opposed to alternative methods, in gingivitis patients.Conclusion: Evidence from controlled trials, most of which were also randomized, shows that woodsticks do not have an additional effect on visible interdental plaque or gingival index, but do, however, provide an improvement in interdental gingival inflammation by reducing the bleeding tendency.

Aim: To review the available literature, considering the effect of instrumentation with the Vector® ultrasonic scaler on human teeth in vitro and in vivo compared to conventional ultrasonic instruments and/or hand instrumentation. The assessed effects are calculus removal, time of instrumentation, root surface aspects, cell attachment, patients' perception, bleeding upon probing, pocket depth, clinical attachment loss and microbiological effects.Materials and methods: MEDLINE-PubMed and the Cochrane Central register of controlled trials (CENTRAL) were searched up through January 2008 to identify appropriate studies. Results: Independent screening of the titles and abstracts of 270 MEDLINE-PubMed and 15 Cochrane papers resulted in 15 suitable publications. The studies differed in design and outcome, so this review summarizes the outcomes in a descriptive manner. Comparisons are presented against conventional ultrasonic system and scaling and root planing.Conclusion: The Vector® ultrasonic scaler provided comparable clinical and microbiological periodontal healing results as scaling and root planing and conventional ultrasonic system in moderately deep pockets. The Vector® ultrasonic scaler may be used as a gentle root debridement device for supportive periodontal therapy, as an alternative to other conventional ultrasonic system. The operator should however consider the extra time needed for instrumentation.

We present a review of six clinical studies investigating the use of photodynamic therapy (PDT) using porphyrin precursors for the treatment of Old World cutaneous leishmaniasis (CL). Thirty-nine patients with a total of 77 lesions received PDT using a range of treatment schedules following topical application of aminolevulinic acid (ALA) or methyl-aminolevulinate (MAL). The tissue response to PDT is accompanied by a mild burning sensation, erythema and reversible hypo- and hyperpigmentation. Few mechanistic studies have addressed the principles underlying the use of PDT for CL. All six reviewed papers suggest that PDT with porphyrin precursors is relatively effective in treating CL. Data are still limited, and PDT cannot at this point be recommended in routine clinical practice. The mechanism of action of this promising therapeutic modality needs to investigated further and additional controlled trials need to be performed.

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).

Confidence intervals (Cis) in principal component analysis (PCA) can be based on asymptotic standard errors and on the bootstrap methodology. The present paper offers an overview of possible strategies for bootstrapping in PCA. A motivating example shows that Ci estimates for the component loadings using different methods may diverge. We explain that this results from both differences in quality and in perspective on the rotational freedom of the population loadings. A comparative simulation study examines the quality of various estimated component loading Cis. The bootstrap approach is more flexible and generally yields better Cis than the asymptotic approach. However, in the case of a clear simple structure of varimax rotated loadings, one can be confident that the asymptotic estimates are reasonable as well.

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.

Discoid lupus erythematosus (DLE) is an uncommon disease in childhood. In this paper we present five new cases of childhood DLE. Two of them are identical twin brothers, who developed similar lesions during an interval of 5 years. This is in favour of the hypothesis that both genetic factors and somatic mutations, due to environmental factors, are implicated in the pathogenesis. A review of the English language literature is also presented. In order to have better epidemiological data on this disease, all cases of childhood DLE, including those published in non-English literature and those not yet published, should be placed together and analysed.

This paper introduces spatial moving average risk smoothing (SMARS) as a new way of carrying out disease mapping. This proposal applies the moving average ideas of time series theory to the spatial domain, making use of a spatial moving average process of unknown order to define dependence on the risk of a disease occurring. Correlation of the risks for different locations will be a function of m values (m being unknown), providing a rich class of correlation functions that may be reproduced by SMARS. Moreover, the distance (in terms of neighborhoods) that should be covered for two units to be found to make the correlation of their risks 0 is a quantity to be fitted by the model. This way, we reproduce patterns that range from spatially independent to long-range spatially dependent. We will also show a theoretical study of the correlation structure induced by SMARS, illustrating the wide variety of correlation functions that this proposal is able to reproduce. We will also present three applications of SMARS to both simulated and real datasets. These applications will show SMARS to be a competitive disease mapping model when compared with alternative proposals that have already appeared in the literature. Finally, the application of SMARS to the study of mortality for 21 causes of death in the Comunitat Valenciana will allow us to identify some qualitative differences in the patterns of those diseases. Copyright © 2012 John Wiley & Sons, Ltd.

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).

Although Western blots are frequently quantified, densitometry is not documented and appears to be based merely on traditions and guesswork. Confirming previous experience, none of 100 randomly selected and systematically scanned most recent papers provided sufficient information on how Western blot results were translated into statistical values. The importance of such information, however, becomes evident from our correlations of plasma erythropoietin values of various mammals determined using RIA and Western blot densitometry. Different common densitometry procedures applied to the identical Western blot revealed p-values of these correlations ranging from 0.000013 to 0.76 reflecting the necessity of a scientifically sound basis for densitometry of Western blots. At present, the current lack of any definitions in densitometry opens the door to uncontrollable acquisition of any desired p-value. Here we provide data that define what should be considered, what avoided and what documented when quantifying Western blots.

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 early detection of outbreaks of diseases is one of the most challenging objectives of epidemiological surveillance systems. In this paper, a Markov switching model is introduced to determine the epidemic and non-epidemic periods from influenza surveillance data: the process of differenced incidence rates is modelled either with a first-order autoregressive process or with a Gaussian white-noise process depending on whether the system is in an epidemic or in a non-epidemic phase. The transition between phases of the disease is modelled as a Markovian process. Bayesian inference is carried out on the former model to detect influenza epidemics at the very moment of their onset. Moreover, the proposal provides the probability of being in an epidemic state at any given moment. In order to validate the methodology, a comparison of its performance with other alternatives has been made using influenza illness data obtained from the Sanitary Sentinel Network of the Comunitat Valenciana, one of the 17 autonomous regions in Spain. Copyright (c) 2008 John Wiley & Sons, Ltd.

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