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Background: Tissue dielectric constant (TDC) values measured at 300 MHz via the open-ended coaxial line reflection method depend on the effective measurement depth and the anatomical site being evaluated. Measurements on the forearm have shown that the TDC values decrease with increasing measurement depth but the spatial variability of the TDC values among forearm anatomical positions is unknown. Our goal was to characterize the extent of such spatial variations. Methods: In 30 healthy seated women (27.4±6.5 years), TDC was measured on the forearm midline and 1.2 cm medial and lateral to the midline at sites 4, 8 and 12 cm distal to the antecubital crease. Results: The midline and medial TDC values increased progressively from 4 to 8 to 12 cm sites ( P<0.001), with the largest spatial gradient along the midline. At a depth of 2.5 mm, the TDC values increased from 26.3±2.8 to 27.4±3.4 to 28.4±3.7, with a maximum difference of 8.2±10.6%. For all sites, the TDC values were significantly ( P<0.001) less for increasing depths. Conclusion: The findings reveal increased TDC values along the forearm from proximal to distal, most prominent at the midline and medial positions. Because many skin-related dermatological and biophysical studies utilize the forearm as a test target, such differences may be important to consider because TDC values in part are reflective of local tissue water (LTW). Although the variation in the TDC values among sites was less than 10%, such differences are of importance when evaluating LTW changes using the TDC method in patients with arm lymphedema that is present in variable arm anatomical locations. [ABSTRACT FROM AUTHOR]

Lymphedema is a chronic condition often requiring lifelong treatment to avoid worsening of extremity and trunk swelling with concomitant complications. The physiological basis for truncal treatment, although clinically recognized, until recently, was not well documented. Herein, we expand on earlier work by reporting on clinical outcomes, therapist observations, and subjective impressions of five patients with truncal lymphedema whose in-home self-treatment includes the Flexitouch® system (FT) pneumatic device. Patients received in-clinic complete decongestive therapy and in-home self-care including FT. Results, determined after 2 months of treatment, showed reductions in trunk and arm swelling, fibrotic tissue softening, pain reduction, and improved range of motion and flexibility. Patients reported that FT was easy and comfortable to use and enhanced in-home compliance. Results suggest that limb and trunk lymphedema can be effectively treated in the home with an advanced programmable pneumatic device with truncal coverage, such as the FT system. [ABSTRACT FROM AUTHOR]

Tissue dielectric constant (TDC) measurements at 300 MHz via the coaxial line reflection method are useful to evaluate local skin tissue water and its change, but virtually all available data relate to measurements on women. Because TDC values in part depend on skin thickness, we hypothesized that differences in male–female skin may be associated with male–female differences in TDC. To test this hypothesis, we compared TDC values in volar forearm skin of 60 young adult volunteers (30 men, 25·0 ± 2·5 years, 30 women, 27·4 ± 6·6 years) in the seated position using a probe with an effective measurement depth of 1·5 mm. Results showed that TDC values (mean ± SD) for men were significantly greater than for women (33·2 ± 4·0 versus 29·4 ± 2·7, P<0·001) constituting an overall difference of about 13%. This finding suggests that when TDC measurements are used in research or clinical studies in which both men and women are included in a common study population, it would be prudent to consider this difference in both experimental design and data interpretation. This is especially true if absolute TDC values are of interest in contrast to changes in TDC values on the same subject subsequent to time passage or secondary to an intervention. Despite greater TDC values measured in men, calculations of the impact of a greater male skin thickness indicate that the greater TDC values of men may or may not reflect a greater relative local skin tissue water in men compared to women . [ABSTRACT FROM AUTHOR]

Background: Tissue dielectric constant (TDC) measured at 300 MHz via the coaxial line reflection method is useful to evaluate local tissue water (LTW) and its change. Because excitation field penetration depth depends on size and geometry of the coaxial probe in contact with the skin, TDC values reflect skin and subcutaneous fat to varying depths depending on the probe used. Because tissue changes that occur with age or body mass index (BMI) may affect tissue water content and its depth distribution, our goal was to use TDC measurements to characterize depth patterns of LTW in normal tissue and to investigate the possible impact of age and BMI. Methods: TDC was measured to depths of 0.5, 1.5, 2.5 and 5.0 mm on both forearms of 69 healthy women (age: 22–82 years, BMI: 18.7–46.1 kg/m2). Results: Independent of age or BMI, TDC values decreased significantly with increasing measurement depth (33.7±5.8 at 0.5 mm to 21.8±3.7 at 5.0 mm) but at all depths dominant and non-dominant TDC values were similar to each other with ratios ranging from 1.025±0.081 at 0.5 mm to 1.017±0.097 at 5.0 mm. TDC values only at 2.5 and 5.0 mm decreased significantly with increasing BMI whereas TDC values only at 0.5 and 1.5 mm increased significantly with age. Conclusion: The findings indicate that normal TDC values are affected differentially by BMI and age in a depth-dependent manner. Possible explanations are discussed. [ABSTRACT FROM AUTHOR]

Lymphedema is increasingly being seen in patients receiving home health care and throughout the general population. Substantial risks of complications are associated with failure to recognize its presence, worsening of the condition and the use of inadequate or incomplete therapy. Therapeutic truncal clearance as a component of therapy is universally accepted by professional therapists as being essential, but often rejected by third-party payers. This therapeutic component is based on sound physiological principles, but there has not been, nor will there likely be, peer-reviewed testing because it is deemed unethical to subject patients to therapy without its use. We believe that if the physiological basis for this therapy were more widely understood, its absolute need would be better recognized. Thus, our goal is to describe those lymphatic system features that directly impact lymphedema development and complications emphasizing the role of and scientific basis for truncal clearance as an essential treatment component. [ABSTRACT FROM AUTHOR]

Previous reports described the use of average tissue dielectric constant (TDC) measurements to assess local tissue water and its change. Our goal was to determine if a single TDC measurement could be used in place of the average of multiple measurements. The comparison criteria used to test this was the extent to which single and averaged measurements yielded similar TDC values in both normal and lymphedematous tissue. Measurements were made in two groups of women; a control group ( n = 20) and a group with unilateral arm lymphedema ( n = 10). In the control group, TDC was measured to multiple depths (0·5–5·0 mm) on both ventral forearms and to a depth of 2·5 mm on the lateral thorax on both body sides. In the lymphedematous group, TDC was measured on both ventral forearms to a depth of 2·5 mm. Results showed that the 95% confidence interval for differences between single and averaged TDC values was less than ±1 TDC unit and that the limits of agreement between methods was less than ±2·5 TDC units (±6·5%) for each condition, site and depth measured. This finding suggests that where this level of agreement is acceptable suitable clinical assessments can be made using a single TDC measurement. [ABSTRACT FROM AUTHOR]

Assessing local tissue water using tissue dielectric constant (TDC) values is useful to evaluate oedema/lymphoedema features and their change. Knowledge of anatomical site and tissue depth dependence of TDC values could extend this method’s utility. Our goal was to compare TDC values obtained at anatomically paired sites and to investigate their depth dependence. In 22 women (12 awaiting surgery for breast cancer and 10 cancer-free control subjects), four sites (mid-forearm, mid-biceps, axilla and lateral thorax) on both body sides were measured with a 2·5-mm sampling depth probe. Also, at forearm, four different probes with sampling depths of 0·5, 1·5, 2·5 and 5 mm were used. TDC values range between 1 for zero water to 78·5 for 100% water. Site comparisons showed TDC values (mean ± SD) to be largest at axilla (36·4 ± 8·9), least at biceps (21·6 ± 3·5) and not different between forearm and thorax (24·3 ± 4·0 versus 24·8 ± 5·0). Group comparisons showed slightly greater values in patients at forearm and biceps ( P<0·05) but no group difference at other sites. Dominant-non-dominant side comparisons showed no significant difference in paired-TDC values in either group at any site. Forearm TDC values decreased with increasing depth from 36·4 ± 4·8 at 0·5 mm to a minimum of 21·4 ± 3·9 at 5·0 mm, with a sharp decline between 1·5 and 2·5 mm. The composite findings suggest that TDC measurements have the necessary features for usefully assessing oedema/lymphoedema and its change on limbs and at body sites not routinely amenable to assessment by other techniques. The depth dependence feature provides additional flexibility to investigate oedematous or lymphoedematous conditions. [ABSTRACT FROM AUTHOR]

Background and Purpose Sequential compression is used to manage lymphedema, but little is known about pressures delivered to the therapeutic targets. This study characterized actual pressures delivered by a traditional compression pump (Lympha Press [LP]) and one using an alternate compression pattern (Flexitouch [FT]). Subjects Ten adults who were healthy volunteered to participate in the study. Methods Pressure-time along the forearm was measured using a 256-pressure sensor array during the pressure cycling of each device. Device assessments were separated by at least 48 hours. Results Pressure patterns and magnitudes produced by the 2 devices differed considerably. The FT pressure pattern displayed at rapid rise and fall, progressing from the wrist toward the elbow. The LP pressure rose slower and was sustained at a higher level during its inflation cycle. Pressures delivered with the LP were significantly greater than those delivered with the FT. Discussion and Conclusion The pressure patterns and magnitudes on treated limbs depend on the device. These differences should be considered before selecting a device for a specific patient. [ABSTRACT FROM AUTHOR]

Background and Purpose Therapy-related changes in limb volumes often are estimated using summated segmental volumes based on adjacent circumference measurements. The purposes of this study were: (1) to determine the effect of different segment lengths on calculated volume reductions after complete decongestive therapy and (2) to determine the effect of excluding posttherapy control limb volumes on calculated reductions in edema volume in patients with unilateral limb lymphedema. Subjects This two-part retrospective study was conducted using data from patients with bilateral leg lymphedema (n=70) and data from patients with unilateral arm lymphedema (n =7) and patients with unilateral leg lymphedema (n=45). Methods For the bilateral leg lymphedema group, pretreatment to posttreatment changes in limb volume were determined using segment lengths of 4, 8, and 12 cm. For the unilateral lymplaedema group, pretreatment to posttreatment changes in edema volume were determined and compared using or not using posttreatment control limb volumes Results Bilateral leg volume changes were similar for all segment lengths but not significantly different from each other. Unilateral edema volume changes were significantly overestimated in both arms and legs when posttherapy control limb volumes were not used. Discussion and Conclusion The results indicate that segment lengths of 4 cm generally are not needed to obtain adequate estimates of leg volume changes. Both limb volumes should be measured to properly assess therapeutic outcomes in patients with unilateral limb lymphedema. [ABSTRACT FROM AUTHOR]

Teenage contraceptive use is often perceived as irresponsible, and Government initiatives are aimed at improving this. This prospective observational cohort study examined contraceptive use in 925 women requesting termination of pregnancy (TOP) and found that usage in all women, regardless of age, was poor with no difference between age groups. These findings challenge frequently made assumptions about irresponsible contraceptive use and imply that contraceptive education, and initiatives to tackle the growing number of TOPs, should not be confined to teenagers but should start in early adolescence and must continue well in to adulthood. [ABSTRACT FROM AUTHOR]

Previous work offers conflicting evidence concerning whether basal skin blood flow (SBF) varies with the menstrual cycle. Our goal was to determine the extent of cycle-dependent changes in forearm SBF parameters and if they are linked to local tissue water content and arm volume changes. Both arms of 10 premenopausal women were evaluated three times during their cycle (days 4, 12 and 22) and 10 postmenopausal women were evaluated once. Each evaluation included laser Doppler blood flow parameters (perfusion, volume and velocity), skin temperature, arm volume and local tissue water determined by a new tissue dielectric constant method. Estradiol and progesterone concentrations were determined at each visit by using saliva samples and analysis showed the expected pattern of variation over the cycle. Main results showed no significant cycle-dependent variations in any SBF parameter, temperature, tissue water or arm volume. Postmenopausal women had significantly less estradiol levels, but did not differ with respect to premenopausal women in any measured parameter except for a slightly less blood velocity ( P<0·01). We hypothesize that that the absence of changes in tissue water and arm volume in our group may account for the constancy of the measured SBF parameters. However, in other populations, hormonally induced tissue changes may occur and contribute to the cycle-dependent changes in resting blood perfusion that have been reported. This possibility suggests that it may be useful to measure and report a skin tissue water index when serial changes in blood perfusion are being investigated. [ABSTRACT FROM AUTHOR]

When people miss a good bargain, they are less likely to take a subsequent one that is not as good. This phenomenon is termed inaction inertia. Two regret-based explanations of it have been proposed. According to one, people anticipate that buying the item will lead to regret because it will remind them that they missed a better opportunity to buy it. According to the other, the regret people experience when missing a bargain, together with a subjective devaluation of the item resulting from that, produces inaction inertia. In two studies, we assessed experienced regret, anticipated regret, subjective valuation (SV) of the bargain and likelihood of purchase. Our findings provide grounds for reconciling the above accounts. The former is more appropriate when the difference between the previous and subsequent bargain is large, and the latter is more appropriate when it is smaller. Furthermore, our findings suggest that previous accounts of inaction inertia are incomplete. Whereas subjective value and regret considerations jointly determine purchase likelihood when no previous opportunity has been missed, regret considerations are the sole determinant of this likelihood when such an opportunity has been missed. Inaction inertia arises at least partly because considering regret turns attention away from the financial advantages of taking the bargain. [ABSTRACT FROM AUTHOR]

Single rapid and deep inspirations (inspiratory gasps, IG) result in arteriolar vasoconstriction with concomitant transient decreases in skin blood flow that are most prominent in fingers and toes. Vascular responses (inspiratory gasp responses, IGR) are determined as the maximum percentage reduction in blood flow and have been used to assess sympathetic neurovascular function in several conditions. Previous studies have described various features of the response but there has been no reported systematic investigation of the degree of similarity between IGR obtained on dominant and non-dominant hands. This aspect is important in procedures that may use IGR to evaluate suspected unilateral sympathetic dysfunction of a limb-pair or to test the effectiveness of physiological interventions imposed on a single limb of a pair. Thus, the goal of our study was to compare IGR magnitudes that were simultaneously determined in paired-fingers of dominant and non-dominant hands. In 30 healthy seated subjects, skin blood perfusion via laser-Doppler (SBF) was measured on the dorsum of the middle finger of both hands while subjects performed three sequential IG at 3-min intervals. Analysis of variance for repeated measures revealed no significant difference in IGR between dominant (79·3 ± 11·2%) and non-dominant hands (81·9 ± 11·6%,P = 0·965) with an overall IGR of 80·6 ± 11·4%. These results indicate that hand-dominance is not a factor that is likely to significantly effect IGR differentials determined in paired-limbs. [ABSTRACT FROM AUTHOR]

Abstract: Our specific aim was to investigate whether a local static magnetic field of a permanent magnet, of either pole, affects resting skin blood perfusion. This was done by measuring skin blood perfusion (SBF) by laser-Doppler in dorsum skin of 2nd and 4th fingers of the nondominant hands of 12 volunteers. Both fingers were first exposed to sham magnets, and then the 2nd finger was exposed alternately to north and south poles of a neodymium magnet that produced a field of 4024 G at the palmar part of the finger and a field of 879 ± 52 G at the site of finger dorsum SBF measurement. Each of the three exposure intervals was 15 min. SBF values were analyzed by first computing the average SBF during the last 5 min of each of the three 15-min exposure intervals. These SBF averages were initially tested for magnet or magnet-pole effects by analysis of variance for repeated measures with finger as a factor, using SBF values for each finger as the test variable. Results of this analysis revealed a large variability in finger SBF among subjects and no significant difference in SBF between exposure conditions (P = 0.705) or any significant interaction between SBF and finger (P = 0.396). However, when intersubject variability was reduced by using the flow difference between treated and nontreated fingers in each exposure interval as the test variable, a statistically significant effect (P = 0.016) attributable to magnet exposure was uncovered. This effect was a reduction in resting SBF in the magnet-exposed fingers that was similar for north and south pole magnet exposure. The present findings are the first to demonstrate a direct effect of locally applied magnets on human skin blood perfusion. [Copyright &y& Elsevier]

Vulnerability of the heel to ulceration in bed-bound persons is related to direct pressure-induced blood flow decreases. Periodic pressure reduction is a clinical strategy to help prevent ulcers by allowing flow-repayment hyperaemia that has a magnitude and duration thought to be related to the duration of the prior interval of ischaemia. However, there are reasons to question whether effects of flow stoppages caused by direct tissue loading are similar to those because of ischaemia without superimposed direct pressure. This question was investigated by comparing posterior heel skin blood flow responses via laser-Doppler perfusion monitoring of 27 supine-lying subjects in whom blood flow was reduced by 5-min of direct heel loading on a support surface and by 5-min of ankle-cuff compression. Results showed that blood flow reductions were the same for both methods but the hyperaemia was significantly greater when flow reduction was produced by direct heel loading. This was true for ratio of peak hyperaemic flow to baseline (8·20 ± 1·32 s versus 4·68 ± 0·80 s, P≤0·001), hyperaemic to baseline 3-min flow-time area ratios (4·70 ± 0·65 s versus 1·95 ± 0·29 s, P≤0·001) and for total hyperaemia durations (352 ± 39 s versus 181 ± 14 s, P<0·001). These findings raise new questions regarding the precise physiological effects of heel and tissue loading in general, the factors that contribute to the hyperaemic response and their clinical impact and interpretation. Possible sources of the observed greater post-loading hyperaemia responses are discussed. [ABSTRACT FROM AUTHOR]

Mental retardation (MR) is an invented bureaucratic category, currently undergoing radical rethinking and likely renaming, that includes many who have biologically based brain disorders, but is itself determined on functional criteria (e.g., IQ below a certain level) that are purely arbitrary. People with MR are socially vulnerable and thus are more likely to be "naïve confessors," "naïve defendants," and "naïve offenders." That is most likely the (largely unarticulated) rationale and justification for the Supreme Court's decision, in Atkins v. Virginia (2002), to exempt the class from execution. Although the decision is to be applauded as a step in a more humane direction, it is problematic to use an indirect, artificial, and insufficiently inclusive category to determine who should or should not be executed. Limited social intelligence (with consequent social vulnerability) is a characteristic of a wide range of brainbased syndromes and disorders, including many who fall above the (artificial) upper IQ limit and, thus, are ineligible for the MR label and the legal protections associated with it. A more equitable, and logical, policy would be to extend execution exemption to all who demonstrate the same kinds of vulnerabilities, especially if they can be linked to some brain-based medical condition, regardless of whether one qualifies for the (soon to be discarded) label of MR. [ABSTRACT FROM AUTHOR]

Studies of past sea levels based on radiocarbon-dated field samples suffer variously from compilation of information from disparate locations and the imprecise nature of the dated indicators. Geographic segregation and systematic elimination of poor samples from time–depth data sets leads to improved interpretation of Holocene sea-level history. An example is presented from Southern Australia, where this is achieved through selection of higher-resolution palaeoenvironmental indicators, separation of transgressive from regressive populations, and geographic regionalisation of data.In Southern Australia, fossil sea-level indicators preserved in prograding coastal plain settings include seagrass, sandflat, mangrove, samphire and chenier ridge organo–sedimentary remains. These provide sea-level time–depth data points with a variety of elevational and dating errors. Preserved organic remains at the transition from Posidonia seagrass to intertidal sandflat environment, and from sandflat to Avicennia mangrove environment provide the most precise local data for tracing sea-level change.Time–depth plots of 233 dated sea-level indicators from South Australia generate a broad sea-level envelope tracing the Southern Australian transgression from 10,000 to ca. 6000 radiocarbon years BP, followed by a more or less consistent level to the present. Finer details of sea-level behaviour are only apparent after systematic selection, separation and regionalisation of the data. The data indicate a very rapid sea-level rise in the early Holocene, at about 16 mm/year, reaching present levels at 6400 years BP. This was followed by regionally variable regression and emergence of the land of 1–3 m, a process that continues to the present. The systematic increase from 1 to 3 m in the elevation of the 6400-year BP highstand with distance away from the shelf margin is consistent with a hydro-isostatic origin for the emergence as predicted by geophysical models. [Copyright &y& Elsevier]

This paper presents the results of a detailed survey into the reasons for the spate of mergers between Geography and Environment Studies that took place in Australian universities from 1989 to 1999. The results, from a 1998 survey, suggest that the development of a symbiotic relationship between the two areas of study is merely a veneer masking a complexity of underlying factors. These include financial reasons, internal university politics, staff changes and mobility, and only in some cases, a genuine academic rationale for a merger. The paper concludes that the superficial appearance of a symbiosis between Geography and Environment Studies generally masks an opportunistic pragmatism which is very site specific in its complexity. The result has been a series of departmental mergers which, although providing a firmer financial footing, raise questions about the academic implications for the development of both study areas as we move into the third millennium. [ABSTRACT FROM AUTHOR]

At Port Pirie, on the eastern coast of Northern Spencer Gulf, South Australia, 10 cores taken along a 3 km transect recovered a succession of Holocene marine sediments. Facies representing shallow subtidal Posidonia seagrass and intertidal sandflat, mangrove and back-storm ridge coastal lagoon environments are recognized on the basis of lithological characteristics and their preserved foraminifera. An assemblage dominated by Nubecularia lucifuga, Peneroplis planatus and Discorbis dimidiatus signifies sediments of shallow subtidal Posidonia seagrass meadows. Subtle changes in the numerical distribution of these species upcore are used to infer the change from subtidal to intertidal sandflat facies; Elphidium crispum and Elphidium macelliforme become more numerous across this transition. The mangrove facies is characterized by Trochammina inflata. This species is present significantly in only one seaward core where modern mangrove woodland continues to grow today and no equivalent biofacies are recognized in other cores. The lagoonal sediments preserve a rich assemblage of species of euryhaline foraminifera. Together with those of the mangrove woodland, they exhibit an ecological succession which can be related to decreasing intervals of tidal inundation and increasing salinity. Helenina anderseni, with subordinate Ammonia beccarii, and Elphidium cf. articulatum are the pioneer species in the euryhaline setting, giving way to Trichohyalus tropicus and Miliolinella schauinslandi. Late stages of hypersaline sedimentation are characterized by Triloculina inflata+Triloculina oblonga. In the mangroves, H. anderseni, A. beccarii and Elphidium cf. articulatum are replaced by Trochammina inflata as the dominant species. In turn, as further sediment aggradation leads to ever shorter intervals of tidal inundation at the landward side of the mangrove woodland, Trochammina inflata is overtaken by Ammobaculites barwonensis. Quantitative foraminiferal biofacies analysis confirms and refines the sedimentological interpretation of intertidal sediment facies from macro-observations of the core materials. It provides independent estimates of the elevation of key facies boundaries in cores and confirmation of a general relative fall in sealevel in Northern Spencer Gulf over the past 7000 yr. [Copyright &y& Elsevier]

A rapid and deep inspiration triggers a sympathetically mediated transient vasoconstriction of skin arterioles (inspiratory gasp vascular response, IGVR). Because the IGVR has been most often measured and studied in skin that is rich in arteriovenous anastomoses (AVAs), such as the palmar aspect of the distal phalanx or plantar aspect of the toes, there is little information on its features in skin areas not dominated by thermoregulatory AVAs. Thus, the dependence of the magnitude of the IGVR on AVAs is unclear. We reasoned that if responses in a region of low AVA density, such as the finger dorsum distal phalanx, were comparable to those in AVA-rich skin, this would clarify the issue. Further, it might then be possible to use such areas to provide a useful complementary target for future study of sympathetically induced vasoconstriction. To test this, we determined the features of the finger dorsum IGVR in 28 healthy volunteers (age 19–57 years, 14 males) in whom distal phalanx skin blood perfusion (SBF) was monitored by laser–Doppler during 21 sequential IGVRs, each separated by 2 min. IGVR was quantified as the minimum SBF during each IGVR, expressed as a percentage of each immediately preceding 2-min SBF average. Results (mean ± SD) revealed an overall IGVR of 72.2 ± 16.7%, which is very near that reported from studies on the AVA-rich palmar finger pad. We therefore conclude that the IGVR does not depend on the presence of AVAs and that the dorsal distal phalanx is a viable alternative for the study of sympathetically related neurovascular responses. [Copyright &y& Elsevier]

A vasomotor reflex triggered by a rapid and deep inspiration causes arteriolar vasoconstriction and a transient decrease in skin blood flow in most people. This is the inspiratory gasp vascular response (IGVR). The most common site of its measurement has been on the palmar or plantar aspect of the digits and little is known about its features in skin with few or any arterial venous anastomoses (AVAs). A basic aspect of this response that has not been systematically studied is its temporal pattern associated with multiple sequential inspiratory gasps (IG) in the same person. Such information would provide insight as to whether there is any form of adaptation or temporal dependence and may serve as a basis for judging response variability. Thus, the present study was undertaken to characterize the normal pattern of responses in finger dorsum skin in a group of 28 normal persons who performed 21 sequential, uniformly spaced IG, over an interval of 42 min. The results show that IGVR measured on the finger dorsum have a magnitude comparable with that obtained on finger pulp, in spite of the relative dearth of sympathetically controlled AVAs on the dorsum. It was also found that the magnitude of the IGVR displays little if any tendency for sequential adaptation or temporal trending. Finally, the results indicate that the largest component of response variability is associated with subject-to-subject differences as compared with sequential variability within subjects. [ABSTRACT FROM AUTHOR]

RAIDD, a caspase recruitment domain (CARD) containing molecule, interacts with procaspase-2 in a CARD-dependent manner. This interaction has been suggested to mediate the recruitment of caspase-2 to the tumour necrosis factor receptor 1 (TNFR1). In this paper we have studied the subcellular localization of RAIDD and its interaction with caspase-2. We demonstrate that endogenous RAIDD is mostly localized in the cytoplasm and to some extent in the nucleus. RAIDD localization is not affected by TNF-treatment of HeLa cells, but in cells ectopically expressing caspase-2, a fraction of RAIDD is recruited to the nucleus. In transfected cells, coexpression of RAIDD and caspase-2 leads to CARDdependent colocalization of the two proteins to discrete subcellular structures. We further show that overexpression of the RAIDD-CARD results in the formation of filamentous structures due to CARD-mediated oligomerization. These structures were similar to death effector filaments (DEFs) formed by FADD and FLICE death effector domains (DEDs), and partially colocalized with DEFs. Our results suggest that similar to the DED, the RAIDD-CARD has the ability to form higher order complexes, believed to be important in apoptotic execution. We also present evidence that RAIDD-CARD oligomerization may be regulated by intramolecular folding of the RAIDD molecule. [ABSTRACT FROM AUTHOR]

An editorial is presented on the approaches to improving the management and treatment of patients with osteoporotic fractures are increasingly advocated in many countries. It outlines the management of those presenting with nonhip fractures is also addressed through the establishment of Fracture Liaison Services. An overview of the systematic approaches for the identification of high fracture risk is presented.

A letter to the editor is presented on an article regarding an vitamin D and bone development.

The global concern about human-induced climatic change and its potential effect on sea-level has dominated the debate on coastal vulnerability, particularly since a common assessment methodology was developed by the Intergovernmental Panel on Climate Change in 1991. There have been numerous attempts to use or adapt this methodology but the focus has remained on sea-level rise as the single most important issue for coastal vulnerability. This paper presents a revised and more holistic coastal vulnerability assessment methodology which incorporates spatial and temporal scales relevant to the predicted impacts of climatic change and current human-induced hazards. Three studies in contrasting coastal environments of South Australia demonstrate that there are significant regional variations in sea-level response, human-induced hazards and local planning issues and that these may present a greater immediate threat than the possibility of sea-level rise. [ABSTRACT FROM AUTHOR]

Presents information on a study which analyzed the distribution of knowledge about environmental issues related to energy and pollution in American high school students. Methodology; Results; Discussion.

Initial and sustained (7-h) impacts of foot-to-knee compression bandaging on leg arterial pulsatile blood flow were assessed by nuclear magnetic resonance flowmetry in eight healthy supine subjects. A widely used bandaging method (zinc impregnated gauze + Coban) and a slight variant (Coban only) were applied one week apart to one leg. Blood flow was measured on each day of bandage application before and after bandaging and after 7 h of normal activity. Initial mean sub-bandage pressures (lateral gaiter) were between 28·4 and 28·9 mmHg but were significantly reduced after 7 h to 16·3–19·4 mmHg. Overall below-knee pulsatile blood perfusion was initially significantly increased by both methods mainly due to increased proximal blood flow. Bandaging was also associated with a decrease in blood perfusion of the nonbandaged control leg mainly due to a decrease in distal blood flow. Neither of these effects were sustained after 7 h. The fact that neither sub-bandage pressure nor blood flow was sustained may indicate a causal linkage, a concept consistent with the finding of a linear relationship between afternoon blood flow and sub-bandage pressure reductions. The implications of the present findings for venous ulcer therapy are speculative and based on the concept that arterial pulsatile flow augmentation is a positive feature. If so, more frequent bandage changes to provide transient flow stimulation or use of bandages to better maintain sub-bandage pressure to sustain flow increases may be useful. [ABSTRACT FROM AUTHOR]

Past studies of female primate reproduction have focused on regularly cycling females, and thus the reproductive characteristics of females in other reproductive states (e.g., pregnant or lactating' have rarely been investigated. In this study, data were collected on estrous swellings and sexual and proceptive behavior in six female lion-tailed macaques during recovery from lactational amenorrhea for the first three to five postpregnancy cycles. For these females, the length of the first lactational recovery swelling cycle averaged 81 days, nearly three times the length of cycles exhibited by nonparturient, isosexually housed females. Actual swelling durations were also nearly three times the Length of those seen in nonlactating females, and occupied a larger proportion of the cycle. For most females, cycle duration and sexual and pruceptive behavior declined progressively over successive cycles. The alpha female in each group accounted for the majority of copulations in the first three cycles, and this effect was pronounced in the first cycle. Extended postpregnancy cycles in this species may be related to female reproductive competition and/or a tactic to attract extra-group males. [ABSTRACT FROM AUTHOR]

Discusses instructional guidelines designed to motivate students with learning problems in the United States. Theoretical perspectives; Identification of intrinsic motivation (IM) in the classroom; Development of IM through mediational learning experiences; Implications for individual educational programs of students with learning problems.

Assesses the current environmental knowledge base in a national probability sample of American high school students. Ability of majority of students to recognize basic facts concerning environmental problems; Inability of students to apply their environmental knowledge; Growth in environmental knowledge from 10th to 12th grade.

The article focuses on the launch of UK Biobank on March 30, 2012 for the use on health-related research of researchers. It states the unique and invaluable dataset gathered of the international osteoporosis community. It mentions that for the investigation of major disease the UK Medical Research Council and Wellcome Trust established the UK Biobank as international resources.

Osteoporosis is a disease characterized by impaired bone microarchitecture and reduced bone mineral density (BMD) resulting in bone fragility and increased risk of fracture. In western societies, one in three women and one in five men will sustain an osteoporotic fracture in their remaining lifetime from the age of 50 years. Fragility fractures, especially of the spine and hip, commonly give rise to increased morbidity and mortality. In the five largest European countries and Sweden, fragility fractures were the cause of 2.6 million disability-adjusted life years in 2016 and the fracture-related costs increased from €29.6 billion in 2010 to €37.5 billion in 2017. In the European Union and the USA, only a small proportion of women eligible for pharmacological treatment are being prescribed osteoporosis medication. Secondary fracture prevention, using Fracture Liaison Services, can be used to increase the rates of fracture risk assessment, BMD testing and use of osteoporosis medication in order to reduce fracture numbers. Additionally, established primary prevention strategies, based on case-finding methods utilizing fracture prediction tools, such as FRAX, to identify women without fracture but with elevated risk, are recommended in order to further reduce fracture numbers. [ABSTRACT FROM AUTHOR]

This study reports the development and characterization of 19 microsatellite primer pairs developed from genomic DNA of European pear ( Pyrus communis) and their transferability to other Pyrus and Malus material. The primers were designed from two different genomic libraries enriched for di- and trinucleotide repeats. When tested in six P. communis cultivars and 15 other Pyrus species, 13 primers revealed single-locus polymorphism and six showed more complex patterns that suggest multiple loci. Two to 18 alleles were detected per locus and two primer pairs were sufficient to discriminate all accessions. Transferability of nine primer pairs to Malus was demonstrated through amplification of discrete products in two accessions. [ABSTRACT FROM AUTHOR]

Ampelomyces spp. are common intracellular mycoparasites of powdery mildews worldwide and a strain has been commercialized as a biocontrol agent against these plant pathogens. In light of recent genetic analyses revealing high internal transcribed spacer sequence variability among Ampelomyces strains on different host plant mildews, yet no sequence variability within the Malus strain, polymorphic microsatellites were required to permit biocontrol and ecological studies of the complex apple/apple mildew/ Ampellomyces tritrophic interaction. For this purpose, described here are the primers to amplify six polymorphic microsatellite loci from Ampelomyces quisqualis isolated from mycelia of the apple powdery mildew fungus, Podosphaera leucotricha. [ABSTRACT FROM AUTHOR]

Summary: The National Osteoporosis Guideline Group (NOGG) has developed intervention thresholds based on FRAX® to characterise patients at high and very high risk of fracture. Introduction: Guidelines for the assessment of fracture risk have begun to categorise patients eligible for treatment into high and very high risk of fracture to inform choice of therapeutic approach. The aim of the present study was to develop intervention thresholds based on the hybrid assessment model of NOGG. Methods: We examined the impact of intervention thresholds in a simulated cross-sectional cohort of women age 50 years or more from the UK with the distribution of baseline characteristics based on that in the FRAX cohorts. The prevalence of very high risk using the hybrid model was compared with age-dependent thresholds used by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (IOF/ESCEO). The appropriateness of thresholds was tested based on the populations treated with anabolic agents. Results: With an upper intervention threshold using the IOF/ESCEO criteria, 56% of women age 50 years or more would be characterised at very high risk. This compares with 36% using the IOF/ESCEO criteria and an age-specific intervention threshold over all ages. With an upper intervention threshold of 1.6 times the pre-existing intervention threshold, 10% of women age 50 years or more would be characterised at very high risk. The data from phase 3 studies indicate that most trial participants exposed to romosozumab or teriparatide would fall into the very high-risk category. Conclusions: Proposals for FRAX-based criteria for very high risk for the NOGG hybrid model categorise a small proportion of women age 50 years or more (10%) in this highest risk stratum. The level of risk identified was comparable to that of women enrolled in trials of anabolic agents. [ABSTRACT FROM AUTHOR]

Summary: This study aimed to determine the interaction between baseline FRAX® fracture probability and romosozumab efficacy. Using an ITT approach, it was determined that the efficacy of romosozumab on clinical fracture, osteoporotic fracture, and major osteoporotic fracture is significantly greater in patients at high baseline fracture risk, when compared with placebo. Introduction: Post hoc analyses of placebo-controlled osteoporosis treatment studies have shown significantly greater reductions of fracture incidence for higher fracture risk patients. This study determined the interaction between baseline FRAX® fracture probability and romosozumab efficacy in the placebo-controlled first year of the phase 3 FRAME study (NCT01575834). Methods: Using an ITT approach, an extension of Poisson regression analysis studied the relationship between treatment, FRAX® 10-year probability of major osteoporotic fracture (MOF, calculated without BMD) and risk of first incident fracture (adjusting for age and follow-up time). Treatment interactions considered outcomes of all clinical fractures, osteoporotic fractures, MOF, clinical vertebral fractures, and morphometric vertebral fractures. Two-sided p value of < 0.1 for the interaction between treatment and FRAX® was considered significant. Results: Compared with placebo, romosozumab reduced the incidence of all fracture outcomes in the first year (range: 32% reduction in MOF [p = 0.07] to 80% reduction in clinical vertebral fractures [p = 0.038]). Significant interactions were observed between efficacy and baseline FRAX® probability for composite outcomes of clinical fractures, osteoporotic fractures, and MOF (p = 0.064–0.084), but not vertebral fractures (p > 0.3). For example, romosozumab decreased all clinical fractures by 22% at the 25th centile of FRAX® probability but the reduction was 41% at the 75th centile. Exclusion of vertebral fractures from each composite fracture outcome (i.e. only nonvertebral fractures included) showed even stronger interactions with baseline FRAX® probability (p = 0.036–0.046). Conclusions: Efficacy of romosozumab on clinical fracture, osteoporotic fracture, and MOF is significantly greater in patients at high baseline fracture risk compared with placebo. [ABSTRACT FROM AUTHOR]

Summary: The risk of a recurrent fragility fracture varies by age and sex, as by site and recency of sentinel fracture. Introduction: The recency of prior fractures affects subsequent fracture risk. Variable recency may obscure other factors that affect subsequent fracture risk. The aim of this study was to quantify the effect of a sentinel fracture by site, age, and sex where the recency was held constant. Methods: The study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Fracture incidence was compared to that of the general population determined at fixed times after a sentinel fracture (humeral, clinical vertebral, forearm, hip, and minor fractures). Outcome fractures comprised a major osteoporotic fracture and hip fracture. Results: Sentinel osteoporotic fractures were identified in 9504 men and women. Of these, 3616 individuals sustained a major osteoporotic fracture as the first subsequent fracture, of whom 1799 sustained a hip fracture. Hazard ratios for prior fracture were consistently higher in men than in women and decreased progressively with age. Hazard ratios varied according to the site of sentinel fracture with higher ratios for hip and vertebral fracture than for humerus, forearm, or minor osteoporotic fracture. Conclusion: The risk of a recurrent fragility fracture varies by age, sex, and site of sentinel fracture when recency is held constant. [ABSTRACT FROM AUTHOR]

Provides information on the issue of how physicians react when they become ill. Information on their attitudes towards other doctors.

Summary: The risk of a recurrent fragility fracture is particularly high immediately following the fracture. This study provides adjustments to FRAX-based fracture probabilities accounting for the site of a recent fracture. Introduction: The recency of prior fractures affects subsequent fracture risk. The aim of this study was to quantify the effect of a recent sentinel fracture, by site, on the 10-year probability of fracture determined with FRAX. Methods: The study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Fracture probabilities were determined after a sentinel fracture (humeral, clinical vertebral, forearm and hip fracture) from the hazards of death and fracture. Fracture probabilities were computed on the one hand for sentinel fractures occurring within the previous 2 years and on the other hand, probabilities for a prior osteoporotic fracture irrespective of recency. The probability ratios provided adjustments to conventional FRAX estimates of fracture probability for recent sentinel fractures. Results: Probability ratios to adjust 10-year FRAX probabilities of a major osteoporotic fracture for recent sentinel fractures were age dependent, decreasing with age in both men and women. Probability ratios varied according to the site of sentinel fracture with higher ratios for hip and vertebral fracture than for humerus or forearm fracture. Probability ratios to adjust 10-year FRAX probabilities of a hip fracture for recent sentinel fractures were also age dependent, decreasing with age in both men and women with the exception of forearm fractures. Conclusion: The probability ratios provide adjustments to conventional FRAX estimates of fracture probability for recent sentinel fractures. [ABSTRACT FROM AUTHOR]

The incidence of osteoporosis and cardiovascular disease increases with age, and there are potentially shared mechanistic associations between the two conditions. It is therefore highly relevant to understand the cardiovascular implications of osteoporosis medications. These are presented in this narrative review. Calcium supplementation could theoretically cause atheroma formation via calcium deposition, and in one study was found to be associated with myocardial infarction, but this has not been replicated. Vitamin D supplementation has been extensively investigated for cardiac benefit, but no consistent effect has been found. Despite findings in the early 21st century that menopausal hormone therapy was associated with coronary artery disease and venous thromboembolism (VTE), this therapy is now thought to be potentially safe (from a cardiac perspective) if started within the first 10 years of the menopause. Selective estrogen receptor modulators (SERMs) are associated with increased risk of VTE and may be related to fatal strokes (a subset of total strokes). Bisphosphonates could theoretically provide protection against atheroma. However, data from randomised trials and observational studies have neither robustly supported this nor consistently demonstrated the potential association with atrial fibrillation. Denosumab does not appear to be associated with cardiovascular disease and, although parathyroid hormone analogues are associated with palpitations and dizziness, no association with a defined cardiovascular pathology has been demonstrated. Finally, romosozumab has been shown to have a possible cardiovascular signal, and therefore post-market surveillance of this therapy will be vital. [ABSTRACT FROM AUTHOR]

Aim: To explore and synthesize evidence of the literature about healthcare professionals involved in the provision of diabetes management within an Indonesian context. Background: Indonesia is challenged to control the major burden of diabetes prevalence rate that requires a multidimensional approach with the aim to optimize existing health services by involving healthcare professionals who can promote access and provide diabetes management. Methods: This literature review, which is integrated with a scoping study framework, used the electronic databases including CINAHL, PubMed, Scopus and Web of Science to locate papers particular to the Indonesian context. From the total of 568 papers found, 20 papers were selected. Results: The literature review identified physicians, nurses, pharmacists, dieticians and diabetes educators as the providers of diabetes care and management in Indonesia. Collaborative management involving either interdisciplinary or intradisciplinary teams was mentioned in several papers. Internal challenges included limited skills and knowledge. External challenges included high patient volumes; a shortage of healthcare professionals and reduced funding. Conclusions: Overcoming the challenges cannot be undertaken with a workforce dominated by any one single healthcare professional. Coordinating with the government to improve the implementation of different roles in diabetes management will improve patient outcomes and thus reduce the burden of diabetes. Implication for nursing and health policy: Health policy reform should support nurses and other healthcare professionals in their professional development at all levels of health care. Policy makers can use the review findings to modify the current healthcare system to address key issues in workforce development; funding for services and medications; and fostering multidisciplinary care for diabetes management. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Parental smoking during pregnancy and offspring bone mass at age 10 years: findings from a prospective birth cohort," by C. Macdonald-Wallis and colleagues in the 2010 issue.