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The global center of marine biodiversity is located in the western tropical Pacific in a region known as the “Coral Triangle” (CT). This region is also considered the most threatened of all coral reef regions, because multiple impacts, including rising temperatures and coral bleaching, have already caused high mortality of reef corals over large portions of the CT. Larval dispersal and recruitment play a critical role in reef recovery after such disturbances, but our understanding of reproductive connectivity between reefs is limited by a paucity of observations. Oceanographic modeling can provide an economical and efficient way to augment our understanding of reef connectivity, particularly over an area as large as the CT, where marine ecosystem management has become a priority. This work combines daily averaged surface current velocity and direction from a Regional Ocean Modeling System developed for the CT region (CT-ROMS) with a Lagrangian particle tracking tool (TRACMASS) to investigate the probability of larval transport between reefs for a typical broadcasting coral. A 47-year historical simulation (1960–2006) was used to analyze the potential connectivity, the physical drivers of larval transport, and its variability following bi-annual spawning events in April and September. Potential connectivity between reefs was highly variable from year to year, emphasizing the need for long simulations. The results suggest that although reefs in this region are highly self-seeded, comparatively rare long-distance dispersal events may play a vital role in shaping regional patterns of reef biodiversity and recovery following disturbance. The spatial pattern of coral “subpopulations,” which are based on the potential connectivity between reefs, agrees with observed regional-scale patterns of biodiversity, suggesting that the physical barriers to larval dispersal are a first-order driver of coral biodiversity in the CT region. These physical barriers persist through the 21st Century when the model is forced with the Community Earth System Model (CESM) RCP8.5 climate scenario, despite some regional changes in connectivity between reefs.

Objectives Nociceptive thresholds and supra-threshold pain ratings as well as their reduction upon local injection with lidocaine were compared between healthy subjects and patients with erythromelalgia (EM). Methods Lidocaine (0.25, 0.50, 1.0 or 10 mg/mL) or placebo (saline) was injected intradermally in non-painful areas of the lower arm, in a randomized, double-blind manner, to test the effect on dynamic and static mechanical sensitivity, mechanical pain sensitivity, thermal thresholds and supra-threshold heat pain sensitivity. Results Heat pain thresholds and pain ratings to supra-threshold heat stimulation did not differ between EM-patients (n = 27) and controls (n = 25), neither did the dose–response curves for lidocaine. Only the subgroup of EM-patients with mutations in sodium channel subunits NaV1.7, 1.8 or 1.9 (n = 8) had increased lidocaine sensitivity for supra-threshold heat stimuli, contrasting lower sensitivity to strong mechanical stimuli. This pattern was particularly clear in the two patients carrying the NaV 1.7 I848T mutations in whom lidocaine's hyperalgesic effect on mechanical pain sensitivity contrasted more effective heat analgesia. Conclusion Heat pain thresholds are not sensitized in EM patients, even in those with gain-of-function mutations in NaV1.7. Differential lidocaine sensitivity was overt only for noxious stimuli in the supra-threshold range suggesting that sensitized supra-threshold encoding is important for the clinical pain phenotype in EM in addition to lower activation threshold. Intracutaneous lidocaine dose-dependently blocked nociceptive sensations, but we did not identify EM patients with particular high lidocaine sensitivity that could have provided valuable therapeutic guidance. Significance Acute pain thresholds and supra-threshold heat pain in controls and patients with erythromelalgia do not differ and have the same lidocaine sensitivity. Acute heat pain thresholds even in EM patients with the NaV 1.7 I848T mutation are normal and only nociceptor sensitivity to intradermal lidocaine is changed. Only in EM patients with mutations in NaV 1.7, 1.8 or 1.9 supra-threshold heat and mechanical pain shows differential lidocaine sensitivity as compared to controls.

Journal of neutron research 22(2-3), 109 - 118 (2020). doi:10.3233/JNR-200155, In the development of the European Spallation Source, the engineering phase of the Neutron Beam Extraction System is approaching its end. Currently, prototyping is ongoing to verify and increase the understanding of the manufacturing limitations in relation to the engineering aspects and beam extraction requirements from the instruments. After that the manufacturing of the suite of 16 neutron beam port inserts (NBPI) and light shutter systems (LSS) are phased into final detail design and manufacturing. The NBPIs have been developed as a close collaboration between ESS’ instruments design coordinators and intricately integrate a set of copper optics within a controlled atmosphere within the target monolith pressure vessel. The NBPIs therefore includes not only a processed atmosphere but also enables fine alignment of the optics assemblies within it, but also includes a system for inserting it into a very precisely aligned and measured position. Outside the NBPIs, along the neutron beam paths, sits the Neutron Beam Windows and sequentially, the LSS which incorporates an optical bridge beam guide before the beam enters the bunker area and the individual instrument beam transports. ESS have chosen the concept of LSS, which generates demanding requirements for alignment of moving shutter parts. These system parts are placed in the bunker area and bunker basement, areas that are partly accessible during maintenance periods., Published by IOS Press, Amsterdam

Nociceptive thresholds and supra-threshold pain ratings as well as their reduction upon local injection with lidocaine were compared between healthy subjects and patients with erythromelalgia (EM).Lidocaine (0.25, 0.50, 1.0 or 10 mg/mL) or placebo (saline) was injected intradermally in non-painful areas of the lower arm, in a randomized, double-blind manner, to test the effect on dynamic and static mechanical sensitivity, mechanical pain sensitivity, thermal thresholds and supra-threshold heat pain sensitivity.Heat pain thresholds and pain ratings to supra-threshold heat stimulation did not differ between EM-patients (n = 27) and controls (n = 25), neither did the dose-response curves for lidocaine. Only the subgroup of EM-patients with mutations in sodium channel subunits NaHeat pain thresholds are not sensitized in EM patients, even in those with gain-of-function mutations in NaAcute pain thresholds and supra-threshold heat pain in controls and patients with erythromelalgia do not differ and have the same lidocaine sensitivity. Acute heat pain thresholds even in EM patients with the Na

Broschyren sammanfattar övervakning och resultat inom ett urval av delprogram inom den regionala miljöövervakningen i Kalmar län.

BACKGROUND: Breast cancer (BC) burden and care vary substantially across Latin America (LA). Aim: Provide an overview of the epidemiology, outcomes and countries’ risk profiles in LA to identify opportunities for improvement. METHODS: Review of literature (PubMed, LILACS, SCIELO), public databases (Globocan 2002 & 2008, CEPALSTAT, DIRAC, PAHO, WHOSYS, etc) and conference presentations (ASCO, ISPOR). Local experts & patient organizations were surveyed. Current BC epidemiology in LAC, future trends, countries’ risk profiles and outcomes (such as mortality-to-incidence ratios — MIRs) were analyzed and compared (Sweden as benchmark). RESULTS: BC annual incidence (114,900 cases) & mortality (37,000 deaths) are the highest of all cancers in LA and twice as many deaths are expected by 2030. Countries more advanced in the demographic transition, like Uruguay and Argentina, present much higher incidence and mortality but also better outcomes as observed in their MIRs. In LA women are diagnosed younger and at a more advanced stage, especially in countries with poor outcomes, such as Ecuador, Mexico or Peru. The imbalanced progress since 2002 seems to widen the gap in BC outcomes, but countries like Costa Rica are catching up. Age is the main risk factor; while the association of education and wealth with BC occurrence is less significant. Reproductive and lifestyle-related risk factors, proven at a patient level, were not significant at a country-aggregate level and the specialized literature indicates that the evidence on associations between BC and diet is inconclusive. DISCUSSION: LA's considerable variation embedded within per-countries’ averages may be masking underlying causality. Though, it can be inferred that there is no one-suit-all prevention campaign and policies aimed at reducing the risk of developing BC will succeed as long as they are properly targeted and tailored for different needs. Early diagnosis and population-wide access to treatment following evidence-based best practices remain unresolved matters that endow many of these countries with the opportunity to substantially improve the care for their women. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-25.

The aim of the present study was to determine the magnitude of the impact of treating depression to full remission on cost and health-related quality of life. In a naturalistic longitudinal survey recordings of resource use and quality of life were carried out among depressed patients treated with antidepressant therapy in 56 Swedish primary care clinics. We found that a total of 52% of the patients achieved full remission during the study period. Remitting patients had, on average, three outpatient visits less than non-remitting patients (p < 0.01), 22 fewer sick leave days (p = 0.01), which translated into a significantly lower total cost (Euro 2700) compared with non-remitting patients (p < 0.01). Health-related quality-of-life scores improved by 40% for remitting patients when compared with non-remitting ones (p < 0.01). We conclude that remission has a substantial health economic impact on patients treated for depression, which further strengthens the importance of aiming for full remission in the treatment of depression.

High birthweight and increased childhood growth are risk factors for type 1 diabetes. Relative birthweight is associated with HLA genotypes that confer a high risk of diabetes. Our aims were to test whether young children prior to clinical onset of type 1 diabetes have increased: (1) birthweight or birth length standard deviation scores (SDS); (2) height development SDS; or (3) BMI SDS during first 18 months of life and whether these parameters are related to HLA genotypes or mid-parental height (MPH).Birthweight, birth length, weight and height were obtained from 58 type 1 diabetes children and 155 controls matched for HLA or not in the Diabetes Prediction in Skåne study.Birth length SDS corrected for MPH was increased in children developing diabetes compared with all (p0.048) and with non-HLA- (p0.050) but not with HLA-matched controls. Children developing diabetes had increased height gain at 0 to 18 months of age (p0.005). Diabetic children were significantly taller from 6 to 18 months of age when correcting for MPH compared with non-HLA-matched as well as HLA-matched controls, but BMI was not increased.Birth length SDS was associated with diabetes risk HLA. When corrected for MPH, children developing diabetes were taller at birth than non-HLA- but not taller than HLA-matched controls. Diabetic children had increased MPH-corrected height up to 18 months of age compared with both HLA- and non-HLA-matched controls. High-risk HLA affects prenatal growth, but other factors may explain the increased postnatal linear growth in children developing diabetes.

All 410 ten- and twelve-year-old children of a school district underwent two repeated physical examinations within the school services, the first by the school nurse, the second by the school doctor. The aim was to compare their assessments to see if physical class examinations could be delegated to the nurse in future in order to release doctor's time. More than half of the children were found to have slight deviations from normal, most common of the spine and in the skin. The nurse detected many more deviations than the doctor but their assessments showed good agreement concerning functionally important deviations. Newly detected functionally important deviations were noted in 8 children (2%). The routine physical examination could perfectly well be delegated to the school nurse who has the necessary prerequisites to take this responsibility and screen out those children in need of a doctor's assessment, in this study 20%. She would release valuable time for the doctor who could then apply himself to the real health problems of the children of today: chronic diseases, behavioural and school problems, many of which frequently are concerns beyond the boundaries of traditional medical care.

Gentic structure in populations of Fucus vesiculosus (Phaeophyceae) over spatial scales from 10 m to 800 km

Genetic and morphological identification of Fucus radicans sp. nov. (Fucales, Phaeophyceae) in the brackish Baltic Sea

Reproduction of attached large brown algae is known to occur only by sexual zygotes. Using microsatellites we show evolution of asexual reproduction in the bladder wrack promoting population persistence in the brackish water Baltic Sea (< 6 psu). Here a dwarf morph of Fucus vesiculosus is dominated by a single clone but clonal reproduction is also present in the common form of the species. We describe a possible mechanism for vegetative reproduction of attached algae, and conclude that clonality plays an important role in persistence and dispersal of these marginal populations, in which sexual reproduction is impaired by low salinity.

Pneumococcal vaccination of older persons is thought to be cost-effective in preventing pneumococcal pneumonia, but evidence of clinical protection is uncertain. Because there is better evidence of vaccination effectiveness against invasive pneumococcal disease, we determined the cost-effectiveness of pneumococcal vaccination of persons agedor =65 years in preventing hospital admission for both invasive pneumococcal disease and pneumococcal pneumonia in 5 western European countries. In the base case analyses, the cost-effectiveness ratios for preventing invasive disease varied from approximately 11,000 to approximately 33,000 European currency units (ecu) per quality-adjusted life year (QALY). Assuming a common incidence (50 cases per 100,000) and mortality rate (20%-40%) for invasive disease, the cost-effectiveness ratios were12,000 ecu per QALY in all 5 countries. For preventing pneumococcal pneumonia, vaccinating all elderly persons would be highly cost-effective to cost saving. Public health authorities should consider policies for encouraging pneumococcal vaccination for all persons agedor =65 years.

The aim of this study was to compare the usefulness of two different questionnaires assessing oral health-related quality of life (OHRQoL) at the basic examination and after initial dental hygiene treatment (DHtx).A total of 42 patients referred for periodontal treatment completed the Oral Health Impact Profile (OHIP-14) and the General Oral Health Assessment Index (GOHAI) at the basic periodontal examination. They underwent DHtx and completed the questionnaires once again after the treatment.No statistically significant differences could be found between the two assessments, neither for the total scores nor for any of the separate items of the OHIP-14 or the GOHAI. However, the GOHAI questionnaire seems to result in a greater variety in the responses indicating that the floor effect is not as pronounced as for the OHIP-14. Those who had rated their oral health as good reported significantly better OHRQoL on both questionnaires. The same pattern was found for patients who reported that they were satisfied with their teeth. After DHtx and necessary extractions, there was a statistically significant correlation between the number of teeth and the total scores on both questionnaires. No other statistically significant correlations with periodontal variables could be found.No statistically significant difference could be found after DHtx compared to before in regard to OHRQoL assessed with OHIP-14 and GOHAI. However, there was a greater variety in the responses with the GOHAI questionnaire; it may hereby be more useful for patients with periodontal disease.

Using Monte Carlo (MC) simulation, mean-field and scaling arguments we investigate forces between charged spherical aggregates conferred by an oppositely charged polymeric chain. At interaggregate separations comparable to the length of the chain the force is attractive due to a special type of long-range bridging attraction mediated by the polyelectrolyte chain, adsorbed to both aggregates. Beyond a certain separation (capture separation) there is a symmetry-breaking transition in the monomer density distribution, resulting in a preferential adsorption of the chain to one of the aggregates.

Adherence to lipid-lowering therapy in clinical practice is less than ideal. Analysis of registry data has indicated that this is associated with poor outcomes. The objective of the present analysis was to assess the impact of high adherence to drug (defined as80% of days covered), compared with low adherence to drug (50% of days covered) in terms of risk of events and long-term economic consequences.Open-label follow up of a randomised placebo-controlled trial in hypertensive patients.Cox proportional hazards and Poisson regression models were used to assess the hazard ratio of patients with high adherence compared with low adherence while controlling for cardiovascular risk. A Markov model was used to predict the long-term costs and health outcomes associated with poor adherence during the follow-up period.Both statistical models indicated that high adherence is associated with improved prognosis [Cox model: 0.75; 95% confidence interval (CI): 0.56-0.98, Poisson model hazard ratio: 0.73; 95% CI: 0.58-0.98]. Discounted at 3.5% per year, the Markov model predicts that as a consequence of higher adherence during the follow-up period, costs would be higher (1689 pounds per patient compared with 1323 pounds per patient) because of higher drug costs, but the projected survival and quality-adjusted survival (QALY) would also be longer (10.83 compared with 10.81 life years and 8.13 compared with 8.11 QALYs).Given the higher risk of cardiovascular events associated with low adherence shown here, measures to improve adherence are an important part of the prevention of cardiovascular disease.

We have recently proposed a theoretical framework for the effect of the eluting salt ionic strength of the eluent on the retention factor of proteins in ion-exchange chromatography of proteins. It is based on the solution of the linearized Poisson-Boltzmann equation for two oppositely charged planar surfaces in contact with a salt solution and describes the coulombic interaction between the protein and the oppositely charged stationary-phase surface. At sufficiently high salt concentrations in the mobile phase van der Waals interactions between the protein and the stationary phase become important. In this work we consider the effect of salt on the combined coulombic and van der Waals interactions by combining the electrostatic theory with the theory for van der Waals interactions. The combined theory describes the retention of proteins as a function of eluting salt concentration over a wide salt concentration range. The protein molecules are, according to the proposed theory, held in a diffuse layer close to the stationary phase and are not in a distinct layer, which is assumed in the traditional thermodynamic interpretation of the capacity factor. For this reason, we also examine the thermodynamic interpretation of the capacity factor when it is due to distant dependent interactions.

The force between two parallel zwitterionic surfaces has been calculated using Monte Carlo computer simulations. The zwitterions are modelled as two oppositely charged hard spheres joined by a string of length L with parameters chosen to mimic a phospholipid system. All centers interact by a homogeneous Coulomb interaction and by a hard sphere exclusion. The anchoring of the negative centers to the surfaces has been treated within two different models. They were either anchored by a parabolic potential or by a protrusion potential, i.e., a potential proportional to the distance between the center and the surface. The latter model gives a more realistic picture of the interaction between amphiphilic surfaces in aqueous solution but here only repulsive forces could be calculated. The first model also allowed the calculation of attractive forces. For distances D between the surfaces, as defined by the location of the negative centers, that are larger than 2L there is an attractive force of the classical van der Waals type. When, on the other hand, D Recently it was suggested (Israelachvili and Wennerstrom, Langmuir, 6 (1990) 873 ) that the repulsive so called hydration force observed for biological lipid systems has its origin in confinements of surface excitations induced by a second surface. Here we demonstrate how this mechanism works in a particular microscopic model of the surface and we show that it gives an important contribution to the total force. Although still simplistic several qualitative features of the force in the phospholipid systems are reproduced in the calculations. For example, a reduction of the size of the charged centers leads to a decrease in the repulsive force. This mimics the observed difference between phosphatidyl choline and phosphatidyl ethanolamine.

After administration of 600 mg of the antiepileptic oxcarbazepine to 7 healthy volunteers, serum and stimulated saliva samples were collected for the next 72 h. Concentrations of 10-OH-carbazepine, the main metabolite of oxcarbazepine, were determined by an HPLC method. The time-concentration curves showed a median Tmax of 8 h followed by a plateau until 24 h indicating saturable kinetic processes. Based on the curves, the pharmacokinetic parameters were calculated. The half-life of 10-OH-carbazepine in saliva, 13.8 +/- 3.7 (SD) h, was significantly shorter than in serum, 19.3 +/- 6.2 (SD) h. The half-life of 10-OH-carbazepine in serum was inversely correlated to the free fraction, estimated by the ratio saliva/serum concentrations. Calculation of free fraction by this method showed that 53.1 +/- 14.4 (SD) % of 10-OH-carbazepine is unbound in serum. There was a good correlation (r = 0.914) between serum and saliva concentrations of 10-OH-carbazepine from 8-72 h after administration of oxcarbazepine. This finding indicates that saliva concentrations may prove useful, as has been shown for carbamazepine, in therapeutic monitoring of oxcarbazepine treatment.

The aim of this randomized placebo-controlled study is to ascertain the costs of intravenous thrombolytic therapy (rt-PA) in the first year after suspected myocardial infarction and to measure the treatment effect on quality of life. The main findings are that the direct costs (including all health care expenditure), on average were 9880 SEK higher in the rt-PA group (N = 153) than in the placebo group (N = 160). At the same time the indirect costs were 4200 SEK lower in the rt-PA group. The total cost of the first year after suspected myocardial infarction were on average 5680 SEK higher in the rt-PA group. The treatment gain in mean life expectancy calculated with a yearly mortality rate of 6% from the end of follow up was 1.25 years. Quality of life was measured using the Nottingham Health Profile and was classified according to NYH As functional classification. The Nottingham Health Profile (NHP) results show that the rt-PA patients had a slightly higher (worse) score in all dimensions after one month with the exception of sleep. After 12 months the differences no longer exist and the rt-PA patients had even lower (better) scores in the sleep and energy dimensions. The calculated cost-effectiveness ratio varies from 3090 to 5970 SEK per life year saved and the calculated cost-utility ratio varies from 3260 SEK to 6310 SEK per QALY gained. In comparison with other heart disease treatments, intravenous thrombolysis is cost-effective.

To evaluate the effectiveness of an individually tailored oral health educational programme for oral hygiene self-care in patients with chronic periodontitis compared with the standard treatment.A randomized, evaluator-blinded, controlled trial with two different active treatments were used with 113 subjects (60 females and 53 males) randomly allocated to an experimental or a control group. The individually tailored oral health educational programme was based on cognitive behavioural principles and the individual tailoring for each participant was based on participants' thoughts, intermediate, and long-term goals, and oral health status. The effect of the programmes on gingivitis [gingival index (GI)], oral hygiene [plaque indices (PlI) and self-report], and participants' global rating of treatment was evaluated 3 and 12 months after oral health education and non-surgical treatment.Between baseline and the 12-month follow-up, the experimental group improved both GI and PlI more than the control group. The mean gain-score difference was 0.27 for global GI [99.2% confidence interval (CI): 0.16-0.39, p0.001] and 0.40 for proximal GI (99.2% CI: 0.27-0.53, p0.001). The mean gain-score difference was 0.16 for global PlI (99.2% CI: 0.03-0.30, p=0.001), and 0.26 for proximal PlI (99.2% CI: 0.10-0.43, p0.001). The subjects in the experimental group reported a higher frequency of daily inter-dental cleaning and were more certain that they could maintain the attained level of behaviour change.The individually tailored oral health educational programme was efficacious in improving long-term adherence to oral hygiene in periodontal treatment. The largest difference was for interproximal surfaces.

We have used Monte Carlo simulations to study the interaction of two uniformly charged colloidal particles with adsorbed oppositely charged polyelectrolytes. A predominantly attractive net force is found. The force consists of an attractive term due to bridging and electrostatic correlations and a repulsive term of direct entropic origin. At large separations the force is found to be determined by electrostatic interactions, but at shorter separations the bridging by polyelectrolytes stretching between the colloids is the dominant contribution. This bridging attraction is large and significant in comparison with the ordinary van der Waals interaction.

ObjectivesThe objective of the present study was to assess the impact of depression on patients' health-related quality of life (HRQL) with the EQ-5D instrument over 6 months while on antidepressant treatment.MethodsA total of 447 patients were recruited at 56 primary care centers to this naturalistic longitudinal observational study. Patients older than 18 years with depressive symptoms, and who initiated an antidepressant therapy because of depression were included in the study. Data on patients' sociodemographics, daily activity, and quality of life (EQ-5D) were collected using questionnaires completed during outpatient general practitioner visits for a follow-up period of 6 months.ResultsThe mean EQ-5D utility score at baseline was 0.47 (0.44–0.49). Milder cases of depression reported a health utility of 0.60, whereas moderately and severely depressed patients reported utility values of 0.46 and 0.27, respectively (P < 0.01). At end of follow up the average utility was 0.69 (0.67–0.72), corresponding to an increase of 0.23 over 6 months (P < 0.01). Regression analyses showed that, all else equal, patients who were on sick leave were associated with 10% lower utility.ConclusionDepression has a substantial impact on HRQL. Our results indicate that treatments for depression are associated with significant improvement in EQ-5D index score over a course of 6 months. Self-reported patient valuations are important outcomes for cost-utility analysis of new treatments for depression and the present study provides important evidence for future economic evaluations.

Objectives: The objective of this study was to develop a model to assess the cost-effectiveness of a new treatment for patients with depression.Methods: A Markov simulation model was constructed to evaluate standard care for depression as performed in clinical practice compared with a new treatment for depression. Costs and effects were estimated for time horizons of 6 months to 5 years. A naturalistic longitudinal observational study provided data on costs, quality of life, and transition probabilities. Data on long-term consequences of depression and mortality risks were collected from the literature. Cost-effectiveness was quantified as quality-adjusted life-years (QALYs) gained from the new treatment compared with standard care, and the societal perspective was taken. Probabilistic analyses were conducted to present the uncertainty in the results, and sensitivity analyses were conducted on key parameters used in the model.Results: Compared with standard care, the new hypothetical therapy was predicted to substantially decrease costs and was also associated with gains in QALYs. With an improved treatment effect of 50 percent on achieving full remission, the net cost savings were 20,000 Swedish kronor over a 5-year follow-up time, given equal costs of treatments. Patients gained .073 QALYs over 5 years. The results are sensitive to changes in assigned treatment effects.Conclusions: The present study provides a new model for assessing the cost-effectiveness of treatments for depression by incorporating full remission as the treatment goal and QALYs as the primary outcome measure. Moreover, we show the usefulness of naturalistic real-life data on costs and quality of life and transition probabilities when modeling the disease over time.

The aim of the present study was to determine the magnitude of the impact of treating depression to full remission on cost and health-related quality of life. In a naturalistic longitudinal survey recordings of resource use and quality of life were carried out among depressed patients treated with antidepressant therapy in 56 Swedish primary care clinics. We found that a total of 52% of the patients achieved full remission during the study period. Remitting patients had, on average, three outpatient visits less than non-remitting patients (p0.01), 22 fewer sick leave days (p = 0.01), which translated into a significantly lower total cost (Euro 2700) compared with non-remitting patients (p0.01). Health-related quality-of-life scores improved by 40% for remitting patients when compared with non-remitting ones (p0.01). We conclude that remission has a substantial health economic impact on patients treated for depression, which further strengthens the importance of aiming for full remission in the treatment of depression.

We investigated medical resource consumption, productivity loss and costs associated with patients treated with antidepressants for depression in primary care in Sweden. Patients on treatment for depression were followed naturalistically for six-months, and data on patients' characteristics, daily activity and resource-use were collected. The total cost per patient was estimated at euro 5,500 (95%CI euro 5,000-6,100) over six months in 2005 prices. Direct costs were estimated at euro 1,900 (euro 1,700-2,200), 35% of total costs, and indirect costs at euro 3,600 (euro 3,100-4,100), 65% of total costs. The cost for antidepressants represented only 4% of the total costs. We conclude that the burden of depression is high, both to the individual as well as to wider society, and there seems to be a particular need for therapies that have the potential to improve productivity in depressed patients.

Reproduction of attached large brown algae is known to occur only by sexual zygotes. Using microsatellites we show evolution of asexual reproduction in the bladder wrack promoting population persistence in the brackish water Baltic Sea (6 psu). Here a dwarf morph of Fucus vesiculosus is dominated by a single clone but clonal reproduction is also present in the common form of the species. We describe a possible mechanism for vegetative reproduction of attached algae, and conclude that clonality plays an important role in persistence and dispersal of these marginal populations, in which sexual reproduction is impaired by low salinity.

Der Finger-Boden-Abstand-Test (FBA; Abb. 1 ) und der Straight-Leg-Raising-Test (SLR) sind reliable Tests fur spezifische Wirbelsaulenerkrankungen. Bei Patienten mit chronischem Ruckenschmerz und einer spezifischen Funktionsstorung, wie zum Beispiel radikularem Schmerz, zeigen diese Tests eine gute Korrelation zur subjektiven schmerzbedingten Beeintrachtigung. Beide Tests sind bislang jedoch nicht ausreichend untersucht hinsichtlich ihrer Validitat im zeitlichen Verlauf und hinsichtlich ihres pradiktiven Wertes beim akuten/subakuten und chronischen Ruckenschmerz mit oder ohne radikulare Ausstrahlung.

We have found a polymorphism in the ECP (eosinophil cationic protein)-gene at position 434 according to GenBank accession number NM 002935. This polymorphism would cause the change of the amino acid arginine (base at position 434 is G) at position 97 to threonine (base at position 434 is C).To investigate the prevalence of the ECP-polymorphism and to screen for disease associations.DNA of 209 medical students and 76 asthmatic subjects was analysed. The 434 genotype in the ECP-gene was detected by cleavage of the amplified DNA sequence with the restriction enzyme PstI and analysis of the cleaved product by agarose gel electrophoresis.The prevalences of the polymorphism in the student population were 53%, 39% and 8% for the 434GG, the 434GC and the 434CC genotype, respectively, with allele frequencies of 72% (434G) and 28% (434C). Subjects reporting allergy had a higher prevalence of the 434G allele than non-allergic subjects (P = 0.0056). Of the students who were Phadiatop-positive and had allergic symptoms, 79% had the 434GG genotype, whereas the 434GC and 434CC genotypes were present in 82% of those who did not express allergic symptoms (P0.001). Among the 76 patients with asthma, patients with allergic asthma had a significantly higher proportion of 434GG compared with patients with non-allergic asthma (P = 0.04). None of the 18 subjects of the two groups with the 434CC genotype had allergy.The 434(GC) polymorphism in the ECP-gene is related to the development of allergic symptoms, suggesting a central role for the ECP molecule in the process.

The objective of the study was to evaluate the validity of oscillometric systolic ankle pressure in symptomatic leg arterial occlusive disease. Ankle pressure measurements using oscillometric curves obtained using a standard 12-cm cuff with a specially designed device for signal processing were validated against the continuous wave (CW) Doppler technique. Thirty-four subjects without signs or symptoms of peripheral vascular disease (68 legs) and 47 patients with leg ischaemia (85 legs) varying from moderate claudication to critical ischaemia were examined. The oscillometric curves were analysed using several algorithms reported in the literature, based on the assumption that maximum oscillations are recorded near mean arterial pressure. In normals, reasonable agreement between CW Doppler and oscillometric methods was seen. When an algorithm that determined the lowest cuff pressure at which maximum oscillations occurred, and a characteristic ratio for systolic pressure of 0.52 was used, the mean difference between CW Doppler and oscillometry was 1.7 mmHg [range -19 to +27, limits of agreement (2 SD) 21.1 mmHg]. In ischaemic legs, oscillometry overestimated systolic ankle pressure by a mean of 28.8 mmHg [range -126 to +65, limits of agreement 82.8 mmHg]. The difference was more pronounced among patients with critical ischaemia compared with claudicants, and also more evident among diabetics. The error of oscillometric pressure determination in subjects with leg arterial disease inversely increased with CW Doppler ankle pressure. In 39% of the recordings in legs with a CW Doppler systolic pressure below 100 mmHg, the oscillometric mean arterial pressure was higher than the recorded CW Doppler systolic pressure. In conclusion, the oscillometric method to determine systolic ankle pressure, based on the concept of maximum cuff oscillations occurring near mean arterial pressure, is not reliable in leg arterial disease, usually overestimating ankle pressure.

The pneumococcal vaccine has been shown to be about 70 percent efficacious in preventing invasive pneumococcal disease in elderly persons. In a European multicenter study, pneumococcal vaccination was moderately cost-effective in preventing hospital admission due to invasive pneumococcal disease in persons 65 years of age or above. In Sweden the cost was approximately 300,000 SEK per quality adjusted life years (QALY) gained, but only about 60,000 SEK per QALY in a two-way sensitivity analysis making reasonable assumptions regarding the incidence and mortality of invasive pneumococcal disease in this age group. On the basis of these findings, pneumococcal vaccination should be recommended for all persons 65 years of age or older.

A study on diffusion measurements of the protein lysozyme in liquids and agarose gels, at different pH and ionic strengths, has been performed using holographic laser interferometry. The measurements showed that the diffusive flux was very dependent on pH and ionic strength when the protein was not at its isoelectric point or when the charge of the lysozyme molecules was not screened by ions in the solution. Evaluation of the experimental data with Fick's law, resulted in diffusion coefficients for lysozyme that are strongly dependent on pH and ionic strength. Evaluation of the experimental data using a more general transport model, based on chemical potential gradients instead of concentration gradients resulted in lysozyme diffusion coefficients that are independent of pH and ionic strength. The chemical potential was estimated by using the Poisson-Boltzmann equation.

The ionization state of seven glutamate residues, one aspartate, and the C-terminal alpha-COOH group in bovine apo calbindin D(9k) has been studied by measurement and modeling of the pH titration curves and apparent pK(a) values. The observed pK(a) ranged from 3.0 to 6.5. Most of the observed acidic groups were half-ionized at lower pH values than those in unstructured proteins. As a rule, the ionization equilibria extended over a wider pH range than in the case of unperturbed single titrations, indicating a complex influence of protein charges on the charge state of each individual residue. Glu17, which is a backbone Ca(2+)-ligand in the N-terminal binding loop of calbindin D(9k), was half-protonated at pH 3.6 but manifested biphasic titration with apparent pK(a) values of 3.2 and 6.5. Complementary Monte Carlo simulations of the titration process and pK(a) values of the acidic groups in calbindin D(9k) reproduce the experimentally observed titration features, except for the pronounced double titration of Glu17. Discrepancies between the results from direct measurement and from modeling may be partly caused by changes in the protein structure when the net charge changes from -8 to +11 over the isoelectric point at pH 5. Proteins 1999;37:106-115.