Long Term Study

Diabetes" and related "Health Beliefs Concerning Diabetes" (Bradley's questionnaires, 1984), a fully randomized short-of structured outpatient education for Functional Insulin Treatment (FIT: selective insulin dosages for eating, fasting or term controlled Study 1 (four weeks, 32 patients), and longterm uncontrolled pilot Study 2 (three years, 68 patients) were correcting hyperglycaemia) on perceived control over diabetes and related health beliefs. FIT was thought to influence the performed. Results: The short-term study revealed that FIT induced the feeling of independence from situational control perception of self-efficacy in diabetes, in contrast to conventional treatment, based on scheduled, rigid food intake and while self-managing diabetes. In the long-term study, the patients were increasingly freed from the feeling of being under insulin delivery-it allows flexible eating, provided independent control of glycemia. Methods: Structured, comprehen-the control of physician and treatment-related restrictions, which-together with higher perceived self-efficacy-con-sive, outpatient group training in FIT for selective use of insulin either for eating, fasting or correction included practi-tributed to the feeling of "empowerment." This was associated with high treatment satisfaction and significant improvement cal "insulin games." The FIT program focused on everyday criteria for choices of insulin dosages and thus on the patient's of glycemic control. Conclusion: Structured out-patient group training for FIT results in measurable improvement of pa-ability to execute his/her newly gained flexible treatment to his/her everyday life while preventing acute and late complica-tients' perceived control over diabetes and self-efficacy.

A large prospective long-term study with users of natural family planning (NFP) methods has been conducted to analyze the relation between unintended pregnancy rates and sexual behavior with special reference to barrier method use in the fertile phase. Seven hundred and fifty eight NFP beginners, 19-45 years of age, 14870 cycles, 28 unintended pregnancies were studied. Of the couples, 54.2% use NFP only or predominantly and 45.9% use mixed methods (additional barrier method use in the fertile phase in 55.7% of the cycles). The overall pregnancy rate after 12 cycles of exposure is 2.2% according to the actuarial method. There is no significant difference between NFP users and mixed methods users and also no significant effect of duration of use in the first 5 years of exposure. During "perfect use" the pregnancy rate at 12 months is 0.63%. When only protected intercourse takes place in the fertile phase the pregnancy rate is 0.45%. The symptothermal method of NFP is most un...

The importance of patient-reported outcomes such as health-related quality of life (HRQL) in clinical research is increasingly acknowledged. In order to yield valid results, the measurement properties of HRQL questionnaires must be thoroughly investigated. One aspect of such a validation process is the demonstration of content validity, i.e. that the questionnaire covers all relevant aspects. We review studies reporting on consequences of thyroid disorders and present the frequency of identified aspects, both overall HRQL issues and classical thyroid symptoms, in order to evaluate which issues are relevant for patients with thyroid diseases. Furthermore, existing questionnaires for thyroid patients are reviewed. A systematic search was performed in the Medline, Cinahl and Psycinfo databases and the reference lists of the relevant articles were hand-searched. Seventy-five relevant studies were identified. According to these studies, patients with untreated thyroid disease suffer from a wide range of symptoms and have major impairment in most areas of HRQL. Furthermore, the studies indicate that impairments in HRQL are also frequent in the long term. Six HRQL questionnaires for thyroid patients were identified. Generally, data supporting the validity of these questionnaires were sparse. According to the available literature, the quality of life of thyroid patients is substantially impaired over a wide range of aspects of HRQL in the untreated phase and continues to be so in many patients also in the long term. Studies systematically exploring the relative importance of these various aspects to thyroid patients are lacking, as is a comprehensive, validated thyroid-specific HRQL questionnaire.

Rarely do ecologists have the data needed to assess the impacts of invading species on biodiversity, i.e. pre-and post-invasion census information from both invaded and control sites. Using a 21-year time series, we demonstrate that the invasion of Harp Lake, Ontario, Canada, by the Eurasian spiny water flea, Bythotrephes longimanus, a zooplanktivore, was accompanied by a rapid and long-lasting reduction in the average species richness of crustacean zooplankton, particularly of cladoceran taxa. No such reduction was observed in seven nearby un-invaded lakes over the same two decades. If the Harp Lake results are typical, we predict a widespread reduction in crustacean zooplankton richness on the Canadian Shield for three reasons. Shield lakes provide the invader with good habitat. Its dispersal rates and colonization success are high. Zooplankton richness in Harp Lake is now unusually low for a Shield Lake of its size and acidity.

It is generally considered that stress causes decreased immune function in fish. In this study we examined in Atlantic salmon (Salmo salar Linnaeus) the effects of both short-(a single 15 s out of water) and long-term (4 weeks of daily handling 15 s out of water) stress on plasma cortisol (free and total) and glucose levels, expression of interleukin-1b (IL-1b) and survival of head kidney (HK) macrophages under culture with Aeromonas salmonicida. In the short-term study, samples were collected prior to the application of the stressor, and at 1, 3, 6, 12 and 24 h post stress. Free and total plasma cortisol levels and the percentage of free cortisol increased significantly in the stressed group at 1 and 3 h post stress. Plasma glucose levels were significantly higher than those of control fish at 1, 3 and 6 h post stress. Constitutive expression of IL-1b in macrophages isolated from head kidneys in stressed fish was significantly higher at 1 and 3 h post stress. However, lipopolysaccharide (LPS) stimulated expression of IL-1b in HK macrophages, exhibited significantly higher fold increases in unstressed fish compared to stressed fish. In the long-term study, with the exception of an increase in plasma glucose levels at 1 week, there were no significant differences in stress parameters between groups. There was a significantly higher constitutive IL-1b expression in macrophages isolated from stressed fish over the first 2 weeks. At weeks 1, 2 and 3 the magnitude of IL-1b response of isolated HK macrophages to LPS stimulation was reduced in >90% of the stressed fish. At 4 weeks there was no significant difference in inducible IL-1b expression between the groups. Macrophages isolated from stressed fish also showed significantly decreased survival when exposed to A. salmonicida. This study shows a clear pattern from repeated handling stress, whereby effects on immune cells begin with increased constitutive expression of IL-1b, followed by decreased stimulation of leucocytes by extracellular antigen, and finally decreased

Sediment traps were deployed on the Northwest Shelf (NWS) of Australia in November 1996, to determine fluxes of organic matter and inorganic elements from the photic zone to deeper waters in a transect extending from Exmouth Shelf to Exmouth Plateau. Infiltrex II water samplers collected particulate and dissolved organics from the water column near the trap sites. Surface sediments and sediment cores were also collected over the study region. Lipid biomarkers were used to determine the sources of organic carbon and its cycling processes on the NWS.Dry weight fluxes from the traps ranged from 124 to 616 mg m−2 day−1and particulate organic carbon (POC) fluxes ranged from 22 to 42 mg m−2 day−1. The biogenic lipids consisted of biomarkers indicative of marine zooplankton, phytoplankton and bacteria, plus traces of land plant markers. A large contribution of unresolved complex material (UCM), which is indicative of petroleum, was detected at four times the biogenic hydrocarbon flux at shallow stations, and up to seven times the biogenic hydrocarbon flux at the most offshore station.There is essentially no river input, and only trace aeolian-derived material to contribute to primary production on the NWS of Australia. Most of the organic matter produced are rapidly recycled in the water column and the small fraction of lipids that settle to the sediments is already partially degraded and undergoes further rapid degradation in the surface sediments. Natural oil seeps also provide utilisable organic carbon to the system. The production and vertical flux rates of organics determined in this study are comparable to those reported in studies of shallow traps in oceanic areas from long-term studies in the Arabian Sea, and other coastal margins such as the Bay of Biscay (France) and California (USA).In offshore areas, most “living” lipid materials passed through the GFF filters thus invalidating POC estimates based on high volume sampling. To adequately assess living (particulate) carbon, gentle filtration of low volume seawater samples is more accurate, as shown by this solid phase absorption study of individual lipid biomarkers.

Variation of abundance, dominance and diversity of tardigrades were studied over a period of 54 months in a carpet of the moss Rhytidiadelphus squarrosus that covered a lawn in the Black Forest (Germany). Altogether 19,909 individuals belonging to 24 species were extracted from the moss. Macrobiotus hufelandi (56%), Macrobiotus richtersi (18%) and Diphascon pingue (12%) were the most abundant and dominant species. Dominances of the other species varied between 0.01 to 2.15%. Generally, species diversity (Shannon-Index and evenness) was highest during the winter. A temporal variation in numbers with a decline in winter and an increase in spring until fall was seen in M. hufelandi, D. pingue and less clear in M. richtersi. Three species (Diphascon rugosum, Hypsibius dujardini, Hypsibius cfr. convergens) showed a cyclic variation with clear peaks in wintertime. The moist season favoured species that were considered as hygrophilous in the literature, whereas the relatively dry sunny seasons promoted the relative increase of euryhygric species. The composition of the tardigrade community was strikingly robust over the years. Fourteen species were always present during the entire period of investigation. However, changes in the species composition over the years, and cyclical temporal presence of certain species stress the significance of long-term studies to estimate species richness in a given habitat. Application of the Spearman rank correlation test to the data set of the whole study period showed different correlations between the mean number of tardigrades as well as the mean number of individuals of selected species (dominance >1) and rainfall, humidity and temperature. Correlations confirmed some of the ecological dependences of tardigrade species known from literature. Conflicting classifications suggest dependence from other variables or perhaps presence of ecotypes.

Objective and design: To investigate the severity and duration of colitis induced by two different doses of 2,4,6-trinitrobenzenesulfonic acid (TNBS) and the changes in mast cell number in acute infl ammation and in the recovery process of colitis. Methods: Colitis was induced in rats by an enema of TNBS (10 or 30 mg) in 25 % ethanol. Macroscopic and histologic changes of the colon, colon weight and mast cell counts were examined at various times (7, 30 and 60 days) after colitis induction. Results: TNBS induced a colonic damage which was doserelated for both severity and time necessary to complete recovery. On day 7 after colitis induction 10 mg TNBS induced macroscopic and microscopic alterations of colonic architecture that completely resolved at day 60. By contrast, 30 mg TNBS induced massive necrosis, thickening of the colon, severe histologic changes that were only partially reversed after two months. Mast cell number in the submucosa and muscularis propria decreased signifi cantly in the acute phase of infl ammation (7 days) and slowly increased thereafter, reaching a maximum level (up to about 5-fold) at day 60 after both doses of TNBS. Conclusions: Present data confi rm the ability of TNBS to induce in rats damage to the colon that was dose-dependent for severity and duration. Moreover, these data unravel a different role of mast cells in TNBS-induced colitis: an early degranulation in the acute phase of infl ammation and a subsequent accumulation of mast cells in the late phase of the disease, associated with tissue repair.

The Pressure-State-Response framework for environmental reporting was used as a basis to develop a long-term study of people's perceptions of the state of the New Zealand environment. A postal survey of 2000 people, randomly drawn from the New Zealand electoral roll was used to gather data -an effective response rate of 48% was achieved. A range of different resource sectors was examined. We report on New Zealand's air, native animals and plants, and marine fisheries, as well as New Zealand compared to other developed countries. Respondents generally considered that in terms of pressures, states and responses, New Zealand was performing better than other developed countries and that for the resources examined here overall performance was in the adequate to good range, except for marine fisheries. The survey appears to be a useful tool for linking perceptions data into State of the Environment reporting. It also helps identify policy issues where perceptions do not match other scientific evidence or management initiatives. Such findings can be important for the successful implementation of policy measures.

Several long-term mark recapture studies have been conducted on box turtles (Terrapene c. carolina) providing valuable information on life span, basic demography, home range, and apparent effects of environmental changes on box turtle survival. One of the longest studied populations was first marked in 1942 on the Patuxent Wildlife Research Center in Maryland, and has been surveyed every 10 years

The objective of this study was to determine the effect of calcium phosphate mineral content on the bone in-growth at the expense of composite of co-polylactide polymer charged with 2 different ratios of b-TCP granules (10 and 24 w-% of b-TCP). The evaluation was realized in a long term rabbit bone model. After 24, 48 and 76 weeks, the implants were examined by micro CT, scanning electron microscopy (SEM) using backscattered electron (BSE) and light microscopy (polarized and blue light microscopy). No foreign body reaction was detected during the 76 weeks follow-up in any of the test samples. Polymer hydrolysis began at approximately 24 weeks, by 76 weeks, the pure polymer implant had begun to release P(96L/4D)LA particles and show signs of peripheral localized bone resorption. A decrease in the amount of CaP was noticed between 24 and 76 weeks in both 10 wt-% and 24 wt-% b-TCP/P(96L/4D)LA composites. The study showed that the highest bone in-growth was with 24 wt-% b-TCP/P(96L/4D)LA composite. Bone in-growth and mineralization were evident for the composites associated with specific peripheral bone architecture. Fluorescent labelling demonstrated high bone in-growth and remodeling at the interface, while for pure co-polymer no bone remodeling or bone activity was maintained after 48 weeks. The study demonstrated the positive effect of calcium phosphate content into P(96L/4D)LA. This kind of composite is a suitable resorbable osteoconductive matrix, which provides long term stability required for ligament fixation device.

Although type 2 diabetes is determined primarily by lifestyle and genes, dietary composition may affect both its development and complications. Dietary fat is of particular interest because fatty acids influence glucose metabolism by altering cell membrane function, enzyme activity, insulin signaling, and gene expression. This paper focuses on the prevention of type 2 diabetes and summarizes the epidemiologic literature on associations between types of dietary fat and diabetes risk. It also summarizes controlled feeding studies on the effects of dietary fats on metabolic mediators, such as insulin resistance. Taken together, the evidence suggests that replacing saturated fats and trans fatty acids with unsaturated (polyunsaturated and/or monounsaturated) fats has beneficial effects on insulin sensitivity and is likely to reduce risk of type 2 diabetes. Among polyunsaturated fats, linoleic acid from the n-6 series improves insulin sensitivity. On the other hand, long-chain n-3 fatty acids do not appear to improve insulin sensitivity or glucose metabolism. In dietary practice, foods rich in vegetable oils, including non-hydrogenated margarines, nuts, and seeds, should replace foods rich in saturated fats from meats and fat-rich dairy products. Consumption of partially hydrogenated fats should be minimized. Additional controlled, long-term studies are needed to improve our knowledge on the optimal proportion of different types of fats to prevent diabetes.

Habitat destruction and fragmentation are the root causes of many conservation problems. We conducted a literature survey and canvassed the ecological community to identify experimental studies of terrestrial habitat fragmentation and to determine whether consistent themes were emerging from these studies. Our survey revealed 20 fragmentation experiments worldwide. Most studies focused on effects of fragmentation on species richness or on the abundance(s) of particular species. Other important themes were the effect of fragmentation in interspecific interactions, the role of corridors and landscape connectivity in individual movements and species richness, and the influences of edge effects on ecosystem services. Our comparisons showed a remarkable lack of consistency in results across studies, especially with regard to species richness and abundance relative to fragment size. Experiments with arthropods showed the best fit with theoretical expectations of greater species richness on larger fragments. Highly mobile taxa such as birds and mammals, early-successional plant species, long-lived species, and generalist predators did not respond in the "expected" manner. Reasons for these discrepancies included edge effects, competitive release in the habitat fragments, and the spatial scale of the experiments. One of the more consistently supported hypotheses was that movement and species richness are positively affected by corridors and connectivity, respectively. Transient effects dominated many systems; for example, crowding of individuals on fragments commonly was observed after fragmentation, followed by a relaxation toward lower abundance in subsequent years. The three long-term studies ( у 14 years) revealed strong patterns that would have been missed in short-term investigations. Our results emphasize the wide range of species-specific responses to fragmentation, the need for elucidation of behavioral mechanisms affecting these responses, and the potential for changing responses to fragmentation over time.

Population size is a major determinant of extinction risk. However, controversy remains as to how large populations need to be to ensure persistence. It is generally believed that minimum viable population sizes (MVPs) would be highly specific, depending on the environmental and life history characteristics of the species. We used population viability analysis to estimate MVPs for 102 species. We define a minimum viable population size as one with a 99% probability of persistence for 40 generations. The models are comprehensive and include age-structure, catastrophes, demographic stochasticity, environmental stochasticity, and inbreeding depression. The mean and median estimates of MVP were 7316 and 5816 adults, respectively. This is slightly larger than, but in general agreement with, previous estimates of MVP. MVPs did not differ significantly among major taxa, or with latitude or trophic level, but were negatively correlated with population growth rate and positively correlated with the length of the study used to parameterize the model. A doubling of study duration increased the estimated MVP by approximately 67%. The increase in extinction risk is associated with greater temporal variation in population size for models built from longer data sets. Short-term studies consistently underestimate the true variances for demographic parameters in populations. Thus, the lack of long-term studies for endangered species leads to widespread underestimation of extinction risk. The results of our simulations suggest that conservation programs, for wild populations, need to be designed to conserve habitat capable of supporting approximately 7000 adult vertebrates in order to ensure long-term persistence. #

Marine turtle fibropapillomatosis (FP) is a disease primarily affecting green turtles (Chelonia mydas) that is characterized by multiple cutaneous masses. In addition, the condition has been confirmed in other species of sea turtles. The disease has a worldwide, circumtropical distribution and has been observed in all major oceans. Although reported since the late 1930s in Florida, it was not until the late 1980s that it reached epizootic proportions in several sea turtle populations. Long-term studies have shown that pelagic turtles recruiting to near shore environments are free of the disease. After exposure to these benthic ecosystems, FP manifests itself with primary growths in the corner of the eyes spreading to other epithelial tissue. One or more herpesviruses, a papillomavirus, and a retrovirus have been found associated with tumors using electron microscopy and molecular techniques; however, the primary etiological agent remains to be isolated and characterized. Field observations support that the prevalence of the disease is associated with heavily polluted coastal areas, areas of high human density, agricultural runoff, and/or biotoxin-producing algae. Marine turtles can serve as excellent sentinels of ecosystem health in these benthic environments. FP can possibly be used as an indicator but correlations with physical and chemical characteristics of water and other factors need to be made. Further research in identifying the etiologic agent and its association with other environmental variables can provide sufficient parameters to measure the health of coastal marine ecosystems, which serve not only as ecotourism spots but also as primary feeding areas for sea turtles.

Purpose Treatment of anal fistulas by use of adhesives is an attractive method because of its simplicity and it can be performed on an ambulatory basis. Furthermore, if the treatment is unsuccessful, adhesive use does not subsequently prevent the surgeon from utilizing alternative surgical techniques and/or products. BioGlue® Surgical Adhesive is a two-component surgical adhesive composed of bovine serum albumin and glutaraldehyde. We evaluated the usefulness of BioGlue® for the treatment of high transsphincter anal fistulas. Methods Patients diagnosed with high transsphincter anal fistulas of cryptoglandular origin, whether relapsed or not, were included in this study. A seton was placed before the injection of BioGlue® into the fistula track of high transsphincter anal fistulas in patients with secondary tracts and/or purulent collections. Clinical charts, operative reports, and endoanal echography results obtained for each patient were reviewed. Results Fourteen patients (13 males; mean age, 39.9 (range, 24–66) years) with high transsphincter anal fistulas of cryptoglandular origin were recruited into the study. The average time of symptom evolution was 35.6 (range, 2–96) months. Ten of 14 cases were for relapsed fistulas. Six patients required the placement of a seton 37 (range, 32–42) days before the BioGlue® injection. Patients were followed for a mean length of 13.92 (range, 3–21) months, and the fistula healed completely in only seven patients (50 percent). Conclusions These preliminary results demonstrate that BioGlue® may be useful for treating patients with high transsphincter anal fistulas. Further prospective long-term studies are needed.

The recently developed Morphological Acceleration Factor (MORFAC) approach for morphodynamic upscaling enables numerical model simulations of coastal evolution at decadal to millennial time scales. Primarily due to the massive increase in modeling time scales it affords, the MORFAC approach is now standard in state-of-the-art commercially available coastal morphodynamic modeling suites. However, the general validity of the MORFAC concept for coastal applications has not yet been comprehensively investigated. Furthermore, a robust and objective method (as opposed to the subjective and inelegant trial and error method) for the a priori determination of the highest MORFAC that is suitable for a given simulation (i.e. critical MORFAC) does not currently exist. This communication presents some initial results of an ongoing, long-term study that attempts to rigorously and methodically investigate the limitations and strengths of the MORFAC approach. Based on the results of a strategically designed numerical modeling exercise using the morphodynamic model Delft3D, two main outcomes are presented. First, the main dependencies and sensitivities of the MORFAC approach to fundamental forcing conditions and model parameters are elucidated. Second, a criterion based on the Courant-Friedrichs-Levy (CFL) condition for bed form propagation that maybe used as a guide to determine the critical MORFAC a priori is proposed.

Although yohimbine (YOH) has been available for the treatment of male erectile dysfunction (ED) for longer than Viagra 1 , there is a perception that little is known about the clinical performance of the drug. This review attempts, by comprehensive analysis of the literature, to cover the clinical, pharmacological, and therapeutic profiles of YOH, relevant to its potential utility in the management of patients with ED. Relatively few well-designed studies have been completed. From these, however, it can be concluded that YOH as monotherapy possesses only modest efficacy in ED patients. In acute and chronic (long-term) studies, YOH has been found to be relatively free of side effects over the dose range predicted to be effective in ED. At much higher doses, the most frequently observed effects, consistent with the primary pharmacological action of the drug, are elevation of blood pressure, a slight anxiogenic action, and increased frequency of urination. These side effects are all easily reversible on termination of YOH therapy. There is increasing evidence that the erectogenic action of YOH can be augmented by concomitant administration of agents that augment the release and/or action of nitric oxide in the corpus cavernosum. YOH has yet to be studied in female sexual dysfunction. Overall, the benefit risk profile of YOH would indicate that it has potential, more probably as part of a combination strategy, e.g., with a drug that enhances the nitric oxide pathway, in the treatment of ED.

Although oil activities generate numerous forms of environmental impact on biological communities, studies of these impacts on Brazilian coastal ecosystems are rare. Results of tests for the content of oil in sediments and organisms indicate a substantially high rate of degradation. Results for uptake of polycyclic aromatic hydrocarbons in bivalves suggested the recent occurrence of oil spills and that these organisms differed in their capabilities to bioconcentrate oil. The mangrove community has suffered constant inputs of oil and has responded with increased numbers of aerial roots, generation of malformed leaves and fruits by plants, and a decrease in litter production. Studies of the impact of oil on rocky shore communities and the toxicity of oil and its by-products to marine organisms have confirmed the results reported in the literature. Presently most of the available studies deal with the macroscopic effects of oil on organisms and have indicated that the nature of oil, climate characteristics, the physical environment, and the structure of the community influence the symptoms of oil contamination in organisms of coastal waters. Longterm studies should be carried out to assess changes in community structure, sublethal effects in populations, and the resilience of contaminated ecosystems.

River Atna is situated in south-eastern Norway and stretches from approx. 1400 m a.s.l. in the Rondane Mountains, through Lake Atnsjøen, at 701 m a.s.l.; to the confluence with River Glomma at 338 m a.s.l. The catchment area is 1323 km 2 , oligotrophic and very susceptible to acid precipitation. The river water is very poor in nutrients and ions, and pH varies from 5.0 to 7.2. Samples were taken each year from 1987 to 2002 at three to five localities from 1280 to 380 m a.s.l. Insect larvae were collected by Surber sampling and by kick sampling. Malaise traps were used to collect adults of Plecoptera, Trichoptera, Chironomidae and Limoniidae. A total of 16 taxa of Ephemeroptera, 24 taxa of Plecoptera, 39 taxa of Trichoptera, 125 taxa of Chironomidae and 52 taxa of Limoniidae, were identified. Our results from Atna provide some support for a zonation of the river based on zoobenthos. The occurrence and abundance of functional groups among the Plecoptera, Trichoptera, and Chironomidae are discussed in relation to the River Continuum Concept (RCC). Our conclusion is that grazers dominate in the zoobenthos in streams in the treeless alpine region in Norway. Natural lakes, which occur in most watercourses in Norway, appear to cause a disturbance in relation to the original RCC concept, as the zoobenthos community in and below the lake outlet is dominated by collectors (filter feeders). The pattern found in the Atna watercourse is probably a general pattern for a northern watercourse in the Holarctic, where the glacial periods created lakes in most watercourses. The results of the long term sampling in Atna are discussed in relation to the practicalities and the cost-benefit of zoobenthos in efficient bio-monitoring in rivers.

Obesity Surgery,[962][963][964][965][966][967][968][969] The rising prevalence of morbid obesity and the increased incidence of super-obese patients (BMI >50 kg/m 2 ) seeking surgical treatments has led to the search for surgical techniques that provide adequate EWL with the least possible morbidity. Sleeve gastrectomy (SG) was initially added as a modification to the biliopancreatic diversion (BPD) and then combined with a duodenal switch (DS) in 1988. It was first performed laparoscopically in 1999 as part of a DS and subsequently done alone as a staged procedure in 2000. With the revelation that patients experienced weight loss after SG, interest in using this procedure as a bridge to more definitive surgical treatment has risen. Benefits of SG include the low rate of complications, the avoidance of foreign material, the maintenance of normal gastro-intestinal continuity, the absence of malabsorption and the ability to convert to multiple other operations. Reduction of the ghrelinproducing stomach mass may account for its superiority to other gastric restrictive procedures. SG should be in the armamentarium of all bariatric surgeons. Nonetheless, long-term studies are necessary to see if it is a durable procedure in the treatment of morbid obesity.

The impact of African elephantsLoxodonta africana Blumenbuch, 1797 on biodiversity is hotly debated in wildlife management circles with scientists polarised in their views. This polarisation is largely due to the individual experiences of researchers. We aimed to determine whether elephants or rainfall patterns drove changes in vegetation condition (Normalised Difference Vegetation Index; NDVI) by avoiding a site-specific approach and looking at the issue at a broader scale. We used published estimates of elephant population density from 30 sites and recorded the change in density from 1995–1999, from 1999–2002 and from 2002–2006. We also recorded the deviation of annual rainfall from the long-term mean for those periods. We modelled these variables against the change in NDVI between periods using mixed effects models. We found that elephants were more influential in driving change in vegetation condition than rainfall, and this also occurred at one of our individual test sites where long-term data were available (Kruger). Elephants and rainfall combined to drive change in vegetation condition at our other long-term test site (Amboseli). Management activities (fencing, water provision) may cause the differences between the two long-term study sites. Change in productivity driven by rainfall has ramifications for biodiversity, suggesting that elephant derived changes in vegetation productivity (NDVI) also impacts on biodiversity. Thus, this study supports previous findings from individual sites that elephants impact vegetation, however there is also a suggestion that these impacts may vary according to management actions.

Conservation strategies for long-lived vertebrates require accurate estimates of parameters relative to the populations' size, numbers of non-breeding individuals (the ''cryptic'' fraction of the population) and the age structure. Frequently, visual survey techniques are used to make these estimates but the accuracy of these approaches is questionable, mainly because of the existence of numerous potential biases. Here we compare data on population trends and age structure in a bearded vulture (Gypaetus barbatus) population from visual surveys performed at supplementary feeding stations with data derived from population matrix-modelling approximations. Our results suggest that visual surveys overestimate the number of immature (,2 years old) birds, whereas subadults (3-5 y.o.) and adults (.6 y.o.) were underestimated in comparison with the predictions of a population model using a stable-age distribution. In addition, we found that visual surveys did not provide conclusive information on true variations in the size of the focal population. Our results suggest that although longterm studies (i.e. population matrix modelling based on capture-recapture procedures) are a more time-consuming method, they provide more reliable and robust estimates of population parameters needed in designing and applying conservation strategies. The findings shown here are likely transferable to the management and conservation of other long-lived vertebrate populations that share similar life-history traits and ecological requirements.

This article suggests that a genuine reform endeavor towards the "Science for All" paradigm should adopt a holistic approach. There are several countries around the world that adopted the "Science for All" paradigm at the beginning of the 21 st century. However, while looking closely at the amount of change that took place in schools following the new paradigm, it seems that like previous reforms, there is a gap between the rhetoric and the actual change. A series of studies indicate that Earth systems science approach is much effective than the traditional "science for all" approach. While implementing it correctly, it succeeds to attract students from both groups -the high achievers group and the much bigger group of students to whom the traditional science programs were frequently inaccessible. Both groups found the Earth System approach attractive and interesting and both gained a significant amount of knowledge and understanding. However, the earth systems approach alone will not be enough and in order to attract most of the students and in addition such programs should be based on a holistic approach that should also include the following characteristics: (1) Learning in an authentic and relevant context as much as possible.

Background and purpose In Pakistan, almost 70% of the population lives in rural areas. Ninety-four percent of households in rural areas and 58% in urban areas depend on biomass fuels (wood, dung, and agricultural waste). These solid fuels have poor combustion efficiency. Due to incomplete combustion of the biomass fuels, the resulting smoke contains a range of health-deteriorating substances that, at varying concentrations, can pose a serious threat to human health. Indoor air pollution accounts for 28,000 deaths a year and 40 million cases of acute respiratory illness. It places a significant economic burden on Pakistan with an annual cost of 1% of GDP. Despite the mounting evidence of an association between indoor air pollution and ill health, policy makers have paid little attention to it. This review analyzes the existing information on levels of indoor air pollution in Pakistan and suggests suitable intervention methods. Methods This review is focused on studies of indoor air pollution, due to biomass fuels, in Pakistan published in both scientific journals and by the Government and international organizations. In addition, the importance of environmental tobacco smoke as an indoor pollutant is highlighted. Results Unlike many other developing countries, there are no long-term studies on the levels of indoor air pollution. The limited studies that have been undertaken indicate that indoor air pollution should be a public health concern. High levels of particulate matter and carbon monoxide have been reported, and generally, women and children are subject to the maximum exposure. There have been a few interventions, with improved stoves, in some areas since 1990. However, the effectiveness of these interventions has not been fully evaluated. Conclusion Indoor air pollution has a significant impact on the health of the population in Pakistan. The use of biomass fuel as an energy source is the biggest contributor to poor indoor air quality followed by smoking. In order to arrest the increasing levels of indoor pollution, there is a dire need to recognize it as a major health hazard and formulate a national policy to combat it. An integrated effort, with involvement of all stakeholders, could yield promising results. A countrywide public awareness campaign, on the association of indoor air pollution with ill health, followed by practical intervention would be an appropriate approach. Due to the current socioeconomic conditions in the country, development and adoption of improved cooking stoves for the population at large would be the most suitable choice. However, the potential of biogas as a fuel should be explored further, and modern fuels (natural gas and LPG) need to be accessible and economical. Smoking in closed public spaces should be banned, and knowledge of the effect of smoking on indoor air quality needs to be quantified.

Results of several long-term studies of non-woody litter decomposition in forests indicate that we need to rethink why and how we measure rates of litter decomposition. Effects on litter decomposition rates were postulated to explain some of the nutritional effects of factors such as tree species, forest harvesting and fertilization. However, the accumulated experimental evidence indicates that litter decomposition rates do not mediate these responses. Many studies have reported litter mass loss becoming extremely slow at values considerably below 100%, indicating that early decay rates may not accurately foreshadow the entire decay process. Exclusion of soil faunal activities from current measurements of decomposition rates seriously reduces the likelihood that we are properly modeling decomposition. Finally, the use of regression and correlation analyses to determine which climate or initial litter quality factors control decay rate has led to many unwarranted and potentially misleading conclusions. These concerns are illustrated with examples from a suite of litter decomposition studies in British Columbia, Canada. Insights into nutrient cycling and carbon storage in ecosystems are more likely to arise from measuring the mass and nutrient content of annual litter input and determining the maximum decomposition limit and nutrient content at that stage, than by measuring early rates of decay. Improved predictions of relative decay rates of plant litters are likely to arise from a holistic approach based on plant life attributes rather than correlations based on individual initial litter chemistry parameters. Finally, a better understanding of the fate of faecal material of soil fauna is necessary before we can accurately predict and model litter decomposition. #

Background: Terminalia chebula (Combretaceae) has been widely used in Ayurveda for the treatment of diabetes. In the present investigation, the chloroform extract of T. chebula seed powder was investigated for its antidiabetic activity in streptozotocin-induced diabetic rats using short term and long term study protocols. The efficacy of the extract was also evaluated for protection of renal functions in diabetic rats.

This is the conference proceedings of the UNWTO Ulysses Conference 2007, "Knowledgebased Development through Tourism," which was held in Madrid, Spain on 30-31 May 2007. This conference was organized by the UNWTO Education Council and UNWTO Education and Knowledge Management Department.

The commercial culture of shrimp in low water salinities has been successfully achieved. However, there are no long-term studies on the growth response of shrimp culture in freshwater. In the present study white shrimp Penaeus vannamei was cultured in freshwater (0 ppt) at three densities (90, 130 and 180 shrimp m − 2 ) and comparisons made of the resulting growth, length-weight relationship and condition factor data. Gravimetric data were recorded during a 210-day trial to estimate growth rates, the length-weight relationship and the condition factor (according to Fulton's equation). Weight gain results showed the freshwater culture system to be viable, with effects from density (P b 0.05). Growth rates decreased as density increased, exhibiting an inverse relationship (P b 0.05, R 2 = 0.68). Survival decreased as density increased with differences between treatments (P b 0.05). A potential model was used to analyze the length-weight relationship of the treatments. The slopes were different between treatments according to an ANCOVA and a Tukey test (P b 0.05). The function exponents showed that the 130 shrimp m − 2 treatment produced organisms with isometric growth (b = 2.99) in good condition (t = 0.96; P N 0.05). The 90 shrimp m − 2 treatment produced positive allometric growth and the 180 shrimp m − 2 treatment negative allometric growth.

Patients with neuropathic pain (NP) are challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated at a consensus meeting. Medications were considered for recommendation if their efficacy was supported by at least one methodologically-sound, randomized clinical trial (RCT) demonstrating superiority to placebo or a relevant comparison treatment. Recommendations were based on the amount and consistency of evidence, degree of efficacy, safety, and clinical experience of the authors. Available RCTs typically evaluated chronic NP of moderate to severe intensity. Recommended first-line treatments include certain antidepressants (i.e., tricyclic antidepressants and dual reuptake inhibitors of both serotonin and norepinephrine), calcium channel a2-d ligands (i.e., gabapentin and pregabalin), and topical lidocaine. Opioid analgesics and tramadol are recommended as generally second-line treatments that can be considered for first-line use in select clinical circumstances. Other medications that would generally be used as third-line treatments but that could also be used as second-line treatments in some circumstances include certain antiepileptic and antidepressant medications, mexiletine, N-methyl-D-aspartate receptor antagonists, and topical capsaicin. Medication selection should be individualized, considering side effects, potential beneficial or deleterious effects on comorbidities, and whether prompt onset of pain relief is necessary. To date, no medications have demonstrated efficacy in lumbosacral radiculopathy, which is probably the most common type of NP. Long-term studies, head-to-head comparisons between medications, studies

Based on the body of evidence implicating ocular blood flow disturbances in the pathogenesis of glaucoma, there is great interest in the investigation of the effects of antiglaucoma drugs and systemic medications on the various ocular vascular beds. The primary aim of this article was to review the current data available on the effects of antiglaucoma drugs and systemic medications on ocular blood flow. We performed a literature search in November 2002, which consisted of a textword search in MEDLINE for the years 1968-2002. The results of this review suggest that there is a severe lack of well-designed long-term studies investigating the effects of antiglaucoma and systemic medications on ocular blood flow in glaucomatous patients. However, among the 136 articles dealing with the effect of antiglaucoma drugs on ocular blood flow, only 36 (26.5%) investigated the effects of medications on glaucoma patients. Among these 36 articles, only 3 (8.3%) were long-term studies, and only 16 (44.4%) were double-masked, randomized, prospective trials. Among the 33 articles describing the effects of systemic medications on ocular blood flow, only 11 (33.3%) investigated glaucoma patients, of which only one (9.1%) was a double-masked, randomized, prospective trial. Based on this preliminary data, we would intimate that few antiglaucoma medications have the potential to directly improve ocular blood flow. Unoprostone appears to have a reproducible antiendothelin-1 effect, betaxolol may exert a calcium-channel blocker action, apraclonidine consistently leads to anterior segment vasoconstriction, and carbonic anhydrase inhibitors seem to accelerate the retinal circulation. Longitudinal, prospective, randomized trials are needed to investigate the effects of vasoactive substances with no hypotensive effect on the progression of glaucoma.

This study presents the results of a ten year monitoring programme on cultural and tourism development in the city of Sibiu. Over the ten year research period the programme expanded to cover a wide range of data sources, including resident and visitor surveys, stakeholder interviews and secondary statistical data. The research started at a fairly low level with studies of single events in the cultural agenda of Sibiu. The programme was significantly expanded in 2007 thanks to the staging of the European Capital of Culture in ...

The growth in the use of cellular phone has raised the concerns about the possible interaction between the electromagnetic fields (EMF) radiation and the biological effects on human tissues, particularly the brain and the human immune system. These concerns have induced a large volume of research studies. However, most of the previous review studies are concentrated on negative effects and no published work took in consideration all possible effects caused by the use of cell phones. In this paper we aim to provide review of some studies which investigated the possible negative and positive biological effects of cell phone radiation on human tissues. This review will provide answers for public concerns about the risk of using cell phone. Our conclusion shows that long-term exposure to EMF radiation from a cell phone could cause health effects, such as brain cancer. Some positive health effects due to the exposure to the EMF radiation such as improve bone healing and reduce toxic effects of chemotherapy are highlighted. Finally, some studies have also showed no effect due to exposure to EMF. More long-term studies and analysis are much needed

Anecdotal evidence, sighting reports, Inuit traditional knowledge, and photographic identification indicate that killer whale (Orcinus orca) occurrence in Hudson Bay is increasing. Killer whales were not known to be present in the region prior to the mid-1900s but have since shown an exponential increase in sightings. More sightings from Foxe Basin, Nunavut in the north to Churchill, Manitoba in the south appear to be related to a decrease in summer sea ice in Hudson Strait. Killer whale activity during the open water season has been concentrated in the northwest Hudson Bay region that includes the Repulse Bay and northern Foxe Basin areas.