A comprehensive molecular phylogeny of Dalytyphloplanida (Platyhelminthes: Rhabdocoela) reveals multiple escapes from the marine environment and origins of symbiotic relationships

In this study we elaborate the phylogeny of Dalytyphloplanida based on complete 18S rDNA (156 sequences) and partial 28S rDNA (125 sequences), using a Maximum Likelihood and a Bayesian Inference approach, in order to investigate the origin of a limnic or limnoterrestrial and of a symbiotic lifestyle in this large group of rhabditophoran flatworms. The results of our phylogenetic analyses and ancestral state reconstructions indicate that dalytyphloplanids have their origin in the marine environment and that there was one highly successful invasion of the freshwater environment, leading to a large radiation of limnic and limnoterrestrial dalytyphloplanids. This monophyletic freshwater clade, Limnotyphloplanida, comprises the taxa Dalyelliidae, Temnocephalida, and most Typhloplanidae. Temnocephalida can be considered ectosymbiotic Dalyelliidae as they are embedded within this group. Secondary returns to brackish water and marine environments occurred relatively frequently in several dalyeliid and typhloplanid taxa. Our phylogenies also show that, apart from the Limnotyphloplanida, there have been only few independent invasions of the limnic environment, and apparently these were not followed by spectacular speciation events. The distinct phylogenetic positions of the symbiotic taxa also suggest multiple origins of commensal and parasitic life strategies within Dalytyphloplanida. The previously established higher-level dalytyphloplanid clades are confirmed in our topologies, but many of the traditional families are not monophyletic. Alternative hypothesis testing constraining the monophyly of these families in the topologies and using the approximately unbiased test, also statistically rejects their monophyly

Barriers to apply cardiovascular prediction rules in primary care: a postal survey

BACKGROUND: Although cardiovascular prediction rules are recommended by guidelines to evaluate global cardiovascular risk for primary prevention, they are rarely used in primary care. Little is known about barriers for application. The objective of this study was to evaluate barriers impeding the application of cardiovascular prediction rules in primary prevention. METHODS: We performed a postal survey among general physicians in two Swiss Cantons by a purpose designed questionnaire. RESULTS: 356 of 772 dispatched questionnaires were returned (response rate 49.3%). About three quarters (74%) of general physicians rarely or never use cardiovascular prediction rules. Most often stated barriers to apply prediction rules among rarely- or never-users are doubts concerning over-simplification of risk assessment using these instruments (58%) and potential risk of (medical) over-treatment (54%). 57% report that the numerical information resulting from prediction rules is often not helpful for decision-making in practice. CONCLUSION: If regular application of cardiovascular prediction rules in primary care is in demand additional interventions are needed to increase acceptance of these tools for patient management among general physicians

Eosinophilic cystitis mimicking bladder tumor

A 48-year-old man presented to the Urology Department with acute dysuria and macroscopic hematuria for 2 days. There was no frequency or nocturnal enuresis. Analysis of midstream urine showed hematuria and pyuria

The Effect of Various Levels of Dietary Starch on Glycogen Replenishment in the Light Working Horse

Nine Quarter Horses (2 to 7 yr; 409 to 494 kg BW) were used in a 3 x 3 Latin square with replication study lasting 105 d to determine the effect of various levels of dietary starch on glycogen replenishment in the light working horse. Horses were fed 1 % BW/d in Coastal Bermudagrass hay with remaining calories met by a high starch (HS), medium starch (MS), or low starch (LS) concentrate. After a 7 d washout period, horses were transitioned to 1 of the 3 diets over 7 d for a 14 d treatment period where they were then worked to fatigue in a standardized exercise test (SET). Total diets provided an average of 1,206.67, 844.61, and 263.13 g of starch/d in HS, MS, and LS, respectively. Horses were lightly exercised for 30 min 3 d/wk. The SET consisted of a 30 min trot in a panel exerciser, followed by 27 min of an incremental high-intensity work on a treadmill. Skeletal muscle biopsies were taken from the biceps femoris at rest, immediately after the SET, and 24 and 48 h post exercise. Samples were submerged in liquid nitrogen and stored at -80ºC until glycogen analysis using a commercial kit. Venous blood samples were taken at rest, immediately post exercise, 10 min after recovery, and 24 h post exercise. Data was analyzed using Proc Mixed (SAS) program. High starch had higher resting muscle glycogen concentration (P = 0.009) than MS (10.25 vs. 8.28 μg/mg wet wt). Low starch had higher glycogen concentration 24 h post (P = 0.04) than HS (9.52 vs. 7.68 μg/mg wet wt). High starch utilized more glycogen than MS or LS. A slight reduction in glycogen post exercise for MS and LS indicated that fat or protein may have been used as substrate for exercise. Results indicated that feeding 1,206.67 g starch/d did not yield an advantage in recovery time over a MS or LS diet. Energy expenditure during the SET yielded similar (P = 0.98) blood lactate concentrations, resulting in the formation of a prediction equation of y = 0.002x^2 – 0.3102x + 6.6874

Bonding mechanism from the impact of thermally sprayed solid particles

Power particles are mainly in solid state prior to impact on substrates from high velocity oxy-fuel (HVOF) thermal spraying. The bonding between particles and substrates is critical to ensure the quality of coating. Finite element analysis (FEA) models are developed to simulate the impingement process of solid particle impact on substrates. This numerical study examines the bonding mechanism between particles and substrates and establishes the critical particle impact parameters for bonding. Considering the morphology of particles, the shear-instability–based method is applied to all the particles, and the energy-based method is employed only for spherical particles. The particles are given the properties of widely used WC-Co powder for HVOF thermally sprayed coatings. The numerical results confirm that in the HVOF process, the kinetic energy of the particle prior to impact plays the most dominant role in particle stress localization and melting of the interfacial contact region. The critical impact parameters, such as particle velocity and temperature, are shown to be affected by the shape of particles, while higher impact velocity is required for highly nonspherical powder

Atrial fibrillatory rate as predictor of recurrence of atrial fibrillation in horses treated medically or with electrical cardioversion

Background The recurrence rate of atrial fibrillation (AF) in horses after cardioversion to sinus rhythm (SR) is relatively high. Atrial fibrillatory rate (AFR) derived from surface ECG is considered a biomarker for electrical remodelling and could potentially be used for the prediction of successful AF cardioversion and AF recurrence. Objectives Evaluate if AFR was associated with successful treatment and could predict AF recurrence in horses. Study design Retrospective multicentre study. Methods Electrocardiograms (ECG) from horses with persistent AF admitted for cardioversion with either medical treatment (quinidine) or transvenous electrical cardioversion (TVEC) were included. Bipolar surface ECG recordings were analysed by spatiotemporal cancellation of QRST complexes and calculation of AFR from the remaining atrial signal. Kaplan-Meier survival curve and Cox regression analyses were performed to assess the relationship between AFR and the risk of AF recurrence. Results Of the 195 horses included, 74 received quinidine treatment and 121 were treated with TVEC. Ten horses did not cardiovert to SR after quinidine treatment and AFR was higher in these, compared with the horses that successfully cardioverted to SR (median [interquartile range]), (383 [367-422] vs 351 [332-389] fibrillations per minute (fpm), P < .01). Within the first 180 days following AF cardioversion, 12% of the quinidine and 34% of TVEC horses had AF recurrence. For the horses successfully cardioverted with TVEC, AFR above 380 fpm was significantly associated with AF recurrence (hazard ratio = 2.4, 95% confidence interval 1.2-4.8, P = .01). Main limitations The treatment groups were different and not randomly allocated, therefore the two treatments cannot be compared. Medical records and the follow-up strategy varied between the centres. Conclusions High AFR is associated with failure of quinidine cardioversion and AF recurrence after successful TVEC. As a noninvasive marker that can be retrieved from surface ECG, AFR can be clinically useful in predicting the probability of responding to quinidine treatment as well as maintaining SR after electrical cardioversion

Improving patient adherence to lifestyle advice (IMPALA): a cluster-randomised controlled trial on the implementation of a nurse-led intervention for cardiovascular risk management in primary care (protocol)

Background Many patients at high risk of cardiovascular diseases are managed and monitored in general practice. Recommendations for cardiovascular risk management, including lifestyle change, are clearly described in the Dutch national guideline. Although lifestyle interventions, such as advice on diet, physical exercise, smoking and alcohol, have moderate, but potentially relevant effects in these patients, adherence to lifestyle advice in general practice is not optimal. The IMPALA study intends to improve adherence to lifestyle advice by involving patients in decision making on cardiovascular prevention by nurse-led clinics. The aim of this paper is to describe the design and methods of a study to evaluate an intervention aimed at involving patients in cardiovascular risk management. Methods A cluster-randomised controlled trial in 20 general practices, 10 practices in the intervention arm and 10 in the control arm, starting on October 2005. A total of 720 patients without existing cardiovascular diseases but eligible for cardiovascular risk assessment will be recruited. In both arms, the general practitioners and nurses will be trained to apply the national guideline for cardiovascular risk management. Nurses in the intervention arm will receive an extended training in risk assessment, risk communication, the use of a decision aid and adapted motivational interviewing. This communication technique will be used to support the shared decision-making process about risk reduction. The intervention comprises 2 consultations and 1 follow-up telephone call. The nurses in the control arm will give usual care after the risk estimation, according to the national guideline. Primary outcome measures are self-reported adherence to lifestyle advice and drug treatment. Secondary outcome measures are the patients' perception of risk and their motivation to change their behaviour. The measurements will take place at baseline and after 12 and 52 weeks. Clinical endpoints will not be measured, but the absolute 10-year risk of cardiovascular events will be estimated for each patient from medical records at baseline and after 1 year. Discussion The combined use of risk communication, a decision aid and motivational interviewing to enhance patient involvement in decision making is an innovative aspect of the intervention. Trial registration Current Controlled Trials ISRCTN5155672

Translating shared decision-making into health care clinical practices: Proof of concepts

Background: There is considerable interest today in shared decision-making (SDM), defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal is to bring together the resources and the expertise needed to develop an interdisciplinary and international research team on the implementation of SDM in clinical practice using a theory-based dyadic perspective. Methods: Participants include researchers from Canada, US, UK, and Netherlands, representing medicine, nursing, psychology, community health and epidemiology. In order to develop a collaborative research network that takes advantage of the expertise of the team members, the following research activities are planned: 1) establish networking and on-going communication through internet-based forum, conference calls, and a bi-weekly e-bulletin; 2) hold a two-day workshop with two key experts (one in theoretical underpinnings of behavioral change, and a second in dyadic data analysis), and invite all investigators to present their views on the challenges related to the implementation of SDM in clinical practices; 3) conduct a secondary analyses of existing dyadic datasets to ensure that discussion among team members is grounded in empirical data; 4) build capacity with involvement of graduate students in the workshop and online forum; and 5) elaborate a position paper and an international multi-site study protocol. Discussion: This study protocol aims to inform researchers, educators, and clinicians interested in improving their understanding of effective strategies to implement shared decision-making in clinical practice using a theory-based dyadic perspective