Design and implementation of a low temperature, inductance based high frequency alternating current susceptometer.

We report on the implementation of an induction based, low temperature, high frequency ac susceptometer capable of measuring at frequencies up to 3.5 MHz and at temperatures between 2 K and 300 K. Careful balancing of the detection coils and calibration allow a sample magnetic moment resolution of 5 × 10-10 Am2 at 1 MHz. We discuss the design and characterization of the susceptometer and explain the calibration process. We also include some example measurements on the spin ice material CdEr2S4 and iron oxide based nanoparticles to illustrate functionality.

Validation of the GerdQ questionnaire for the diagnosis of gastro-oesophageal reflux disease.

BACKGROUND: The diagnosis of gastro-oesophageal reflux disease (GERD) remains a challenge as both invasive methods and symptom-based strategies have limitations. The symptom-based management of GERD in primary care may be further optimised with the use of a questionnaire. AIM: To assess the diagnostic validity of the GerdQ questionnaire in patients with symptoms suggestive of GERD. METHODS: Patients with symptoms suggestive of GERD without alarm features, underwent upper endoscopy, and if normal, pH-metry. Patients were followed for 4 weeks and GerdQ was completed blinded to the investigator at both visits. Reflux oesophagitis or pathological acid exposure was used as diagnostic references for GERD. The diagnostic accuracy for GERD on symptom response to proton pump inhibitor (PPI) was assessed. RESULTS: Among the 169 patients, a GerdQ cutoff ≥9 gave the best balance with regard to sensitivity, 66% (95% CI: 58-74), and specificity, 64% (95% CI: 41-83), for GERD. The high prevalence of reflux oesophagitis (81%) resulted in a high proportion of true positives, but at the same time a high proportion of false-negatives. Consequently, GerdQ had a high positive predictive value, 92% (95% CI: 86-97), but a low negative predictive value, 22% (95% CI: 13-34), for GERD. Symptom resolution on PPI therapy had high sensitivity, 76% (95% CI: 66-84), but low specificity, 33% (95% CI: 17-53), for GERD. CONCLUSIONS: GerdQ is a useful complementary tool for the diagnosis of gastro-oesophageal reflux disease in primary care. The implementation of GerdQ could reduce the need for upper endoscopy and improve resource utilisation. Symptom resolution on proton pump inhibitor did not predict gastro-oesophageal reflux disease.

Randomised clinical trial: a comparison between a GerdQ-based algorithm and an endoscopy-based approach for the diagnosis and initial treatment of GERD.

BACKGROUND: The diagnosis of gastro-oesophageal reflux disease (GERD) remains challenging. An algorithm, facilitated by a questionnaire, may provide a more structured and cost-effective care of patients. AIM: To compare symptom control achieved with empirical therapy for GERD, in an algorithm based on the GerdQ (new structured pathway, NSP), with that of current care after endoscopy (ordinary clinical pathway, OCP). METHODS: Patients with symptoms of GERD, but without alarm features, were randomised in an open, parallel-group study and followed for 4-8 weeks. In the NSP, GerdQ score was used as a basis for both diagnosis and a treatment algorithm. Patients with high likelihood of GERD were treated empirically with a PPI whereas patients with low likelihood of GERD received therapy chosen by the clinician. In the OCP, diagnosis and treatment were based on endoscopy or pH-metry findings. The statistical hypothesis was non-inferiority of NSP to OCP. RESULTS: A total of 147 patients (86.5%) in the NSP and 133 patients (80.1%) in the OCP arm were responders. Overall, NSP was non-inferior to OCP, but not superior (P = 0.14). Patients with high likelihood of GERD had significantly better symptom relief in the NSP (P = 0.03), whereas those with low likelihood of GERD showed a numerical difference in favour of an endoscopy-based approach (OCP). NSP saved 146 € per patient. CONCLUSIONS: A symptom-based approach using GerdQ reduced health care costs without loss in efficacy. Patients with high likelihood GERD benefited from empirical treatment. An algorithm based on GerdQ may provide physicians with a tool for a more structured care of patients (ClinicalTrials.gov NCT00842387).

Simultaneous intramuscular pressure and surface electromyography measurement in diagnosing the chronic compartment syndrome.

We investigated the value of surface electromyography (EMG) as an aid to diagnosing the chronic compartment syndrome (CCS) by detecting elevated intramuscular pressure (IMP) at rest after an exercise test that was caused by remaining muscle contraction. IMP and EMG were measured in the anterior tibial muscle in 37 patients who were suspected to have CCS after an exercise test. At rest after the test, the EMG signal was positive in five of 37 (14%) patients, indicating that patients had remaining muscle contractions that elevated IMP. IMP exceeded 30 mmHg in 16 of 37 patients (43%). In 13 of these 16 patients, the EMG signal was silent, confirming that they had CCS. In the remaining three patients, the EMG signal was initially positive (5-34% of maximal voluntary contraction), and then became silent after communicating with the patients to relax their legs. Only one of the three patients was proven to have CCS. Other reasons for leg pain were diagnosed in 23 patients. The results demonstrated that simultaneous measurements of IMP and EMG differentiate elevated IMP at rest after exercise due to the volumetric load of the compartment muscles seen in patients with CCS and due to the remaining muscle contraction, thereby preventing a false diagnosis of CCS.

Environmental changes in the North Atlantic Region: SCANNET as a collaborative approach for documenting, understanding and predicting changes.

The lands surrounding the North Atlantic Region (the SCANNET Region) cover a wide range of climate regimes, physical environments and availability of natural resources. Except in the extreme North, they have supported human populations and various cultures since at least the end of the last ice age. However, the region is also important at a wider geographical scale in that it influences the global climate and supports animals that migrate between the Arctic and all the other continents of the world. Climate, environment and land use in the region are changing rapidly and projections suggest that global warming will be amplified there while increasing land use might dramatically reduce the remaining wilderness areas. Because much of the region is sparsely populated--if populated at all--observational records of past environmental changes and their impacts are both few and of short duration. However, it is becoming very important to record the changes that are now in progress, to understand the drivers of these changes, and to predict future consequences of the changes. To facilitate research into understanding impacts of global change on the lands of the North Atlantic Regions, and also to monitor changes in real time, an EU-funded network of research sites and infrastructures was formed in 2000: this was called SCANNET--SCANdinavian/North European NETwork of Terrestrial Field Bases. SCANNET currently consists of 9 core sites and 5 sites within local networks that together cover the broad range of current climate and predicted change in the region. Climate observations are well replicated across the network, whereas each site has tended to select particular environmental and ecological subjects for intensive observation. This provides diversity of both subject coverage and expertise. In this paper, we summarize the findings of SCANNET to-date and outline its information bases in order to increase awareness of data on environmental change in the North Atlantic Region. We also identify important gaps in our understanding and identify where the roles of existing infrastructures and activities represented by SCANNET can facilitate future research, monitoring and ground-truthing activities.

Low-dose inhaled budesonide once or twice daily for 27 months in children with mild asthma.

This study is an extended follow-up for 24 months of a 12-week trial to study the long-term clinical efficacy of low-dose inhaled budesonide (BUD) once or twice daily in children with mild asthma. A total of 122 children (mean age 9.7 years, girls/boys; 42/80) with mild asthma (FEV1 103.7% of predicted, reversibility in FEV1 3.5%, and fall in FEV1 after exercise 12.2%), not previously treated with inhaled steroids, were included in a double-blind, randomized, parallel-group study. The children were treated with inhaled BUD 100 or 200 microg administered via Turbuhaler once daily in the morning, 100 microg twice daily, or placebo for 27 months. Exercise and methacholine challenges were performed at 3-month intervals the first year and at 6-month intervals the second year, in a total of seven visits. A significant dose-response effect favoring BUD 200 microg daily (vs 100 microg daily) was found when comparing changes in FEV1, FEF25%, and FEV50%; the fall in FEV1 after an exercise test; and the effect on blood eosinophils. Bronchial hyperreactivity to methacholine decreased significantly on three visits in patients treated with BUD 200 microg daily compared to placebo. Growth rate was not significantly affected except in children aged 7-11 years at baseline after 12 months of treatment. In conclusion, 100 or 200 microg daily of inhaled BUD for 27 months is safe and effective in protecting against exercise-induced asthma and achieving nearly normal lung function. Baseline lung function was not significantly affected in this group of children with mild asthma.

An enantioselective route to paeonilactone A via palladium- and copper-catalyzed reactions.

We herein report on a formal total synthesis of paeonilactone A involving palladium-, copper-, and enzyme-catalyzed reactions starting from 1,3-cyclohexadiene. The key step in the synthesis, a palladium(II)-catalyzed 1,4-oxylactonization of a conjugated diene, simultaneously introduces two of the oxygen substituents required for the target molecule. The synthesis also includes our recently developed copper(I)-catalyzed cross-coupling reaction between dienyltriflates with Grignard reagents, introducing one of the methyl groups present in the target molecule. This new approach toward paeonilactone A allows complete control of all four stereogenic centers and is the first enantioselective route toward paeonilactone A starting from an achiral substrate.

Asymmetric allyl-metal bonding in substituted (eta3-allyl) palladium complexes: X-ray structures of cis- and trans-4-acetoxy-

Enantiomerically pure cis and trans isomers of 4-acetoxy-[eta3(1,2,3)-cyclohexenyl]palladium chloride dimers (cis-1 and trans-1) were prepared from enantiomerically pure trans-1-acetoxy-4-chloro-2-cyclohexene. X-ray analyses of these complexes show that in the trans complex (trans-1) the six-membered ring prefers a chair conformation, whereas in the cis complex (cis-1) the cyclohexenyl ring has a boat conformation. According to the X-ray structure of trans-1 the Pd-C3 bond is shorter than the other allylic terminal palladium-carbon bond (Pd-C1). On the other hand, in cis-1 the Pd-C3 and Pd-C1 bond lengths are identical within the experimental error. The calculated structures (B3PW91/LANL2DZ + P) of trans-1 and cis-1 also display differences in the allylpalladium bonding. The asymmetric allylpalladium bonding in trans-1 is explained on the basis of pi-sigma electronic interactions between the 4-acetoxy substituent and the allyl-metal moiety.

Patient compliance in a clinical trial with inhaled budesonide in children with mild asthma.

Children's use of inhalation devices can give valuable information about their adherence to asthma therapy. The aim of this study was to examine treatment adherence of low dose inhaled budesonide or placebo administered via Turbuhaler twice daily in children with mild asthma participating in an asthma trial, by comparing diary registration with the number of doses remaining in the inhaler. A total of 163 children (age 7-16 yrs, 56 females, 107 males) with mild asthma (mean baseline forced expiratory volume in one second (FEV1) was 103% of predicted), were included into a double blind, randomized study. After a two-week run-in period, the children received inhaled budesonide, either 100 microg or 200 microg daily, and/or placebo for 12 weeks. All patients used daily diary cards throughout the study. Results from 161 patients were analysed. Mean compliance according to the diary was 93%, whereas estimated mean compliance when counting remaining doses in the Turbuhaler was 77%. Overuse of medication was found in 7% of the children. There was no significant difference in compliance between sex in the study group, whereas children aged < or =9 yrs had significantly better drug adherence than older children. No significant relationship was found between symptom score and compliance. In conclusion, even with optimal patient follow-up in a clinical trial, adherence to prophylactic asthma treatment is considerably lower than the patients own reports from the use of daily diary cards.