Socioeconomic health inequalities in adolescence are not consistently reported. This may be due to the measurement of self-reported general health, which probably fails to fully capture the psychological dimension of health, and the reliance on traditional socio-economic indicators, such as parental education or occupational status. The present study aimed at investigating this issue using simple questions to assess both the physical and psychological dimension of health and a broader set of socioeconomic indicators than previously used.This was a cross-sectional survey of 5614 adolescents aged 16-18 years-old from 25 senior high schools in Greece. Self-reported general and psychological health were both measured by means of a simple Likert-type question. We assessed the following socio-economic variables: parents' education, parents' employment status, a subjective assessment of the financial difficulties experienced by the family and adolescents' own academic performance as a measure of the personal social position in the school setting.One out of ten (10%) and one out of three (32%) adolescents did not enjoy good general and psychological health respectively. For both health variables robust associations were found in adolescents who reported more financial difficulties in the family and had worse academic performance. The latter was associated with psychological health in a more linear way. Father's unemployment showed a non-significant trend for an association with worse psychological health in girls only.Socioeconomic inequalities exist in this period of life but are more easily demonstrated with more subjective socioeconomic indicators, especially for the psychological dimension of health. Almost three decades following the publication of the Black Report  socioecoA number of methodological issues may help explaining these inconsistencies. First, measurement of socioeconomic status in adolescence is not straightforward. Parental socioeconomic characteristics, such as parental educational level, social/occupational class and family income, are often used as measures of the socioeconomic status of adolescents. It is suggested however that adolescents may not be able to accurately report their parent's socioeconomic status . In addiSecond, concerning health outcomes, self-reported health is one of the most frequently used health indicators in studies about adolescent health. Self-reported health is usually measured by means of a single question asking respondents to rate their recent overall health status on a Likert-type scale from excellent to poor. It has been used in many different cultural contexts and the findings indicate that it is a powerful indicator of clinical outcome and mortality , which cThe aim of the present paper was to investigate this issue by studying the association between socioeconomic status and both general and psychological health, assessed in a similar crude way, in a sample of Greek adolescents. We hypothesized that the association between socioeconomic status and health of the adolescents would be more evident in the psychological component of health compared to general health.The data reported in this paper were derived from the "Epirus School Project"  which isSecondary education in Greece is distinguished into lower secondary  and upper secondary . Upper secondary schools are further distinguished into Senior High Schools (Lyceum) and Technical Vocational Schools. The majority of students (75%) attend Senior High Schools. In the "Epirus School Project" only Senior High Schools were selected, while Technical Vocational Schools will be included in a separate future survey. At the time of the design of the study approximately 75000 students attended 1193 Senior High Schools.Schools were selected according to the following rules: a) all Senior High Schools of the major cities in the north-western part of Greece (regions of Epirus and Aetoloakarnania) due to the proximity of this area to the University of Ioannina, b) all Senior High Schools in one randomly selected district of the Athens Metropolitan Area , c) all Senior High Schools of the island of Paros in the Aegean Sea (the island was conveniently selected). A total of 25 schools took part in the study. The median number of participants per school was 225 pupils ranging from 138 to 425. The main fieldwork took place between January 2007 and April 2008.The "Epirus School Project" used a two-phase design . In the We used two health indicators in the present study: self-reported general health and self-reported psychological health. Self-reported general health was measured by means of the common question, by which respondents are asked to rate their recent general health status. There were five possible responses: "excellent", "very good", "good", "fair" and "poor". Similarly, self-reported psychological health was measured by asking respondents to rate their recent psychological state. There were again five possible answers: "excellent", "very good", "good", "fair" and "poor". We should like to note that in the context of the present study we have also collected several other measures of psychological health including the detailed fully-structured psychiatric interview on the second phase (CIS-R) . On a suWe used the following SES indicators:We measured the socioeconomic characteristics of both parents, since evidence shows that maternal socioeconomic characteristics have an equally, or even more, significant impact on child and adolescent health . Pupils Regarding employment, we chose to use the variable "employment type", which discriminates/distinguishes not only between employment status (employed - unemployed), but also between the different sectors of employment . More specifically "employment type" was divided into seven groups: "public sector employee"; "private sector employee"; "self-employed"; "pensioner"; "unemployed"; "housewife" (as regards the mother's employment type) or "inability to work" (as regards the father's employment type) and "else". In Greece the legislative framework relating to the combination of family life and career  differs significantly between public and private sector . Greek sIt has been suggested that directly questioning adolescents about their family's income can be unreliable . TherefoIn Greece, where typical 16-18 years-old adolescents have not yet entered the labour market, neither have they completed their education, own educational level or occupation cannot be used as a measure of personal social position. Academic performance in school has been often used as a measure of the social position of the pupils in school [Questions about several sociodemographic variables were also included in the self-reported questionnaire .The analyses were all conducted using the statistical software package STATA 9.0. Self-reported general health and self-reported psychological health were treated as dichotomous variables, which can take the following values: "poor health", which represents the sum of the values "fair" and "poor" of the initial variables self-reported general and psychological health, and "good health", which represents the sum of the values "good", "very good" and "excellent".The association between health measures and sociodemographic and socioeconomic variables were investigated in a series of logistic regression models. To take into account the potential clustering of our data (since adolescents were nested into 25 schools) we carried out a two-level logistic model  in STATA using the xtlogit command . The xtlIn order to compare gender differences in proportions of self-reported general and psychological health we used Pearson's chi square. The correlation between the Likert-type question about self-reported psychological health and the instruments of GHQ-12 and SDQ  was calculated using Spreaman's rho.Baseline socio-demographic and socioeconomic characteristics of the sample are shown in Table Table Crude and adjusted odds ratios for both self-reported psychological and general health are shown in Table In the unadjusted analysis, pupils who had a mother or father with higher than primary education were less likely to report poor psychological health, while regarding general health only mother's educational level consistently showed this association. However, adjustment for the various sociodemographic and socioeconomic variables reduced these associations which became non significant.In the unadjusted analysis pupils with unemployed fathers were more likely to report poor psychological health and a similar but not significant trend was found for general health. Adjustment for the remaining socioeconomic variables and especially the presence of financial difficulties in the family weakened this association. In a separate analysis for boys and girls it became clear that the effect of father's unemployment was evident only in girls  but further adjustment for the remaining variables resulted in a non significant odds ratio for poor psychological health in girls .The presence of financial difficulties in the family was significantly associated with both worse psychological and general health showing additional evidence of a dose-response relationship . A possible association between parental unemployment and poor health has been reported by previous studies. Financial stress is considered to be the most important consequence of unemployment, with regard to the health of the unemployed individual or the family members. More specifically, income seems to affect psychological health indirectly via subjectively appraised financial strain .As regards alternative socioeconomic measures, adolescents' subjective view on the financial difficulties of the family, as well as their school performance, were both strongly associated with self-reported general and psychological health. The question about financial difficulties is a frequently used indicator among studies about adult health ,43 but aLimitations of the present study include the cross-sectional nature of our data, which means that the cause and effect relationships cannot be investigated. In addition, health evaluation was based on adolescents' self-reports without parental reports or medical verification. It has been argued that when self-report is used to collect data it may lead in overestimation of the morbidity of the population . Self-reMoreover, psychological health was crudely assessed with a single question that was designed to be very similar to the question on self reported general health. We did so because our aim was to investigate how these questions compare with each other as regards the sociodemographic and socio-economic associations. The simple question on psychological health was highly correlated with the GHQ-12, a commonly used instrument to assess psychological morbidity in surveys around the world. It was also significantly correlated with the emotional sub-scale of the SDQ. According to the results of this study, this question also seems to be a useful indicator of mental health in adolescence capable of demonstrating socioeconomic inequalities in mental health in this period of life. However, as this is a crude assessment, a degree of misclassification is inevitable but most likely this will not lead to systematic errors.Employment status was also based on adolescents' self-report and this may increase the risk for misclassification. This misclassification is expected to be random and therefore, if it influences the results, this will be towards the null value, i.e. against our hypotheses. Moreover, the question about parental employment status did not include information about the exact occupation and as a result an official "occupational status" classification was not possible. Finally, it should be noted that these results refer to a sample of adolescents attending general upper secondary schools in Greece and generalizations beyond this school setting are not recommended. Furthermore, the sample of the study included only senior high schools. Since there are big differences in perceived health between senior high schools and technical vocational schools, there might also have been differences in the associations between self-rated health and socioeconomic indicators.We investigated the issue of socioeconomic health inequalities in a sample of Greek adolescents. It emerges that many adolescents do not enjoy good general health. The burden of psychological problems appears to be significantly higher. When subjective socioeconomic indicators are used, such as subjective assessment of the presence of financial difficulties in the family and adolescent's assessment of their school performance, socioeconomic health inequalities are reported in this period of life too.Our findings indicate that adolescents' view on the position of their family in the social context, as well as on their own position in the area where they are mainly active, i.e. the school, are more useful in predicting adolescents' health than are parental education or occupation. The relationship between social class and health may be mediated through people's actual experience of their financial situation, affluence and well-being. Traditional socioeconomic measures were designed to express these experiences according to social realities that may do no longer exist. Today societies undergo some major changes. Occupation seems to be unable to guarantee safety and affluence any more. In order to really find what lies beneath, we possibly have to implement additionally some alternative measures, especially when investigating a generation, which is being brought up in the middle of a financial crisis.The authors declare no competing interests in relation to this paper.KM helped in data collection, contributed to the statistical analyses and drafted the manuscript. PS was responsible for the conception and design of the study, helped in data collection, contributed to the statistical analysis and helped in the writing of the paper and interpretation of the results. DN made critical comments and helped in the writing and interpretation of the results.SB helped in data collection, in the statistical analysis, in the writing of the manuscript and interpretation of the results. AZ made critical comments that helped in the interpretation of the results and the final writing of the paper.SS made critical comments that helped in the interpretation of the results and the final writing of the paper. VM helped in obtaining funding for the study, in the writing of the paper and interpretation of the results. All authors read and approved the final manuscript.


Nearly 1300 cases of leishmaniasis have been identified in American military personnel deployed to Iraq and Afghanistan. The symptoms of this disease can range from a mild, self-limiting cutaneous infection to a deadly visceral infection and are not prevented by chemoprophylaxis or immunization. Effective treatments, however, are available. The disease-causing parasite is spread through the bite of the female sand fly. Although the disease occurs in both the Old World and the New World, the parasite species differ between the hemispheres. The large number of cases in military veterans has caused some concern that Old World, temperate-adapted parasite species could be introduced into the native sand fly populations of American military facilities where veterans of the current conflicts return following their deployments. This paper reports part of a larger study to analyze the risk of such an accidental importation. Four potential habitats on two large Army facilities in the Southeast United States were surveyed to determine relative sand fly density. The National Land Cover Map was used to provide sand fly density prediction maps by habitat.Leishmania spp. on Fort Bragg, therefore, is considered to be much lower than on Fort Campbell.Sand fly density was significantly higher in deciduous forest and even higher at the interface between forest and open grassland. The evergreen forest and agricultural fields supported very low densities. On Fort Campbell, KY, the percentage of land covered by suitable habitat was very high. A sand fly density prediction map identified large tracts of land where infected individuals would be at higher risk of exposure to sand fly bites, resulting in an increased risk of introducing the parasite to a native insect population. On Fort Bragg, NC, however, commercial farming of long leaf pine reduced the percentage of the land covered in vegetation suitable for the support of sand flies. The risk of introducing an exotic A readily available land cover product can be used at the regional level to identify areas of sand fly habitat where human populations may be at higher risk of exposure. The sand fly density prediction maps can be used to direct further surveillance, insect control, or additional patient monitoring of potentially infected soldiers. Leishmania spp. The disease has a spectrum of manifestations, from minor, self-limiting cutaneous (skin) lesions to extreme disfigurement and death.[Phlebotomus. In the New World, all disease vectors are in the genus Lutzomyia. Parasite species also differ between the hemispheres. New World leishmaniasis is usually limited to tropical or semi-tropical environments, though a recent outbreak of cutaneous leishmaniasis in Texas demonstrates that parasites normally associated with Central America are capable of spreading into the United States.[Leishmaniasis is an arthropod-borne and zoonotic disease that infects man incidentally. It is caused by nd death. The parad States. Old WorlBetween 2001 and 2006, nearly 1300 incident diagnoses of leishmaniasis were detected in veterans of the current conflicts in Iraq and Afghanistan. and treaLeishmania parasites into the sand fly populations of the temperate New World. The study was in three parts:This paper reports part of a larger study to assess the risk of introducing Old World 1. A survey of sand fly species on American military facilities with large numbers of soldiers deploying to Iraq or Afghanistan ;Leishmania spp.;2. A feeding study to assess the ability of a New World sand fly species to become infected with an Old World 3. An analysis of sand fly abundance to identify plant communities where the risk of sand fly bites is increased.This paper reports on the third part of the study.Sergentomyia spp.[Previous studies have linked adult sand fly abundance to a variety of environmental factors. Although one study noted an association between soil chemistry and the abundance of myia spp., most hamyia spp. New Worlmyia spp. In northmyia spp.Lu. vexator (Coq.) was noted on steep slopes in mature mixed hardwood forests. However, on Ossabau Island off the coast of Georgia, Lu. shannoni Dyar was most active in established maritime live oak forests, with mixed hardwood and pine forests harboring significantly fewer sand flies.[Lu. apache, which indicated a potential range through steppe and semi-desert vegetative provinces from Arizona to Idaho.[Possibly due to the relative lack of sand fly-borne diseases in the United States, fewer studies on sand fly ecology have been performed in this country. However, a recent outbreak of canine visceral leishmaniasis has stimulated interest in the possible role of sand flies in the transmission of disease. When a fnd flies. In the sto Idaho.Leishmania spp. from the current war zones into the United States is dependent upon a variety of factors, including the susceptibility of North American sand flies to infection, the ability of the parasite to develop in the fly, and the availability of suitable vertebrate reservoirs. Environmental factors suitable for supporting large vector populations are also important variables. This part of the study attempts to identify and locate those variables in areas where returning, and possibly infected, veterans could come into contact with sand fly vectors.The risk of importing exotic 2-baited CDC light trap with a protective cover. The contents of each trap were collected before 0900 each morning, packed in padded boxes and mailed overnight to the Uniformed Services University of Health Sciences in Bethesda, MD. The sample was frozen until it could be microscopically examined and sorted. Sand flies were placed in a lacto-phenol clearing solution for at least 30 days, mounted on slides and identified according to published keys.[Three military facilities with large populations of deploying soldiers were initially selected for the study. The facilities  each represented a different dominant plant community considered suitable for supporting sand flies. Unusual weather patterns in the summer of 2007 destroyed most of the trapping sites on Fort Hood, so only Fort Campbell and Fort Bragg are reported here. Twenty sites from a variety of vegetation communities were selected on each facility. Weekly sampling of sand fly activity on each site was conducted using a COhed keys.Pinus palustris). Hardwood undergrowth is rigorously suppressed with an active controlled burn program as part of an endangered species program, so much of the forested area is monocultural. The forest is highly managed for commercial logging, with extensive efforts in timber, pine cone and pine straw harvesting.Fort Bragg is in Cumberland and Hoke Counties of North Carolina and covers 65,165 ha. The primary forest type is the long leaf pine (th century. Regrowth forest includes the following species: oak (Quercus spp.), hickory (Carya spp.), sassafras , persimmon (Diospyros spp.) and eastern red cedar (Juniperus virginiana) When pine trees are present, they are typically loblolly pine (Pinus taeda) and are in forest management programs.Fort Campbell straddles the borders of Kentucky and Tennessee in the rolling Pennyroyal Plain. It consists of approximately 42,510 ha that experienced nearly complete deforestation by the mid-19Trapping sites were located precisely by GPS and were selected to represent one of four general habitats: deciduous forest, evergreen forest, agricultural land or forest/grassland interface. Because the traps were hung on available trees, the grassland sites were considered to be the transitional area between the forest and grassland (an ecotone). Safety and access issues prevented the selection of an equal number of sites for each habitat surveyed.The trapping rate for each site was determined by dividing the total number of sand flies by the number of trap-nights for the entire study period . The sites were ranked according to rate, then compared using a Kruskal-Wallis test  with veg. For simplification of the maps, land cover classes on the NLCD map were combined into functional habitat categories as shown in Table Sand fly density prediction maps were created using data from the National Land Cover Database 2001 (NLCD 2001). The NLCD is a 30 meter pixel resolution land cover classification of the United States developed from Landsat satellite imagery.,16 NLCD The woody wetlands category corresponded to deciduous trees growing along stream valleys at Fort Bragg and were thus assigned to the deciduous class.Sand fly density prediction maps for the two bases were created in ArcGIS using land cover derived from the NLCD. Several steps were required to produce these maps. In the first step, the land cover maps were converted from a raster (TIFF format) to a vector format (shape file). Next, the land cover classes associated with high densities of sand flies were extracted and saved as separate deciduous and grass/crop shape files. To map the ecotones, the two shape files were used to perform a geographical intersection in ArcGIS with the output consisting of the common line between the two sets of polygons. Fifty meter buffer zones were created around the resulting intersection lines to represent the areas of highest sand fly density at the ecotones. A fifty meter buffer was selected for the buffer zone size based on the estimated flight range of the sand fly. The final prediction map, uses the buffer zone as the highest density and the deciduous land cover as medium density for sand flies. The urban land cover classes are also displayed on the map in order to provide a spatial reference to the map user.Sand fly abundance on Fort Bragg was extremely low, yielding only 31 flies for the entire summer of 2007. The low number of sand flies prevented a comparison between habitats, but it is not surprising given the degree to which Fort Bragg is covered by a highly managed long leaf pine plantation. This habitat has previously been reported as supporting very low numbers of sand flies , so the Lu. shannoni are the only ones presented because this species is the primary human feeding fly. The relatively low densities in pine forest and agricultural lands are consistent with previous studies which demonstrated higher abundance in deciduous forests. These results, however, indicate that the ecotone transition from deciduous forest to open grassland supports the greatest abundance of Lu. shannoni. The concentration of vector populations in ecotones has been noted with other vectors; however, this is the first such report with North American sand fly species.[Table  species.,18Lu. shannoni on Fort Campbell. In particular, the green areas (deciduous forests) and red areas  depict habitats that support greater densities of sand flies. This classification has public health utility because it identifies areas where possibly infected veterans returning from Iraq or Afghanistan are more likely to encounter native American sand flies, in particular Lu. shannoni. Where the red areas are contiguous to black (urban) areas, the risk of human exposure with sand fly bites is considered to be increased. Such an encounter could result in the accidental introduction of an Old World parasite into the New World vector population, where it could subsequently be introduced to a native mammal reservoir population as well.Figure Figure These sand fly density maps provide a planning document for preventing the introduction of an exotic parasite and can be used to direct the following actions:1. Additional sand fly and vertebrate reservoir surveillance in high risk areas where infected veterans live or take part in field exercises;2. Vector control efforts to reduce human exposure to sand fly bites;3. Increased monitoring of returning veterans living or working in high sand fly risk areas.Sand fly populations on Fort Campbell were highly associated with deciduous forests and the transitional ecotone between forest and grassland. This information can be used to construct sand fly density prediction maps for affected areas. These density maps can then be utilized to assess the risk of introducing an exotic parasite with returning veterans. They can also be used to direct insect surveillance, insect control and infestion status monitoring of veterans living near suitable sand fly habitat.The authors declare that they have no competing interests. Toward full disclosure, two of the authors (DC and LK) are commissioned officers in the military of the United States of America. Funding for this research was provided by an internal grant from the Uniformed Services University of Health Sciences in Bethesda, MD.DC designed the experiment, conducted the field research, identified all specimens, performed the statistical analysis and served as the co-primary investigator and primary author. PM and MM performed all GIS analysis of the data; and obtained, reclassified and interpreted all images and results. LK served as the co-primary investigator, obtained all funding and contributed as an author.


Lychnis flos-cuculi populations. We found no evidence for outbreeding depression in resistance reflected by the amount of leaf area consumed. However, herbivore performance was greater when fed on plants from between-population compared to within-population crosses. This can reflect outbreeding depression in resistance and/or outbreeding effects on plant quality for the herbivores. The effects of type of cross on the relationship between herbivore damage and plant fitness varied among populations. This demonstrates how between-population outbreeding effects on tolerance range from outbreeding depression to outbreeding benefits among plant populations. Finally, herbivore damage strengthened the observed outbreeding effects on plant fitness in several populations. These results raise novel considerations on the impact of outbreeding on the joint evolution of resistance and tolerance, and on the evolution of multiple defence strategies.Between-population crosses may replenish genetic variation of populations, but may also result in outbreeding depression. Apart from direct effects on plant fitness, these outbreeding effects can also alter plant-herbivore interactions by influencing plant tolerance and resistance to herbivory. We investigated effects of experimental within- and between-population outbreeding on herbivore resistance, tolerance and plant fitness using plants from 13 to 19  Inter-population crosses and transplantations of plants among populations are used to restore genetically eroded populations In addition to direct negative effects on plant fitness due to reduced genetic variation and increased inbreeding , and plant fitness in greenhouse with plants originating from 13 to 19 (depending on the experiment) fragmented Lychnis flos-cuculi populations. These populations are known to suffer from negative genetic effects of habitat fragmentation as genetic variation within population is reduced and inbreeding increased in small populations Here we investigated outbreeding effects on herbivore resistance against the generalist herbivore We addressed the following questions: 1) Are plants from between-population crosses less resistant and tolerant against herbivory than plants from within-population crosses? 2) Do outbreeding effects on resistance and on tolerance vary among plant populations? 3) Does plant damage modify outbreeding effects on plant fitness?Resistance, measured as 1-the proportion of leaf area damaged by snails, did not differ significantly between plants from within- and between-population crosses , Fig. 1aOutbreeding had no significant effects on tolerance to artificial damage ; Fig. 1cr = −0.035, P = 0.914 N = 19). This indicates that outbreeding affects tolerance differently in different populations and, therefore, the impact of outbreeding on tolerance is not predictable. Outbreeding effects on resistance, or tolerance to clipping did not vary among populations . The population×cross interaction was also not significant . These results suggest no outbreeding depression or benefits in the fitness of undamaged plants. These findings and those on outbreeding effects on plant fitness in relation to snail damage suggest that outbreeding depression in fitness may only become apparent under herbivore damage. Artificial damage did not influence plant fitness nor did it modify the observed outbreeding effects on plant fitness  and their components differently. This raises novel considerations on the impact of outbreeding on the joint evolution of resistance and tolerance. A trade-off between resistance and tolerance is often expected, although so far the evidence supporting such a trade-off is weak L. flos-cuculi, including some of our study populations The observed variation among populations in effects of inter-population outbreeding on tolerance, and a tendency for such variation in plant resistance in terms of snail performance, could arise due to among-population variation in abiotic and biotic factors and genetic history e.g., . Inter-pWe initially predicted that outbreeding depression in herbivore resistance and/or tolerance or both should result in greater outbreeding depression in fitness of damaged plants compared to undamaged plants. In line with our prediction, outbreeding depression in fitness was absent for undamaged plants, but apparent in plants damaged by the snails, though this was the case only for some of the populations.The fact that outbreeding effects on plant fitness under herbivore damage varied from positive to negative among populations indicates that inter-population crosses presumably influenced both plant quality and defence, and the related resource allocation patterns. Disentangling these different effects of outbreeding requires future studies. Our results, however, strongly suggest that previous studies investigating the consequences of between-population crosses may have underestimated outbreeding depression by only considering undamaged plants.The finding that inter-population outbreeding affects herbivore resistance and tolerance differently, and that these effects differ depending on type of damage, raise novel considerations on the impact of outbreeding on the joint evolution of resistance and tolerance, and on the evolution of multiple defence strategies. Understanding how different genetic configurations influence the evolution of plant-herbivore interactions is essential if we are to understand how the genetic consequences of habitat fragmentation influence species interactions and ultimately the structure of communities. Hence, the role of mating systems, and the levels of inbreeding and outbreeding, should be more rigorously investigated in future studies on the evolution of resistance and tolerance. Furthermore, because outbreeding effects on tolerance and resistance are likely to vary among populations, conclusions on outbreeding effects on these defence strategies should not be drawn from studies considering only one or very few populations.Our results also highlight how estimates of outbreeding depression or outbreeding benefits on plant fitness from experimental conditions, where biotic or abiotic stress are not considered, can represent biased estimates of outbreeding effects under natural conditions. Finally, our findings have important implications for conservation. Clearly, plant-herbivore interactions should not be neglected and different plant defence strategies should be considered before mixing gene pools or transplanting plants among populations for conservation purposes.Lychnis flos-cuculi (Caryophyllaceae), is a polycarpic perennial herb that occurs in sunny and moist habitats including wet hay meadows and calcareous fens. It is still widespread and abundant throughout its distribution range, but its populations have become smaller and more isolated in recent decades due to the loss and fragmentation of suitable habitats.The ragged robin, Lychnis flos-cuculi is self-compatible, but its flowers are considered to be predominantly outcrossed Arianta arbustorum (Gastropoda: Helicidae), as the herbivore in our experiment. It occurs commonly throughout Europe L. flos-cuculi in our study populations . Arianta arbustorum is also known to be an important herbivore of related plant species We used the generalist hermaphroditic snail, L. flos-cuculi populations located in calcareous fens in North-East Switzerland. Population sizes ranged from 40 individuals to ca 50000 individuals and the distances between the populations ranged from 1.2 to 68.9 km We used F2 plants from 13 to 19 (depending on the experiment) Initially, F1 offspring of within- and between-population crosses were obtained using 5 to 9 maternal plants from each population. Two flowers per individual were pollinated with a randomly selected plant from the same population and two with pollen of a randomly selected plant from one of the other populations. When the F1 plants were flowering, they were hand pollinated with other F1 plants (F1 × F1 crosses) to obtain the F2 plants. To obtain the F2 plants for within-population crosses each F1 plant resulting from a within-population cross was crossed with an unrelated F1 plant from the same population To investigate resistance and tolerance to snail damage we repotted 2–16 seedlings per family . Half of the plants per family were randomly assigned to the herbivory treatment and the other half served as control. In the herbivory treatment, we covered the plants with cellophane bags, put one snail in each bag, and allowed it to feed on the plant for 6 days. The snails were collected in the field and starved for four days prior to the experiment and they were weighed immediately before and after use in the experiment. The control plants were bagged in the same manner as plants in the herbivore treatment. All snails were released after the experiment.To investigate tolerance to artificial damage, i.e. to a combination of clipping and spraying with jasmonic acid, we repotted 2–16 seedlings per family . We randomly assigned half of the plants per family to a clipping treatment where 50% of the rosette leaves were clipped and sprayed with jasmonic acid (250 mg jasmonate powder in 10 ml EtOH dilluted in 1.19 ml water and mixed up to 1.2 litres). The other half of the plants per family served as open control, in which the plants were not clipped and sprayed with 10 ml EtOH diluted in 1.19 ml water and mixed up to 1.2 litres. Since there were not enough plants to use replicates of exactly the same families for the snail herbivory and clipping treatments and their respective controls, we conducted and analyzed them separately. Before conducting the treatments, we counted the number of rosette leaves as a measure of initial plant size.After the snail herbivory or clipping treatments the plants were allowed to grow in the greenhouse for another 8 weeks. By that time most plants were still flowering although many flowers had started to set fruits. Vegetative growth was still taking place and there were no signs of leaf senescence. We counted the number of rosette leaves as measure of plant size and counted the number of fruits produced.Rausher To estimate resistance after the snails had been feeding on the plants we removed them and counted the number of damaged leaves and estimated the proportion of leaf area damaged visually to the nearest 1%. To aid estimating these percentages a transparent grid was placed on top of the leaves. Two persons estimated these damage percentages independently, which were then averaged for the analysis. We determined snail performance measured as final snail mass and corrected for differences in the initial mass in the statistical analyses. The damage levels in our experiment were similar to those observed in the field Plant tolerance to herbivory reflects the degree to which plants can re-grow after damage and can be investigated by comparing damaged and undamaged individuals or the impact of continuous damage on plant fitness from a group of related or clonally propagated plants . The relative growth rate of the snails was negatively correlated with their initial size . Plant size in terms of the number of rosette leaves was not correlated with snail mass or with their relative growth rate , which indicates that plant size has no impact on resistance or plant quality for the herbivores. Thus, initial snail mass was included as a covariate in the analyses of the proportion of leaf area damaged, number of damaged leaves, and the final snail mass, and initial number of rosette leaves was taken into account as a covariate in the analyses on the proportion of leaf area damaged. 1-proportion of leaf area damaged was log-transformed to meet the assumption of normal distribution.We conducted mixed-model analyses of covariance (ANCOVA) to test for differences in resistance between plants from within- and between-population crosses in the different populations. ANCOVA allows comparing series of regression models and thus to analyze data with both categorical and continuous explanatory variables To examine tolerance to artificial damage, we tested the effects of cross, population, family and clipping on the number of fruits produced by conducting a mixed model analysis of covariance. Treatment (clipped plus sprayed or not) and cross were used as fixed factors and population and family nested within population as random factors. Initial number of rosette leaves was used as a covariate in the analysis to account for differences in initial plant size.Similarly, to examine tolerance to snail damage we conducted a mixed model analysis of covariance to test for the effects of cross and population and snail damage on the number of fruits produced. We treated cross as fixed factor and population and family nested within population as random factors. Adding the interaction terms of level of damage and population, cross and family nested within population allowed us to test the heterogeneity of the slopes (tolerance) and whether the slopes differ between the two crosses or among populations or families. The latter implies genetic variation in tolerance.These analyses also served to test whether the effects of outbreeding on fitness are modified by herbivore damage, and whether the effects of herbivore damage on plant fitness depend on the cross and/or vary among populations. To examine outbreeding effects on fitness of bagged undamaged plants, we analysed the effect of cross, populations, and family also separately for these plants. Initial number of rosette leaves was taken into account as a covariate in all analyses of plant tolerance and fitness.All analyses were conducted using the SAS software . We determined appropriate error terms, degrees of freedom, and F-values for each analysis following Zar


Accurate assessment is required to assess current and changing physical activity levels, and to evaluate the effectiveness of interventions designed to increase activity levels. This study systematically reviewed the literature to determine the extent of agreement between subjectively  and objectively  assessed physical activity in adults.Eight electronic databases were searched to identify observational and experimental studies of adult populations. Searching identified 4,463 potential articles. Initial screening found that 293 examined the relationship between self-reported and directly measured physical activity and met the eligibility criteria. Data abstraction was completed for 187 articles, which described comparable data and/or comparisons, while 76 articles lacked comparable data or comparisons, and a further 30 did not meet the review's eligibility requirements. A risk of bias assessment was conducted for all articles from which data was abstracted.Correlations between self-report and direct measures were generally low-to-moderate and ranged from -0.71 to 0.96. No clear pattern emerged for the mean differences between self-report and direct measures of physical activity. Trends differed by measure of physical activity employed, level of physical activity measured, and the gender of participants. Results of the risk of bias assessment indicated that 38% of the studies had lower quality scores.The findings suggest that the measurement method may have a significant impact on the observed levels of physical activity. Self-report measures of physical activity were both higher and lower than directly measured levels of physical activity, which poses a problem for both reliance on self-report measures and for attempts to correct for self-report – direct measure differences. This review reveals the need for valid, accurate and reliable measures of physical activity in evaluating current and changing physical activity levels, physical activity interventions, and the relationships between physical activity and health outcomes. Physical activity is defined as "any bodily movement produced by the skeletal muscle that results in energy expenditure (EE)" . InactivData collection at the population level often involves self-report (subjective) measures of physical activity through the use of questionnaires, diaries/logs, surveys, and interviews. These measures are frequently used due to their practicality, low cost, low participant burden, and general acceptance . AlthougAs self-report methods possess several limitations in terms of their reliability and validity , objectiThe appropriate method for measuring physical activity at various levels depends on factors such as the number of individuals to be monitored, the time period of measurements and available finances . Many prThe primary objective of this study was to perform a systematic review to compare self-report versus direct measures for assessing physical activity in observational and experimental studies of adult populations. The results from this systematic review provide a comprehensive summary of past research and a comparison between physical activity levels based on direct versus self-report measures in adult populations.The review sought to identify all studies  that presented a comparison of self-report and direct measurement results to reveal differences in physical activity levels based on measurement in adult populations (18 years and over). Studies which examined only a self-report or direct measure, but not both were not included in the review. All study designs were eligible  and both published (peer-reviewed) and unpublished literature were examined.Only studies involving adult populations with a mean age of 18 years and older were considered. Abstracts and titles were examined for their mention of adult populations (using adult$.tw.), but the search relied mostly on the subject headings for adult age groups (exp adult/). This systematic review was conducted simultaneously with a systematic review of the same focus in child populations (mean age < 19 years). A separate pediatric review was carried out as a result of differences in measurement methodologies and hypothesized cognitive and recall abilities between adults and children .The eligible self-report measures of physical activity included: diaries or logs; questionnaires; surveys; and recall interviews. Proxy-reports were excluded because they present issues of reliability due to the potential heterogeneity of reporters . The eligible direct measures of physical activity included: doubly-labeled water (DLW), indirect or direct calorimetry, accelerometry, pedometry, heart rate monitoring (HRM), global positioning systems, and direct observation. Although no language restrictions were imposed in the search, only English language articles were included in the review. Abstracts were included if they provided sufficient details to meet inclusion criteria.The following electronic bibliographic databases were searched using a comprehensive search strategy to identify relevant studies reporting the use of both self-report and direct measures for assessing individual physical activity levels: Ovid MEDLINE(R) (1950 to April Week 4 2007); Ovid EMBASE (1980 to 2007 Week 18); Ovid CINAHL (1982 to April Week 4 2007); Ovid PsycINFO (1806 to April Week 1 2007); SPORTDiscus (1830 to April 2007); Physical Education Index (1970 to April 2007); Dissertations and Theses (1861 to April 2007); and Ovid MEDLINE (R) Daily Update . The search strategy is illustrated using the MEDLINE search as an example . Reviewers were not blinded to the authors or journals when extracting data.The Downs and Black  checklisPercent mean difference was used as the main outcome of this analysis; it was calculated using the formula: [(self-report mean – direct mean)/direct mean]. Only studies with units of measurement that were the same for both the self-report and direct measures were used to calculate percent mean differences. Units were converted where possible. These studies were included in the direct comparison analyses. Forest plots  were constructed to present overall trends in agreement of physical activity by direct measure and gender. As most studies did not employ the same units of measurement  and did not report a measure of variance (e.g. standard deviations or standard errors), pooled estimates and confidence intervals were not calculated.The preliminary search of electronic bibliographic databases, reference lists and grey literature identified 4,463 citations  [Participants in the studies ranged from 10 to 101 years of age. Although the focus of the review was on those aged 18 and over, studies that had a range of ages less than 18 years were not excluded as long as the mean age of the sample was over 18 years. Sample sizes ranged from a low of six  to a hige (IPAQ) . There wA total of five direct measures were used in the assessment of physical activity and included: accelerometers, DLW, indirect calorimetry, HRM, and pedometers. Of the studies included in the synthesis of directly comparable data Table , accelerRisk of bias was assessed for all included studies (n = 173) including those reporting only correlation data. The range of items met on the modified Downs and Black tool was 8 to 15 (maximum possible count was 15) with a mean of 11.7 ± 1.2. Results of the risk of bias assessment indicated that 38% (65/173) of the studies had lower quality (based on a median split count of < 12/15). All studies were given maximum points for describing study objectives. All but one study scored maximum points for describing the main outcomes to be measured and the interventions used (including comparison methods between measures). Although most studies carried out some sort of significance testing on results, most did not report the actual probability values associated with the estimates or their associated measures of random variability . Most studies obtained a high number of items on the reporting section (maximum count of 8) with a mean of 6.9 ± 0.9.The external validity section of the risk of bias assessment had a maximum count of three and consisted of reporting on the representativenessof the subjects and the testing conditions. Almost all of the studies (166/173) reported that the staff, places and facilities where the participants were tested were representative of the testing conditions that would be expected by most individuals . However, 87% (151/173) of the studies did not report on the representativeness of the subjects asked to participate in the study and 95% (165/173) of the studies failed to report on the representativeness of those who were prepared to participate (enrolled) compared to the entire population from which they were recruited (received a score of 0). As a result, the external validity ratings of most studies were poor with a mean of 1.1 ± 0.5.In order to obtain the maximum number of items (four) in the internal validity section, studies must have reported whether any of the results of the study were based on "data dredging", whether the analyses adjusted for any time lag between the two measurements or different lengths of follow-up, whether the statistical tests used to assess the main outcomes were appropriate, and whether the main outcome measures were accurate . Internal validity item counts were generally high with the majority of studies having obtained a four.A qualitative analysis was conducted on the top seven (scores of 14 and 15 out of 15) and lowest seven studies (8 and 9 out of 15) based on scores from the risk of bias assessment. No conclusive patterns were identified from this analysis. The results from the accelerometer studies were further examined, as this was the only group of studies with a good distribution of low and high quality studies based on the accelerometer median split of bias scores. Findings from this analysis did not identify any clear patterns in the differences in agreement between physical activity measured by self-report compared to accelerometer when grouped by low and high quality.One hundred and forty-eight studies -157,190 Seventy-four studies contained comparable data on the measurement of physical activity based on self-report and directly measured values. Table Studies with extreme percent mean differences (≥ 400%) were removed from the forest plots for clarity purposes ,151,181.Percent mean differences were examined separately for the five different direct measures. Accelerometers were the most used direct measure. Self-report measures of physical activity were generally higher than those directly measured by accelerometers Figures  to 5. StThe second-most common direct measure employed was DLW and comparable data with self-report measures are presented in Figures A greater number of HRM and self-report comparisons were observed for studies with both male and female participants (n = 11) or female-only populations (n = 13) versus male-only populations (n = 3). Female-only results showed a general trend toward higher levels of self-reported physical activity , while the male-only  and combined  data had a greater number of studies with lower self-reported physical activity levels when compared to results of HRM.Pedometers and indirect calorimetry were the least commonly used direct measures for studies with comparable data. There were a total of eight comparisons from four studies for pedometers and 15 from two studies for indirect calorimetry Figures  to 8 makSubgroups were qualitatively examined to assess whether any differences existed in the degree of agreement between self-reported and directly measured physical activity. No clear patterns emerged within studies reporting on elderly (range or mean ≥ 65 years) populations ,116,174 Meta-analyses were not possible due to the substantial heterogeneity in units of reporting for physical activity measured by the various self-report and direct methods across the studies, and the significant lack of data with comparable units across measures. As a result, we were unable to determine the sensitivity of the values and the associated measures of error for the studies. Overall effect sizes to summarize the magnitude of discrepancy across the various measures of physical activity could therefore not be calculated.To the authors' knowledge this review represents the most comprehensive attempt to examine the relationship between self-report and directly measured estimates of adult physical activity in the international literature. Risk of bias was assessed and identified that just over one third of the studies had lower quality based on their description of the methods and external and internal validity. Overall, no clear trends emerged in the over- or underreporting of physical activity by self-report compared to direct methods. However, some results suggest that patterns in the agreement between self-report and direct measures of physical activity may exist, but they are likely to differ depending on the direct methods used for comparison and the sex of the population sampled. Interestingly, findings also identified that studies which categorized physical activity by level of exertion  exhibited a trend wherein these categorized studies saw the mean percent differences between the self-report and direct measures increasing with the higher category levels of intensity . These larger differences may reflect a problem with self-report measures attempting to capture higher levels of physical activity, or problems with participant interpretation and recall.Many of the studies tested the relationship between self-report and direct measures by using a correlation coefficient, but this is limited as correlation is only able to measure the strength of the relationship between two variables and cannot assess the level of agreement between them, as well as ignoring any bias in the data . A more A meta-analysis would have allowed us to estimate the overall effect sizes for each of the direct measures and undertake a sensitivity analysis to further understand the degree of bias in the studies. Unfortunately, inconsistent methods and reporting among the studies included made such an analysis methodologically inappropriate. Further research in this area would benefit from greater consistency in the units of reporting and the methods used to facilitate comparisons. For instance, many studies did not report results using the same units, so estimates of agreement between the self-report and direct measures could not be computed. There was also an inconsistency in the number of days measured and the time lag between the self-report and direct measures. It is recommended that authors present their results using the same units for both measures , that the two measurements assess physical activity for and over the same time period, and that all relevant data including a mean and measurement of variance  be included in all reports.Adhering to consistent reporting criteria would increase the comparability of results across studies and enable the calculation of overall effect sizes. At the population level, over- or underestimation of physical activity prevalence has important implications as these data are used to monitor physical activity trends, determine spending for research and physical activity interventions and programming, and to estimate physical inactivity-related risks of disease. Future studies may wish to refer to the updated Compendium of Physical Activities  which prA lack of a clear trend amongst the differences between the self-report methods for assessing physical activity and the more robust direct methods is of concern, especially when trying to establish whether the measures could be used interchangeably. There are several possible explanations for the lack of a clear trend in the data. Many self-report instruments (such as the 7-day PAR) may not have the ability to account for activities of less than 10 minutes in duration or those with a level of exertion lower than brisk walking , whereasJust as with some self-report measures not being able to capture all forms of activity, some direct measures may capture non-physical activity. For instance, the DLW technique is an accurate assessment of total energy expenditure, but it does not only capture physical activity, but rather all forms of energy expenditure including resting energy expenditure and the thermogenic effect of food. DLW is therefore expected to overestimate physical activity unless corrections are made. These and other measurement errors may inflate the between-individual variability in the energy expended in physical activity . FinallyIt is important to take into account all of these factors when comparing self-report and direct measures of physical activity. In specific circumstances (e.g. at different levels of activity) these two methods may not be comparable as they are not able to capture the same parameters of physical activity. Self-report measures may not able to accurately capture all levels of activity, but they may be able to capture how difficult an individual perceives an activity to be and the type of activity that is undertaken . Direct measures, on the other hand, may be more able to capture some of the information not captured in self-report methods , but also possess their own limitations such as the inability to capture arm movements and various types of physical activity (e.g. swimming).Concern regarding the discrepancy between self-reported and directly measured physical activity were recently reported by Troiano and colleagues who examined data from the 2003–2004 National Health and Nutrition Examination Survey (NHANES) which contained the first direct measurements of physical activity in a nationally representative U.S. sample . They co2 overestimated energy expenditure from physical activity records and the 7-day PAR. In confirmation of the trends within our accelerometer data, a recent study (published after our search) of 154 subjects compared a physical activity questionnaire to accelerometry data and identified that the accuracy of the physical activity questionnaire was higher for males than females and for those with a lower BMI [Other factors, such as those related to the population under study, may influence the ability of self-report and direct methods to capture the same measurement. For example, our findings show that in studies with a focus on overweight/obese individuals, self-reported physical activity was overestimated in all cases except for DLW studies involving combined male/female and male-only data. Our results differed from those reported by Irwin, Ainsworth and Conway (2001) . Their sower BMI . It is lThis review had limitations that should be considered when examining the results. First, the sample was limited to studies that included directly comparable data between self-report and direct measures (same units for both measures) or a comparison by way of correlation. Access to primary data from each study was not feasible; therefore, we relied upon reported comparisons and the means of measured physical activity. This reduced the number of studies with reported measures of physical activity by self-report and direct methods and limited our ability to accurately assess the degree of agreement between the two measures. However, when possible we converted non-comparable units to increase the number of studies used. The review did not assess the agreement between proxy-reported physical activity and direct measures. Proxy-report data are less prevalent but is an important means for assessing physical activity in sub-populations such as those who are chronically ill, disabled, or elderly, and who are unable to self-report on their own physical activity levels. Further research is required to assess the validity of proxy-report measures of physical activity when compared to direct methods. Finally, this review did not discern between differences in study protocols related to calibration, cut-points, or collection of the measurements and other population specific characteristics.In conclusion, this review provides an objective summary of the difference in physical activity levels assessed via self-report methods compared to directly measured physical activity. The results may assist researchers considering the use of self-report or direct measurement methods and serves as a note of caution that self-report and directly measured physical activity can differ greatly. Overall there were no clear trends in the degree to which physical activity measured by self-report and direct measures differ. The strength of trends differed by the direct method employed and by the gender of the population sampled. One-third of the studies were of poor quality with most studies having failed to report actual probabilities or measures of variability for estimates and the representativeness of their samples. The costs and benefits of direct measurement need to be considered in any study in order to determine if the added resources required for personnel training and laboratory analyses justify the possible increase in the precision of results. At this time, it is not possible to draw any definitive conclusions concerning the validity of self-report measurements compared to various direct methods, but caution should be exerted when comparing studies across methods.The authors declare that they have no competing interests.SAP carried out the design, bibliographic search, article screening, data abstraction and synthesis and drafted and edited the manuscript. KBA participated in its design and coordination and helped edit the manuscript. MH participated in article screening, data abstraction and editing of the manuscript. JH participated in data abstraction, data synthesis and helped edit the manuscript. SCG participated in the design of the study, provided methodological input, and assisted in the editing of the manuscript. MT conceived the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.


Surgical treatment is the usual therapy for patients with polycystic liver disease and with severe symptoms, yet the results of surgery are often disappointing and the optimal surgical approach is uncertain.We present the case of a 41-year-old Greek woman who underwent combined left hepatectomy with fenestration for symptomatic polycystic liver disease using ultrasound scalpel, fibrin glue and closed suction drain to prevent bile leakage, haemorrhage and ascites. Liver resection using the ultrasound scissors allowed quick parenchyma dissection under haemostatic conditions with safe coagulation of small vessels and bile ducts. Moreover, the ultrasound scalpel was applied to the cyst cavities exposed on the peritoneum to ablate the fluid-producing epithelial cyst lining. We also covered the cut cystic cavities exposed to the peritoneum surface of the liver with fibrin glue. Instead of allowing the opened cysts to drain into the abdominal cavity, we used two wide bore closed suction fluted drains. We did not observe excessive fluid loss through the drainage after the second postoperative day. The drain tubes were removed on the third postoperative day.In our patient, effective treatment of ascites and prevention of bile leakage and bleeding indicate that this new approach is promising and may become a useful surgical technique for polycystic liver disease. Polycystic liver disease (PLD) is a common manifestation of polycystic kidney disease and is associated with an autosomal dominant inheritance. Patients are usually asymptomatic . SymptomWe present the case of a patient who underwent combined left hepatectomy with fenestration for symptomatic PLD using the harmonic scalpel, fibrin glue and closed suction drain to prevent bile leakage and ascites.A 41-year-old Greek woman presented with chronic and unrelenting right upper quadrant pain, epigastric fullness, early satiety, nausea, vomiting and dysphagia. On physical examination, hepatomegaly and tenderness in the right upper quadrant were found. Abdominal ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) revealed multiple liver cysts, particularly in the left hepatic lobe, with characteristics similar to simple hepatic cysts. Multiple cysts were also found in the kidneys and the anterior surface of the pancreas  were located at the right hepatic lobe Figure . There wAfter completion of the resection, the tourniquet was opened and the remaining cut surface carefully inspected for residual bleeding or nonoccluded bile ducts. The cut surface was plain and brownish; biliary leaks or persistent bleeding were easily detected and sutured with 4-0 polypropylene. The ultrasound scalpel was applied to the cyst cavities exposed on the peritoneum in order to attempt ablation of the fluid-producing epithelial cyst lining. To avoid bile leakage and haemorrhage, fibrin glue was spread over the raw surface of the liver. Cysts in the pancreas and kidneys were not treated. Two wide-bore closed suction fluted drains (30 F) were brought out through a separate stab wound; one placed in the subhepatic space and one in the right subdiaphragmatic space. Postoperatively, the patient remained well and without complications. The drain tubes were removed on the third postoperative day, when the drainage had decreased to less than 30 mL in 8 hours. Symptomatic relief and reduction in abdominal girth were achieved. Histologic examination showed von Meyenburg's complexes. The patient was followed up at clinic - special data included hepatic and renal function, symptomatic relief, the patient's working capacity and CT scans. The follow-up showed post-resection hypertrophy of the spared liver and lack of clinically significant cyst progression. Four years after the procedure, the patient had an improved quality of life and functional status without deterioration in her hepatic or renal function.With the widespread use of sensitive imaging techniques, the frequency of non-parasitic hepatic cysts is reported more often. Adult polycystic disease is the most common cystic disease. Liver cysts in patients with polycystic kidney disease are generally asymptomatic, but in a few patients, hepatomegaly from numerous large cysts may cause symptoms ,4.de novo after treatment . Th. Th10]. Handling of the instrument, cutting and coagulation quality were satisfactory and safe. To achieve a better and more effective coagulating effect, the portal structures were occluded by a tourniquet which did not last longer than 30 minutes, together with lowering of the central venous pressure during resection. The liver resection using the ultrasound scissors allowed quick parenchyma dissection under haemostatic conditions with safe coagulation of small vessels and bile ducts of up to 2 to 3 mm in diameter. Larger vessels and biliary ducts were divided with clamps and sutured with 4-0 polypropylene. The major advantage of the ultrasound scalpel was the modest trauma that it produced and the controlled dissection of the tissue. Especially in the periphery, the UltraCision was an ideal dissection instrument: with the absence of large vessels and bile ducts, nearly all of the parenchyma was easily divided without causing bleeding, bile leakage or trauma. Moreover, use of ultrasound scissors on the cyst cavities exposed on the peritoneum was attempted to facilitate ablation of the secretory epithelium and reduction of postoperative continual peritoneal fluid losses. However, we also covered the cut cystic cavities exposed to the peritoneum surface of the liver with fibrin glue ,12. FibrAscites is the commonest complication specific to surgery for PLD, occurring in all patients undergoing resection ,2. We atSurgical management of patients with PLD remains a challenging issue for physicians. The aim of the present study was to investigate the ability of the UltraCision instrument, fibrin glue and closed suction drainage in hepatic resection combined with fenestration for PLD. This method appears to be an advantageous new technique. This case report is not sufficient to draw any final conclusions. Therefore, the benefits of this surgical approach should be further evaluated. However, our initial experience is promising, and we believe that it may become a valuable means in surgery for PLD.CT: computed tomography; MRCP: magnetic resonance cholangiopancreatography; MRI: magnetic resonance imaging; PLD: polycystic liver disease; SGOT: serum glutamic oxaloacetic transaminase; SGPT: serum glutamic pyruvic transaminase; US: ultrasound.Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.CK, CE and EF performed the operation and together with GA and SL contributed to the conception and design of the manuscript. JP and KP analyzed and interpreted the patient regarding the polycystic disease. GA and SL were major contributors in writing the manuscript. All authors read and approved the final manuscript.


Recently, concern has been raised over the appearance of suboptimal responses to ivermectin in Ghana – highlighting the potential threat of the development of resistance to ivermectin. This report summarises a meeting held in Ghana to set the research agenda for future onchocerciasis control. The aim of this workshop was to define the research priorities for alternative drug and treatment regimes and control strategies to treat populations with existing evidence of suboptimal responsiveness and define research priorities for future control strategies in the event of the development of widespread ivermectin resistance.Since 1987 onchocerciasis control has relied on the donation of ivermectin (Mectizan This programme is rightly regarded as a model paradigm for mass treatment control programmes [th anniversary of MDP was an opportunity to reflect on the successes the programme has achieved [Loa loa are evident [Since 1987 onchocerciasis control has relied on the donation of ivermectin , which are areas of hyperendemicity, within the Pru River basin that serve as the focus of Community-Directed Treatment with Ivermectin (CDTI). The total at risk population for onchocerciasis is about 3.2 million.Ivermectin distribution in Ghana started with the use of mobile teams in 1987, with CDTI introduced in 1998. Since the devolution of onchocerciasis control from the former-OCP (Onchocerciasis Control Programme) to Ghana (under APOC), the national programme has been monitoring recrudescence through entomological and epidemiological surveillance activities. Ivermectin treatment started in lymphatic filariasis and onchocerciasis co-endemic areas in 2001 and has undergone a gradual up-scaling to cover 61 endemic districts by 2005. From 2002 to 2007 3.4 million people were treated through CDTI with coverage ranging from 48.4 to 79.1%. Since 2006 onchocerciasis control has been implemented in the context of the Neglected Tropical Diseases Control Programme (NTDCP). Implementation of NTDCP started in April 2007 on a pilot basis in 5 regions of Ghana.Results from the entomological and epidemiological surveillance activities have indicated fly infectivity levels and infection in humans that require improved programme attention. Results of surveys done in 2005, indicated high infectivity rates of 1.82 per 1000 parous flies, from the Asubende site within the Pru River basin. In 2006 results again showed high infectivity rates of 0.556 – 1.01 per 1000 parous flies from sites within the White Volta, Kulpawn, Anum and Pra River basins. Fly nuisance was significantly high in each of the surveyed sites.In 2004 epidemiological surveys showed a microfilaria positive prevalence of 8.9% with 13 out of the 18 villages surveyed having prevalence of more than 5%. About 2.8% and 0.75% had visual impairment and total blindness respectively. About 9 of the 24 communities surveyed in 2006 had prevalence rates above 5% with the highest focus found in 3 sites in the Asante Akim district in Ashanti region. Community microfilarial load (CMFL) ranged from 0.56 – 2.89 mf per skin snip. A site within the Pru River basin produced CMFL of 0.98, which is above the threshold of 0.5 while results of other communities were below this threshold.A number of factors may contribute to the trends observed from entomological and epidemiological surveys, including CDTI coverage, individual compliance and the possibility that the efficacy of ivermectin is compromised.Onchocerca volvulus to ivermectin is manifested by responses that are incompatible with previous experience with multiple treatments. Critical to this definition is incontrovertible evidence of the consumption by the subject of the number of treatments under consideration. Additional factors are parasite exposure to adequate concentrations of ivermectin and control for the effects of ongoing transmission. SOR is usually suspected when the prevalence of and/or the intensity of infection by skin microfilariae are higher than expected and is confirmed by direct examination of the adult worms. Multiple treatments with ivermectin have marked effects on embryogenesis [Suboptimal response (SOR) of ogenesis . Quantitogenesis , a reducogenesis  to arresogenesis . Thus whAn open case control hospital based study  enrolledIn a two phase epidemiological study , 2501 inThe Ghana studies , and worm fertility (by embryogram). A meta-analysis was conducted of both these outcomes after single-dose ivermectin following a systematic review of early clinical and field trials and fitted a mathematical model to the data [Onchocerca volvulus samples from communities in Ghana and Cameroon that have received many treatments have been found to have significant changes in similar genes  compared with worms isolated from treatment-naïve subjects or the same subjects prior to treatment [Drug resistance has been defined as a loss of the normal response to treatment and is heritable . Ivermecthe data . Resultsthe data . This streatment ,17. ThesWolbachia – a bacterial endosymbiont of filarial parasites essential for worm development, fertility and survival and inducer of inflammatory disease pathogenesis. A series of field trials against onchocerciasis and lymphatic filariasis have demonstrated that 4–8 week courses of the antibiotic doxycycline deplete the bacteria and result in the long-term sterility and most importantly death of adult worms [New and alternative treatments for filariasis are therefore urgently needed. The break-through of using antibiotics to target the bacterial symbiont of the parasite has identified a novel treatment and target that offers a superior therapeutic alternative to current anthelminthic drugs -21. The lt worms -21.Wolbachia and female worm sterility for 18 months in all worms except for a few that were acquired after doxycycline treatment [A series of field trials on onchocerciasis in Ghana began with a regimen of daily treatment with 100 mg doxycycline for 6 weeks, followed by ivermectin 4 months later, which resulted in depletion of reatment -23. The reatment . In a moreatment . If one reatment .The 'slow-kill' outcome of doxycycline therapy has several advantages including the elimination of the inflammatory inducing bacteria ,27 and aWolbachia require testing to establish the minimum effective regime for integration into existing control programmes to meet the programmatic aims of eliminating filariasis or be used in more restricted situations, such as during the 'mop-up' phase and the end of programmes, in the event of the emergence of resistance or poor responsiveness to existing drugs or in individuals co-infected with Loa loa and at risk of severe adverse reactions to ivermectin. Definition of the minimal effective regime will also provide an important advance in the treatment options for individual cases outside of controlled areas.The current major obstacles to the use of antibiotic therapy in control of filariasis is the length of treatment, which is considered to be logistically incompatible with the community-directed treatment strategies used for filariasis control and contraindication for children >9 and pregnancy. Shorter regimes using combinations of existing antibiotics effective against L. loa; the risk of severe adverse events following ivermectin therapy in individuals with high intensity of L. loa microfilaraemia precludes the use of ivermectin in many of the forested regions of APOC. The use of doxycycline in these communities has been determined in two trials in Cameroon. 1) A placebo-controlled trial of doxycycline with or without ivermectin in areas of low loaisis co-endemicity, and 2) a trial of community-directed delivery of doxycycline alone in communities with high prevalence of loaisis. The outcome of these trials, which is currently under analysis, should reveal the suitability of these approaches as an alternative therapy for onchocerciasis in areas of loiasis co-endemicity.In the case of communities co-infected with Wolbachia therapy into a public health tool the A-WOL consortium has been established through funding from the Bill and Melinda Gates Foundation to find new drugs active against Wolbachia that improve upon existing antibiotic therapy.In an attempt to translate Anti-the establishment of anti-symbiotic chemotherapy directed against Wolbachia compatible with mass drug administration (MDA) programmes for human filariasis. The expected health outcome would be an alternative treatment for human filariasis to ensure that the long-term goals of global elimination of the public health problems are achieved. A secondary goal is the establishment of anti-symbiotic chemotherapy suitable for a more restricted use, planned for an interim phase in which there is yet no drug or drug combination available that is compatible with MDA usage. For example, in the event of the emergence of drug-resistance to existing treatment in limited populations or as an alternative for communities co-endemic for loiasis.The principal goal is Wolbachia (see Appendix 1). The strategy is intended to cover; 1) the optimization of regimes of drugs with known activity against Wolbachia  the identification of novel drugs and compounds identified through high-throughput screening and target discovery to provide a portfolio of lead candidates in a product pipeline, which could be used in future control and treatment approaches.In order to achieve these goals A-WOL has identified four major objectives to address the discovery and development of new drugs and regimes against ampicin, ,29) for in vitro and in vivo efficacy to doxycycline, novel classes of antibiotic and other drugs active against Wolbachia and validated targets for novel drug design, which provide encouragement that the goals of the programme will be achieved.Progress during the first 12 months of the programme includes the discovery of novel tetracyclines with improved Onchocerca lienalis microfilariae and O. gutturosa adult male worms in vitro and O. lienalis microfilariae in mice. Hits from these screens are then tested against Brugia pahangi in jirds and dogs. From 2006/7 some 5000 compounds have been screened in vitro producing ~100 compounds for follow-up and around 6 lead compounds for optimization. In addition, cyclooctadepsipeptides such as emodepside, show species-dependent activity against filarial nematodes. Variability in sensitivity to larval and adult stages is reported for Acanthocheilonema viteae, L. sigmodontis and B. malayi [Drug discovery and development activities for onchocerciasis continue under the TDR helminth drug initiative. Drugs from a variety of sources are screened against . malayi , but it . malayi .O. volvulus infected subjects which will complete the 18 months efficacy follow up at the end of 2009. Based on the safety and microfilaricidal efficacy data obtained in this trial to date, initiation of a large phase III trial is planned. This will be followed by a study to determine a safe dose in children before application for regulatory agency approval. Data from community studies on safety, efficacy and effect on transmission will be obtained before an expert meeting to assess whether moxidectin can be recommended for use in control programmes by 2014.Another drug being developed for control programme use is moxidectin (Wyeth). A partnership between endemic countries, APOC, TDR and Wyeth is undertaking the development required to determine whether moxidectin has the efficacy and safety not only to eliminate onchocerciasis as a public health problem but to eradicate onchocerciasis. The development has progressed through studies in healthy volunteers to an ongoing Phase II hospital-based trial of up to 192 Vector control was a major component of the onchocerciasis control programme (OCP) and was based on routine aerial application of larvicides over a period of more than 14 years. This is an expensive method of treating the river, but was considered essential due to the vast area within the project. Since OCP was completed, vector control has not been considered feasible or cost-effective in the APOC countries, except for a few small isolated foci in 'special intervention zones' (SIZ).In Ghana, vector control has virtually ceased, except for limited activities associated with the Bui Dam construction, but in Cameroon, temephos has been applied across the full width of the Sanaga river, at selected sites using local boats. Three applications were made ideally at 7 day intervals, with adult blackflies monitored on Perspex sheets covered with a sticky substance, to determine when a subsequent series of larvicide treatments should be applied to keep adult fly populations below a threshold. Other insecticides used in a rotation will be needed to minimise the risk of resistance. Dosage applied was calculated according to WHO recommendations.Simulium spp. The latter affects people's skin and prevents working a full day, so agricultural production has declined. The severity of black flies is considered to have increased and this may be partly due to hydroelectric schemes along the Sanaga River.These control operations were required where areas of tropical rain forest along the Nyong and Sanaga rivers were de-populated due to the high incidence of onchocerciasis and the constant irritation caused by the bites of the vector So far larval control has been confined to major rapids on the Sanaga, but to treat narrower rivers, larvicide could be applied using motorised hydraulic knapsack sprayers fitted with boomless nozzles to project the insecticide across the river.To minimise treatment of rivers, research is need to determine whether adult blackflies can be lured by an attractant to insecticide treated screens as used in tsetse control, and whether insecticide treated over-garments or bandana at the wrists and ankles could reduce the impact of the flies on field workers. Further research is needed to improve monitoring and establish thresholds that determine when control is needed.In Ghana on-going transmission shows that operational research remains critical to sustain gains of the OCP and improve onchocerciasis control. A closely monitored area-wide blackfly management programme could significantly reduce the populations of blackflies, and thus allow agricultural productivity to increase in West Africa. By integrating vector management with drug treatment, such a programme could lead to better use of the drugs by those affected by onchocerciasis. However, capacity building is needed to increase local knowledge of vector ecology, sampling procedures and control techniques.The outcome of the meeting was a list of priorities for research (Appendix 2). Some of these areas are ongoing and funded, but a number of important areas require additional support and renewed effort. Failure to grasp the importance and urgency of addressing these activities runs the serious risk of undoing much of the benefits and achievements of past and current control programmes. A unanimous outcome was the belief that, where possible, this research should be undertaken by African scientists within endemic countries. Sufficient capacity building and funding for such activities are urgently required if the aims of the Yaoundé declaration  are to bThe authors declare that they have no competing interests.MT compiled the report from contributions to each section written by each of the other authors. All authors approved the final draft of the report.A-WOL has four main objectives:O. volvulus and W. bancrofti to test combinations of doxycycline with rifampicin at low doses to achieve shorter regimens to define the optimal regime using drugs already licensed for human use.1) Regime Refinement – To address this we will carry out two phase II field trials in Ghana on Wolbachia-cell line assays compatible with combinational high throughput screening (cHTS) technologies and as a novel tool to screen existing and novel compounds for anti-symbiotic activity.2) Assay development – To develop Wolbachia.3) Library Screening – To screen novel derivatives of tetracycline (TC), large diversity libraries (~100 K compounds) and combinations of existing drugs against Wolbachia genomic annotation. To use bioinformatics to identify the 'essential gene set' of Wolbachia and multi-step computational approaches to identify potential drug targets and develop a surrogate screening system in E. coli. To use aptamer technology to identify inhibitors of novel drug targets to incorporate into HTS.4) Target Discovery – To identify targets and inhibitors of key enzymatic and metabolic pathways predicted from Information on the extent and geographical range of ivermectin responsiveness is needed through:- Spatial and longitudinal monitoring of epidemiological, parasitological, vector and clinical responses- Investigation of parasite genetics in relation to drug susceptibility and the development of genetic markers to quantify connectivity between parasite populations- Improved integration of existing strategies of chemotherapy and vector control- Re-evaluation of control strategies for drugs with macrofilaricidal or permanent sterilizing activityWolbachia endosymbionts- Continue development of macrofilaricidal drugs and approaches to deplete the parasites of - To develop specific, rapid and less invasive tools to improve mapping and provide prospective tools to define control programme endpoint- Evaluate new methods of blackfly trapping for monitoring and to reduce fly density- Optimizing techniques to apply larviciding- Develop research on blackfly attractants, reducing human-vector contact, improved knowledge of vector-parasite combinations- Consider role of Community-directed activities for vector controlTo assist in the planning of activities for:- Identification and optimisation of indicator groups (in the area of diagnostics and programme monitoring)- Monitoring of resistance (detection and quantification of genetic markers)- Exploring different control scenarios, combinations of control measures, timings of applications, etc. that can also delay spread of drug resistance- Vector biology, quantification of vector competence, vector population dynamics, insecticide resistanceCapacity building in all the areas above


Gene rearrangements such as chromosomal translocations have been shown to contribute to cancer development. Human chromosomal fragile sites are regions of the genome especially prone to breakage, and have been implicated in various chromosome abnormalities found in cancer. However, there has been no comprehensive and quantitative examination of the location of fragile sites in relation to all chromosomal aberrations.Using up-to-date databases containing all cancer-specific recurrent translocations, we have examined 444 unique pairs of genes involved in these translocations to determine the correlation of translocation breakpoints and fragile sites in the gene pairs. We found that over half (52%) of translocation breakpoints in at least one gene of these gene pairs are mapped to fragile sites. Among these, we examined the DNA sequences within and flanking three randomly selected pairs of translocation-prone genes, and found that they exhibit characteristic features of fragile DNA, with frequent AT-rich flexibility islands and the potential of forming highly stable secondary structures.Our study is the first to examine gene pairs involved in all recurrent chromosomal translocations observed in tumor cells, and to correlate the location of more than half of breakpoints to positions of known fragile sites. These results provide strong evidence to support a causative role for fragile sites in the generation of cancer-specific chromosomal rearrangements. Tumor cells exhibit various forms of genomic instability, including chromosomal rearrangements, many of which directly contribute to the neoplastic process rather than occurring as a consequence ,2. RearrThere are a variety of ways by which a cell acquires DNA breaks. Breaks can arise from any agent that affects the primary structure of the double helix, like endogenous reactive oxygen species or exogenous factors such as ionizing radiation . More reet al. demonstrated that the deletions of the type seen in cancer can be produced within fragile site FRA3B, a site of rearrangements and deletions that are among the most common type of aberrations found in tumors , MYH11 [nt 6985071~7388966 of NT_010393.15], HMGA1 [nt 24937900~25197258 of NT_007592.14], LAMA4 [nt 16473563~16870257 of NT_025741.14], MLL [nt 21744621~22083352 of NT_033899.7], and AFF4 [nt 34501084~34839367 of NT_034772.5].Three gene pairs in which both genes are mapped to fragile sites  was used to perform the analysis of the data.Using Zukers' MFOLD program , the potAB and LEW compiled and analyzed the databases. AB and LCTP carried out the flexibility and secondary structure analyses. AB and Y-HW wrote the paper. Y-HW designed and coordinated the study. All authors read and approved the final manuscript.Comprehensive list of gene pairs involved in cancer-specific recurrent translocations which result in fusion transcripts. The translocation name(s) for each unique set of genes and the chromosomal locations of all genes are indicated. Genes which co-map to fragile sites are highlighted in gray, and the fragile site is specified.Click here for fileGene pairs involved in cancer-specific recurrent translocations in which the breakpoint in one gene co-localizes with a fragile site. The translocation name(s) for each unique gene set is indicated. The gene within each set located at a fragile site is highlighted in gray, and the cancer(s) in which the fusion transcript is found is included.Click here for fileThe computed lowest free energy of predicted DNA secondary structures. The flanking 125 kb regions are shaded in light gray, and the gene region is shaded in black. The black box indicates the location of the most stable structure found in the sequence. The black line is the curve which best fits the raw data. These curves were generated using the polyfit function of the Matlab program, and are presented in Figure Click here for file


The recent availability of genomic sequences and BAC libraries for a large number of mammals provides an excellent opportunity for identifying comparatively-anchored markers that are useful for creating high-resolution radiation-hybrid (RH) and BAC-based comparative maps. To use these maps for multispecies genome comparison and evolutionary inference, robust bioinformatic tools are required for the identification of chromosomal regions shared between genomes and to localize the positions of evolutionary breakpoints that are the signatures of chromosomal rearrangements. Here we report an automated tool for the identification of homologous synteny blocks (HSBs) between genomes that tolerates errors common in RH comparative maps and can be used for automated whole-genome analysis of chromosome rearrangements that occur during evolution.We developed an algorithm and software tool (SyntenyTracker) that can be used for automated definition of HSBs using pair-wise RH or gene-based comparative maps as input. To verify correct implementation of the underlying algorithm, SyntenyTracker was used to identify HSBs in the cattle and human genomes. Results demonstrated 96% agreement with HSBs defined manually using the same set of rules. A comparison of SyntenyTracker with the AutoGRAPH synteny tool was performed using identical datasets containing 14,380 genes with 1:1 orthology in human and mouse. Discrepancies between the results using the two tools and advantages of SyntenyTracker are reported.SyntenyTracker was shown to be an efficient and accurate automated tool for defining HSBs using datasets that may contain minor errors resulting from limitations in map construction methodologies. The utility of SyntenyTracker will become more important for comparative genomics as the number of mapped and sequenced genomes increases. Understanding of the comparative organization and evolution of mammalian genomes has dramatically improved with the availability of complete genome sequences and detailed physical maps of chromosomes for a growing number of species . RecentlAutomated tools for HSB identification -9 use diAs an input, SyntenyTracker uses a tab-delimited file containing information that includes chromosome assignment of orthologous markers in two genomes, position of each marker in the chromosomes of both genomes, and marker identifiers. The markers in the input table are sorted on the basis of their chromosome assignments and positions in one of the two genomes. This genome is termed as the "reference genome." The second genome is called the "target genome" , the equivalent of HSBs AutoGRAPH first assigns a numerical integer to the markers in both reference and tested genomes and calculates adjacency penalties between consecutive markers on tested genomes. AutoGRAPH breaks a CSO if the adjacency penalty exceeds the penalty chosen by the user. The main difference with SyntenyTracker definition of HSBs is that SyntenyTracker checks the size of inversions and compares them to the threshold selected by the user. The number of markers in an inversion cannot be less than 3.  the order of target genome chromosomes in the original human-mouse orthologous gene input file was changed; b) the order of markers within both reference and target chromosomes was inverted. HSBs defined using such modified input files were compared to the HSBs defined using the original input file. All HSBs from the modified input completely matched original HSBs.To examine how SyntenyTracker accounts for the uncertainties in the order of markers on the RH comparative map when several markers are mapped to exactly the same position on the RH map, we changed the order of such markers on the human-cattle comparative map , definedSyntenyTracker is able to define HSBs on whole-genome comparative data following the set of rules defined by Murphy and coworkers . We demoProject name: SyntenyTrackerProject home page: Operating system(s): Platform independent (web-based application)Programming language: Perl, CGI-PerlOther requirements: A web browserLicense: None for usageAny restrictions to use by non-academics: NoneThe authors declare that they have no competing interests.RD designed, implemented and tested the algorithm, and drafted the manuscript. DML and HAL supervised the work. All authors read and approved the final manuscript.Explanation of HSB definition rules and SyntenyTracker algorithm. This file describes the rules for HSB definition implemented in SyntenyTracker, as well as the algorithm SyntenyTracker follows and contains supplementary tables and figures illustrating how the algorithm works.Click here for fileDefinition of HSBs on the cattle-human radiation hybrid comparative map. Comparison of HSBs defined manually, with SyntenyTracker and AutoGRAPH on the cattle-human radiation hybrid map dataset [ dataset .Click here for fileDefinition of HSBs on a set of human and mouse orthologs. Comparison of HSB definitions between SyntenyTracker and AutoGRAPH on a set of human and mouse orthologs.Click here for file