bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of TOPS (a simplified assessment of neonatal acute physiology) in predicting mortality in transported neonates
Authors: Mathur N B , Arora Daisy
Published: April 2008

Aim: To evaluate role of TOPS (a simplified assessment of neonatal acute physiology) in predicting mortality in transported neonates and to compare it with SNAP II. Design: Prospective study. Setting: Referral Neonatal Unit of a teaching hospital.

Subjects: 175 neonates >1000 g admitted to referral nursery.

Methods: Temperature, oxygenation, capillary refill time (proxy for perfusion) and blood sugar (given the acronym of TOPS) were recorded at admission. SNAP II was also recorded for first 12 hours following admission.

Results: All the TOPS variables had significant correlation with fatality on univariate analysis. Fatality was 100% when all the four TOPS variables were deranged. The sensitivity, specificity, positive and negative predictive values of derangements of two or more TOPS parameters in predicting mortality were 81.6%, 77.39%, 65.3% and 89%, respectively All the variables of SNAP II significantly correlated with mortality. A cut‐off score of 24 was derived from the ROC curve. The sensitivity, specificity, positive and negative predictive values of SNAP II score >24 in predicting mortality were 78.3%, 86.1%, 74.6% and 88.4%, respectively. The area under ROC curve for derangements of 2 or more TOPS parameters was 0.89 while that for SNAP II was 0.88. Both models were well calibrated (p value for Hosmer Lemeshow goodness of fit for TOPS was 0.75 while that for SNAP II was 0.80). The total correct classification rate for TOPS was 81.7%, while that for SNAP II was 83.4%

Conclusion: TOPS has an equally good prediction for mortality as SNAP II and can be used as a simple and useful method of assessment of risk of fatality that can be assessed immediately, at admission.
Determinants of breastfeeding initiation in Xinjiang, PR China, 2003–2004
Authors: Xu Fenglian , Binns Colin , Yu Ping , Bai Yi
Published: April 2008

Aim: To identify the prevalence of breastfeeding initiation and the determinants of the breastfeeding initiation in Xinjiang, PR China, 2003–2004.

Methods: A cohort study of infant feeding practices was undertaken in Xinjiang Uygur Autonomous Region, PR China. A total 1219 mothers were randomly recruited in five hospitals or institutes located in urban and rural areas during 2003 and 2004. Multivariate logistic regression analysis was used to explore factors associated with breastfeeding initiation.

Results: Before discharge from hospital, 92.2% of the mothers were breastfeeding including 66.2% who were exclusively breastfed. A total of 88 mothers (7.8%) were not breastfeeding on discharge from hospital. Breastfeeding before discharge was positively associated giving breastmilk as the first feed (OR 4.05, CI 1.30–12.65) feeding on demand (OR 4.33, CI 1.69–11.08), when the mother felt she had been given enough information about breastfeeding, belonging to a minority ethnic group (OR 3.13, CI 1.21–5.05) and giving birth in spring or summer.

Conclusions: This study has documented breastfeeding initiation rate and associated factors with it in Xinjiang, PR China.
Oral glucose as an analgesic to reduce infant distress following immunization at the age of 3, 5 and 12 months
Authors: Thyr Margit , Sundholm Anneli , Teeland Lawrence , Rahm Vivi‐Anne
Published: April 2008

Aim: To evaluate oral glucose as an analgesic to reduce infant distress after immunization during the first year of life and to investigate if these effects change during this period.

Methods: A prospective controlled trial of the effectiveness of glucose on crying response to immunizations at 3, 5 and 12 months of age. A total of 110 infants were randomized to receive 2 mL of 30% glucose or water. The same solution was given at 3, 5 and 12 months. Crying was registered from onset of the injection up to 120 seconds. Infanrix Polio Hib was administered intra‐muscular in the thigh. Observation nurse and parents were blind to the nature of the solution.

Results: Administration of glucose reduced the mean crying time by 22% at 3 months, 62% at 5 months and 52% at 12 months. The difference was significant at 5 and at 12 months. In the water group, there was a significant correlation between the children who cried at 3 months and who subsequently cried at 5 and 12 months. No correlations were found in the glucose group.

Conclusion: Sweet solution can be used as a simple and safe method to reduce the distress following immunization in infants up to 12 months.
The epidemiology and factors associated with nocturnal enuresis and its severity in primary school children in Taiwan
Authors: Tai Hui‐Lung , Chang Yu‐Jun , Chang Sally Chia‐Chien , Chen Gin‐Den , Chang Chin‐Pao , Chou Ming‐Chih
Published: April 2008

Purpose: To investigate the prevalence of nocturnal enuresis among children in elementary school in Taiwan and to evaluate its associated factors and severity.

Materials and Methods: A randomly selected cross‐sectional study was conducted from elementary schools in Changhua county, Taiwan in 2003. In all, 9228 questionnaires were sent to 46 schools in 26 districts.

Results: A total of 92.1% (8496/9228) of questionnaires were completed. The overall prevalence of nocturnal enuresis was 6.8%. The ratio of male to female was about 1.5 (8.0% vs. 5.5%). The prevalence of enuresis according to age group declined from 12.5% at 6 years to 2.0% at 12 years. The prevalence of enuresis in the urban area did not show significant difference from that of rural area (6.2% vs. 6.9%). Of the factors associated with enuresis, gender, age, urinary frequency or urgency, heredity, drinking habit before sleep and difficulty in waking showed significant difference after multiple logistic regression analysis. After multivariate analysis, difficulty in waking and time of wetting were the only factors significantly associated with the severity of enuresis.

Conclusion: Our investigation showed the prevalence of enuresis is similar to those reports from the north of Taiwan and most of other western countries, but higher than that of China and Hong‐Kong. Difficulty in waking and time of wetting were the only factors significantly associated with the severity of enuresis.
Parent experiences of paediatric care (PEPC) questionnaire: reliability and validity following a national survey
Authors: Garratt Andrew M , Bjertnæs Øyvind Andresen , Barlinn Jon
Published: April 2008

Aim: To describe the development and evaluation of a parent completed questionnaire to measure parent experiences of inpatient paediatric care, the parent experiences of paediatric care (PEPC).

Methods: Literature review, parent interviews, pre‐testing and a national survey of 6144 parents of children who were inpatients at one of the 20 paediatric departments within Norway in 2005.

Results: Three thousand three hundred and eight (53.8%) parents responded to the questionnaire. Low levels of missing data suggest that the PEPC is acceptable. The questionnaire includes six scales as supported by the results of factor analysis: nursing services (seven items), doctor services (five items), organisation (four items), information – examinations and tests (two items), information – discharge (three items) and hospital facilities (four items). Cronbach's alpha and test‐retest correlations ranged from 0.7 to 0.9. Comparisons of scale scores with several variables including overall satisfaction with care and pain control, supported validity.

Conclusion: The PEPC questionnaire includes important aspects of hospital care from the perspective of the parent. It has good evidence for internal consistency, test‐retest reliability and validity and is recommended in surveys of parent experiences of paediatric inpatient care.
Ocular complications at the limits of viability
Authors: Pulzer Ferdinand , Robel‐Tillig Eva , Knüpfer Matthias , Foja Christian , Gebauer Corinna , Kiess Wieland
Published: April 2008

Aim: To evaluate the incidence of retinopathy of prematurity (ROP) and other ocular morbidities in extremely premature infants.

Methods: A retrospective analysis of the prevalence and nature of ocular abnormalities in a cohort of 22 extremely pre‐term infants born <25 + 0 weeks of estimated gestational age (GA) was performed.

Results: The children were grouped according to the observed disorder: 13 out of 22 (59%) neonates with mild ophthalmologic findings (ROP ≤ stage II) [Group 1], 5 out of 22 (23%) infants with ROP stage III or more (Group 2) and 4 out of 22 (18%) neonates with severe ocular morbidity (congenital cataract, microphthalmia, partial optic nerve atrophy and corneal perforation due to an ulcer with lens protrusion), partly combined with ROP ≥ stage III (three of four). One child of 22 (5%) needed laser therapy. Out of 22 admitted infants, 20 (91%) were discharged alive.

Conclusion: The high rate of ocular morbidity besides ROP in extremely pre‐term infants is noteworthy. Mechanisms influencing the postnatal development of the eye, especially their relation to the grade of prematurity and neonatological therapeutical strategies, require further investigations.
Mode of delivery and threshold retinopathy of prematurity in pre‐term ELBW neonates
Authors: Manzoni P. , Farina D. , Maestri A. , Giovannozzi C. , Leonessa M. L. , Arisio R. , Gomirato G.
Published: April 2008

Background: Retinopathy of prematurity (ROP) is a multifactorial disease, but little is known about its relationship with perinatal risk factors. We tested the hypothesis that the mode of delivery may be associated with threshold ROP as defined by CRYO‐ROP.

Methods: We conducted a prospective, cohort analysis of a database of all extremely low birth weight (ELBW) neonates (=birth weight <1000 g) admitted over a 8‐year period from 1997 to 2004 to a large tertiary neonatal intensive care unit in a urban area of northern Italy and screened for ROP. Incidence of threshold ROP was calculated for the whole studied population. The definition of threshold ROP was as defined by the CRYO‐ROP study. Univariate analysis was performed to look for significant associations between threshold ROP and several possible associated factors, and among them, the mode of delivery (vaginal delivery or caesarean section). When an association was indicated by p < 0.05, multiple logistic regression was used to determine the factors significantly associated with ROP.

Results: Enrolled ELBW neonates were 174, and 46 of them (26.4%) displayed threshold ROP. Threshold ROP occurred in 40.9% (27 of 66) of the neonates vaginally delivered and in 17.5% (19 of 108) of those born via caesarean section (R.R. 3.35; 95% CI 1.230–4.855; p = 0.008 at univariate analysis, and =0.04 at multivariate logistic regression after controlling for birth weight, gestational age, intraventricular haemorrhage grade 2 or more, days on supplemental oxygen, systemic fungal infection). Birth by vaginal delivery was not significantly associated with other major sequelae of prematurity (intraventricular haemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis).

Conclusions: In our Institution birth by vaginal delivery is a significant and independent predictor of threshold ROP in ELBW infants. We suggest to consider closely ophthalmological surveillance for pre‐term ELBW infants born this mode.
Weight gain in childhood and body composition at 18 years of age in Brazilian males
Authors: Victora Cesar G , Sibbritt David , Horta Bernardo L , Lima Rosângela C , ScD Tim Cole , Wells Jonathan
Published: April 2008

Aim: To assess the association between weight gain at different time periods during childhood and measures of adiposity in late adolescence.

Methods: A population‐based birth cohort carried out in Pelotas, a 320 000‐inhabitant city in a relatively developed area in Southern Brazil. All newborns in the city's hospitals were enrolled in 1982. Weight gain from 0–1, 1–2, 2–4 and 4–15 years were expressed as changes in weight‐for‐age Z‐scores relative to the NCHS/WHO reference. In 2000, 79% (2250) of all males were located when enrolling at the national Army. Weight and height were assessed. Body composition indicators (fat mass/height2, lean mass/height2, fat mass/lean mass2.3) were estimated through bioimpedance. Analyses were adjusted for maternal and social factors, as well as for gestational age.

Results: In the adjusted analyses, birthweight and weight gain in the first year of life were positively associated with attained height at age 18 years. Except for the fat mass/lean mass2.3 ratio, all weight‐related outcomes were positively associated with weight gain in different periods of life. Children who gained weight rapidly in more than one time period became fatter at age 18 years, independently of when fast growth took place.

Conclusions: Height was primarily determined by fetal and infant growth. Weight‐related indices, including the fat/lean mass ratio, were more strongly influenced by later growth. No clear critical windows of growth during which absolute tissue masses are programmed could be identified.
New reference values for the Alberta Infant Motor Scale need to be established
Authors: Fleuren K M W , Smit L S , Stijnen Th , Hartman A
Published: April 2008

Aim: The Alberta Infant Motor Scale (AIMS) is an infant developmental test, which can be used to evaluate motor performance from birth to independent walking. Between 1990 and 1992 Piper and Darrah determined reference values in a cohort in Canada. To our knowledge no study has been carried out to determine whether the Canadian data are representative for other countries. In the present study we aimed to establish whether the AIMS test needs new reference values for Dutch children.

Methods: Motor performance of 100 Dutch children, aged 0–12 months, was measured using the AIMS test.

Results: The mean percentile score of the Dutch children was 28.8 (±22.9, range 1–85). The percentile scores of the group were significantly lower than scores of the Canadian norm population (p < 0.001), whereby 75% of the Dutch children scored below the 50th percentile. These lower scores were not be explained by sex, racial differences or congenital disorders and were seen in all age groups.

Conclusion: We conclude that new reference values on the AIMS test for the age group of 0–12 months need to be established for Dutch children. It is recommended that the need for new normative data is also determined in all other European countries.
Health and nutritional status of children of adolescent mothers: experience from a diarrhoeal disease hospital in Bangladesh
Authors: Abdullah Kawsari , Malek Mohammad A , Faruque Abu S G , Salam Mohammed A , Ahmed T
Published: April 2008

Aim: The study aimed at assessing clinical and nutritional features and socioeconomic characteristics of the first birth‐order children (1–48 months) of adolescent mothers.

Methods: Five hundred and thirty‐nine first birth‐order children of both sexes, aged 1–48 month(s) were studied. All study children had adolescent mothers aged ≤19 years (when attending hospital), who attended (as a patient) the Dhaka hospital of ICDDR, B during 2000–2005. A similar group of children (n = 540) of mothers aged 25–29 years (when attending hospital) constituted the comparison group.

Results: Malnutrition indicated by underweight [OR 2.3, 95% CI 1.7–3.1, p < 0.001], stunting [OR 2.1, 95% CI 1.5–2.8, p < 0.001], wasting [OR 1.8, 95% CI 1.3–2.7, p = 0.001], infancy (<12 months old) [OR 2.8, 95% CI 2.1–3.9, p < 0.001], duration of hospitalization (≥48 h) [OR 1.6, 95% CI 1.2–2.2, p = 0.001], DPT immunization [OR 1.8, 95% CI 1.3–2.5, p = 0.001] and maternal illiteracy (no formal schooling) [OR 1.5, 95% CI 1.1–2.0, p = 0.007] were significantly associated with children of adolescent mothers, after adjusting for co‐variates in the logistic regression analysis. Similar results were also observed when different indices of malnutrition (stunting, underweight or wasting) were added separately to the different models.

Conclusion: Children of adolescent mothers are likely to be more malnourished, have lesser opportunities for DPT immunization and have longer duration of hospitalization. Adolescent mothers were also more likely to be illiterate. Therefore, the development of preventive and therapeutic strategies will be required to reduce morbidity and improve the health and nutrition status of both children and their adolescent mothers.
The effects of swaddling on oxygen saturation and respiratory rate of healthy infants in Mongolia
Authors: Narangerel G. , Pollock J. , Manaseki‐Holland S. , Henderson J.
Published: April 2008

Background: Infant swaddling is common practice in some developing countries where infant respiratory morbidity is also prevalent. Little is known about the effect of swaddling on respiratory variables in healthy infants. Such information could have important implications for respiratory diseases.

Aims: To compare respiratory rates (RR) and arterial oxygen saturations (SaO2) of healthy swaddled infants and non‐swaddled infants during different conditions of sleep and arousal.

Setting: Community based, nested case control study in Ulaanbaatar, Mongolia.

Subjects and Methods: Habitually swaddled and non‐swaddled infants aged 9–10 weeks taking part in a randomised controlled trial of swaddling. Respiratory rate and SaO2were measured during quiet wakefulness, feeding, quiet and active sleep. Habitually swaddled infants were studied in swaddled and non‐swaddled conditions. Habitually non‐swaddled infants were studied only in the non‐swaddled state.

Results: SaO2was higher during awake states compared with sleep states in all groups of infants. Habitually swaddled infants had lower mean SaO2in the swaddled compared with non‐swaddled condition (96.5% vs. 96.9%, p < 0.01) but these were not significantly different from the mean SaO2of non‐swaddled infants (96.9%, minimum p = 0.22). Habitually swaddled infants in the swaddled and non‐swaddled states had similar respiratory rates, but these were, in both cases, significantly lower than in habitually non‐swaddled infants.

Conclusion: Swaddling has little or no clinical effect on SaO2or respiratory rates in healthy 9–10‐week‐old infants in Mongolia.
Thyroid function in children with sepsis and septic shock
Authors: Lodha Rakesh , Vivekanandhan S , Sarthi Manjunatha , Arun S , Kabra S K
Published: April 2008

Aim: A prospective study was conducted to determine thyroid hormone levels and their relationship to survival in children with septic shock and sepsis.

Methods: We estimated thyroid hormone levels (T3, T4, TSH, fT3 and fT4) in children with septic shock and compared with those in children with sepsis.

Results: Twenty‐four children (13 boys) with septic shock and 25 children (14 boys) with sepsis were enrolled. The median T3, T4, fT3, fT4 and TSH (95% confidence interval) were 40 (40–40.23) ng/dL, 4.45 (1.9–6.03) μg/dL, 1.85 (1.2–2.37) pg/mL, 0.77 (0.57–0.95) ng/dL, 0.51 (0.26–1.15) μIU/mL, respectively in children with septic shock group compared with 130 (98.28–163.48) ng/dL, 9.3 (7.66–10.63) μg/dL, 3.2 (3–4.27) pg/mL, 1.3 (1.1–1.4) ng/dL, 2.85 (1.07–3.61) μIU/mL, respectively, in children with sepsis. Children with septic shock who died (n = 12) had higher TSH levels compared to those who survived (p = 0.04). There was no difference in hormone levels between children with catecholamine responsive and catecholamine resistant septic shock.

Conclusion: Children with septic shock had lower levels of T3, T4, fT3, fT4 and TSH compared to those with sepsis. Findings of our study suggest that derangement of thyroid functions in children is not an important factor contributing to the severity of septic shock.
Age and gender differences in VO2max in Swedish obese children and adolescents
Authors: Berndtsson G , Mattsson E , Marcus C , Larsson U Evers
Published: April 2008

Aim: To describe age and gender differences in estimated maximum oxygen uptake (VO2max) and participation in organized physical activity in Swedish obese children and adolescents, and compare the results with an age‐matched reference group representative of the general population.

Methods: Two hundred and nineteen obese children (102 boys, 117 girls, aged 8–16 years, Body Mass Index (BMI) 24.3–57.0 kg.m−2) performed a submaximal bicycle ergometry test and an interview concerning participation in organized physical activity.

Results: The obese children had lower relative VO2max (p < 0.001) than the reference group. In contrast to the reference group no age or gender differences were detected in the obese children aged 11–13 years and 14–16 years. With increased age (after 11 years) the obese children participated less in organized physical activity than the reference group (p < 0.001). In obese adolescents, participation in organized physical activity in leisure time explained 7% and BMI 45% of the variance in relative VO2max.

Conclusion: The obese children had lower relative VO2max, and participated less in organized physical activity than the reference group. The variance in relative VO2max was primarily explained by BMI. Obese adolescents, especially boys, were found to be at risk of physical inactivity.
Milk for small infants
Authors: Funkquist E‐L , Tuvemo T , Jonsson B , Serenius F , Nyqvist KH
Published: April 2008

This study investigated weight patterns of infants born SGA, in relation to two different feeding regimens during hospital stay. We compared 21 SGA infants prescribed 200 mL/kg milk on day 2, with 21 infants, prescribed 170 mL/kg on day 9. The infants fed according to the proactive nutrition policy tolerated large volumes of milk and showed lower weight loss.

Conclusion: A proactive nutrition policy demonstrably reduces weight loss in SGA infants.
Blood visfatin concentrations in normal full‐term pregnancies
Authors: Malamitsi‐Puchner Ariadne , Briana Despina D. , Gourgiotis Dimitrios , Boutsikou Maria , Baka Stavroula , Hassiakos Dimitrios
Published: April 2008

Aim: To prospectively investigate blood visfatin concentrations during the perinatal period in normal pregnancies.

Methods: Visfatin concentrations were determined in maternal, umbilical cord (representing the foetal state) and neonatal blood on day 1 (N1) and 4 (N4).

Results: Maternal and foetal visfatin concentrations were similar (18.83 ± 4.27 and 19.35 ± 4.90 ng/mL, respectively). There were significant correlations between maternal and foetal (r = 0.742, p < 0.001), as well as between N1 and N4 (r = 0.487, p = 0.029) visfatin concentrations. Foetal concentrations were significantly elevated compared to N1 (p = 0.032). There was no difference between N1 and N4 concentrations. However, there was a correlation between birth weight and neonatal visfatin concentrations: there was a mean increase in N1 and N4 visfatin concentrations by 0.221 ng/mL and 0.292 ng/mL, respectively, for every unit increase in customized centile (adjusted birth weight) (p = 0.021 and p = 0.005, respectively). No association was found between serum visfatin concentrations and gender, parity or mode of delivery.

Conclusions: Expression in foetal membranes and placental transfer could be responsible for higher blood visfatin concentrations during intrauterine life. Customized centiles seem to be independent predictor variables for postnatal visfatin concentrations. This finding could be attributed to the production of visfatin in adipose tissue, a main contributor to birth weight and consequently to customized centiles.
Efficacy of Pulsed UV‐Light for the Decontamination of Escherichia coli O157:H7 and Salmonella spp. on Raspberries and Strawberries
Authors: Bialka K.L. , Demirci A.
Published: April 2008

ABSTRACT:  Small fruits are increasingly being implicated in outbreaks of foodborne illness, and fresh produce is now the 2nd leading cause of foodborne illness in the United States. Conventional methods of decontamination are not effective, and there is a need to evaluate novel technologies. Pulsed ultraviolet (UV)‐light is one such technology. In this study, pulsed UV‐light was applied to strawberries and raspberries at varying UV doses and times. On raspberries, maximum reductions of Escherichia coli O157:H7 and Salmonella were 3.9 and 3.4 log10 CFU/g at 72 and 59.2 J/cm2, respectively. On the surfaces of strawberries, maximum reductions were 2.1 and 2.8 log10 CFU/g at 25.7 and 34.2 J/cm2, respectively. There was no observable damage to the fruits at these UV doses. The results obtained in this study indicate that pulsed UV‐light has the potential to be used as a decontamination method for raspberries and strawberries.
Antioxidant Properties of Dried Plum Ingredients in Raw and Precooked Pork Sausage
Authors: Nuñez de Gonzalez M.T. , Boleman R.M. , Miller R.K. , Keeton J.T. , Rhee K.S.
Published: April 2008

ABSTRACT: Raw pork sausages with no antioxidant (control), 3% or 6% dried plum puree (DP), 3% or 6% dried plum and apple puree (DPA), or 0.02% butylated hydroxytoluene and butylated hydroxyanisole (BHA/BHT) were (1) stored raw in chubs at 4 °C (RR) and evaluated weekly over 28 d, (2) cooked as patties, vacuum packaged, and stored at 4 °C (PR) for weekly evaluation over 28 d, or (3) cooked, vacuum packaged, and stored at –20 °C (PF) and evaluated monthly over 90 d. DP at 3% or 6% levels was as effective as BHA/BHT for retarding lipid oxidation in PR sausage patties. Likewise, DP at 3% was equally as effective in PF patties, but DP at 6% was even more effective (lower TBARS values) than BHA/BHT for retarding oxidative rancidity. All treatments decreased the fat and increased moisture content of raw sausages but only 6% DP reduced cooking yields. Inclusion of 6% DP decreased internal redness while both 6% DP and DPA increased yellowness of raw sausage. Trained panel sensory evaluations indicated that DP enhanced sweet taste, decreased salt and bitter tastes, and masked cooked pork/brothy, cooked pork fat, spicy/peppery, and sage flavors. In general, warmed‐over flavor notes were not affected by storage treatments. Overall, pork sausage with 3% DP or DPA was as acceptable to consumers as the control or those patties with BHA/BHT, but patties with 6% of either plum product were less desirable. Inclusion of 3% DP was effective as a natural antioxidant for suppressing lipid oxidation in precooked pork sausage patties.
Irradiation Compared with Chlorination for Elimination of Escherichia coli O157:H7 Internalized in Lettuce Leaves: Influence of Lettuce Variety
Authors: Niemira B.A.
Published: April 2008

ABSTRACT:  Pathogenic bacteria internalized in leaf tissues are not effectively removed by surface treatments. Irradiation has been shown to inactivate leaf‐internalized bacteria, but many aspects of targeting these protected pathogens remain unknown. Bacterial cells of a cocktail mixture of 3 isolates of Escherichia coli O157:H7 were drawn into the leaves of iceberg, Boston, green leaf, and red leaf lettuce using vacuum perfusion. The inoculated leaves were treated with a 3‐min wash with sodium hypochlorite solution (0, 300, or 600 ppm) or various doses of ionizing radiation (0.25 to 1.5 kGy). Leaves were stomached to recover the internalized cells and survivors enumerated. Washes with 0 ppm (water), 300 ppm, and 600 ppm chlorine solutions each gave reductions of less than 1 log. These reductions were statistically significant only in the case of green leaf lettuce. In contrast, irradiation effectively reduced E. coli O157:H7 on all varieties examined, with all doses tested being significantly reduced from the untreated control. The specific variety influenced the efficacy of irradiation. The greatest reduction obtained was 5 logs on iceberg lettuce treated with 1.5 kGy. The D10 values (the dose necessary to achieve a 1 log reduction) were significantly (P < 0.05) different among the varieties of lettuce tested, and ranged from 0.30 kGy (iceberg) to 0.45 kGy (Boston). These values were observed to be notably higher than previous irradiation D10 values for E. coli O157:H7 surface inoculated onto these 4 lettuce varieties. This study has shown that irradiation is able to effectively reduce viable E. coli O157:H7 cells internalized in lettuce, and that the variety of lettuce influences the specific response.
Is daily computed tomography image guidance necessary for nasal cavity and nasopharyngeal radiotherapy? An investigation based on helical tomotherapy
Authors: Sheng Ke , Chow Jennifer , Hunter Grant , Larner James , Read Paul
Published: April 2008

To analyze the magnitude of setup errors corrected by helical tomotherapy megavoltage computed tomography (MVCT) on a daily or weekly basis and the impact of those corrections on the delivered dose to the tumor and organs at risk (OARs), we retrospectively analyzed the setup errors for 6 nasal cavity and 4 nasopharyngeal cancer patients treated with helical tomotherapy for 25 – 33 fractions. Each patient had MVCT‐guided repositioning for all fractions of treatment. The new dose–volume histograms (DVHs) and equivalent uniform doses (EUDs) for the planning target volume (PTV) and OARs were calculated for hypothetical situations in which no imaging guidance (IG) or once‐weekly imaging guidance (WIG) took place. The mean total setup error for treatment without daily IG was mm, which could be reduced to mm if WIG were to be performed. The geometric uncertainties from the absence of IG resulted in a reduction of mean PTV EUD by , which could be reduced to with WIG. The EUDs of the OARs increased to Gy or Gy without and with WIG respectively. Without daily IG, the mean uncertainty in patient position has a relatively small effect on the mean dosimetry for PTV and OARs, and the use of WIG can further reduce those effects by approximately half. On the other hand, because of the large variance, with low probability, substantial deviation from the original planned dosimetry may occur without IG. Therefore, daily MVCT is preferred as an important safety measure in the delivery of intensity‐modulated radiation therapy.

PACS number: 87.53.Dq
Development of a geometry‐based respiratory motion– simulating patient model for radiation treatment dosimetry
Authors: Zhang Juying , Xu X. George , Shi Chengyu , Fuss Martin
Published: April 2008

Temporal and spatial anatomic changes caused by respiration during radiation treatment delivery can lead to discrepancies between prescribed and actual radiation doses. The present paper documents a study to construct a respiratory‐motion‐simulating, four‐dimensional (4D) anatomic and dosimetry model for the study of the dosimetric effects of organ motion for various radiation treatment plans and delivery strategies. The non‐uniform rational B‐splines (NURBS) method has already been used to reconstruct a three‐dimensional (3D) VIP‐Man (“visible photographic man”) model that can reflect the deformation of organs during respiration by using time‐dependent equations to manipulate surface control points. The EGS4 (Electron Gamma Shower, version 4) Monte Carlo code is then used to apply the 4D model to dose simulation. We simulated two radiation therapy delivery scenarios: gating treatment and 4D image‐guided treatment. For each delivery scenario, we developed one conformal plan and one intensity‐modulated radiation therapy plan. A lesion in the left lung was modeled to investigate the effect of respiratory motion on radiation dose distributions. Based on target dose–volume histograms, the importance of using accurate gating to improve the dose distribution is demonstrated. The results also suggest that, during 4D image‐guided treatment delivery, monitoring of the patient's breathing pattern is critical. This study demonstrates the potential of using a “standard” motion‐simulating patient model for 4D treatment planning and motion management.

PACS numbers: 87.53.Bn, 87.53.Kn, 87.53.Tf, 87.53.Wz, 87.57.Gg, 89.80.+h
Effect of output variation with dose rate on the Virtual Wedge factor
Authors: Zhu X. Ronald , Gillin Michael T.
Published: April 2008

The Siemens Virtual Wedge factor (VWF: Siemens Medical Solutions, Malvern, PA) may drift significantly because of an increase in output as the dose rate declines. This variation in output is caused by sample and hold boards in the dosimetry circuit that become defective because of radiation damage. Here, we present a simple model based on the principle of Virtual Wedge operation and the measured output variation with dose rate to quantitatively describe VWF drift as a function of field size and wedge angle. Our results support the recommendation that VWF be measured for large field sizes (for example, cm) and large wedge angles (for example, 60 degrees) as a part of routine quality assurance.

PACS numbers: 87.55.Qr, 87.55.N‐
Experimental evaluation of the accuracy of skin dose calculation for a commercial treatment planning system
Authors: Court Laurence E. , Tishler Roy B. , Allen Aaron M. , Xiang Hong , Makrigiorgos Mike , Chin Lee
Published: April 2008

The present work uses the Eclipse treatment planning system (TPS) to investigate the accuracy of skin dose calculations. Micro‐MOSFETs (metal oxide semiconductor field effect transistors) were used to measure skin dose for a range of irradiation conditions (open fields, physical wedges, dynamic wedges, various source‐to‐surface distances) for 6‐MV and 10‐MV beams, and the results were compared with the calculated mean dose to a “skin” structure 2 mm thick for semi‐cylindrical phantoms (representative of a neck or breast). Agreement between the calculated and measured skin dose values was better than for 95% of all measured points (6‐MV and 10‐MV X‐ray spectra alike). For a fixed geometry, the TPS correctly calculated relative changes in dose, showing that minimization of skin dose in intensity‐modulated radiation therapy will be effective in Eclipse.

PACS numbers: 87.53.Bn, 87.53.Dq, 87.66.Pm, 87.66.Xa
The views of cancer patients on patient rights in the context of information and autonomy
Authors: Erer S , Atici E , Erdemir A D
Published: April 2008

Objectives:

The aim of this study is to evaluate the views of cancer patients on patient rights in the context of the right to information and autonomy according to articles related to the issue in the “Patient Rights Regulation”.

Methods:

The research was conducted among cancer patients in the medical oncology department of a research and practice hospital using a random sampling method between June and September 2005. Data were collected during face-to-face interviews using a questionnaire.

Results:

There was a high rate of positive response to the items that the patients have the right to be informed (86.5%), that the physician should inform the patient on the diagnosis and the treatment (92.3%) and that the physician is obliged to inform the patient (76.9%). Only 43.3% of the patients stated that the patient has the right to refuse the treatment recommended by the physician. The participants mostly agreed that the patient should participate in decisions about the treatment and that patient consent should be given (78.8%).

Conclusions:

There are extensive efforts in Turkey towards making patient rights a significant supportive component of health services. For patient rights to become a natural part of medical practice it is necessary to give priority to education of both patients and physicians about patient rights and to lay emphasis on an ethical approach in the patient–physician relationship.
Clinical ethicists’ perspectives on organisational ethics in healthcare organisations
Authors: Silva D S , Gibson J L , Sibbald R , Connolly E , Singer P A
Published: April 2008

Background:

Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature.

Objective:

To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues.

Design and Setting:

Qualitative case study involving semi-structured interviews with 18 clinical ethicists across 13 health organisations in Toronto, Canada.

Results:

From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support.

Conclusion:

Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education.
The quality of bioethics debate: implications for clinical ethics committees
Authors: Williamson L
Published: April 2008

Bioethicists have recently expressed concern over a lack of quality control within the field. This apprehension focuses on bioethics expanding in ways that obscure its distinctive ethical remit and the specialist reasoning skills it requires. This thesis about the quality and conduct of bioethics may have particular relevance for clinical ethics. As one of the youngest offshoots of bioethics, the field focuses on the ethical issues that arise specifically in a clinical context. However, non-ethics specialists are increasingly involved in this field. This means that clinical ethics could be especially vulnerable to the quality control concerns articulated within bioethics. The growing public profile of clinical ethics means that concerns over quality in this area warrant specific attention by those concerned with declining standards in bioethics and those working in clinical ethics.
Minors and informed consent in carrier testing: a survey of European clinical geneticists
Authors: Borry P , Stultiens L , Goffin T , Nys H , Dierickx K
Published: April 2008

Purpose:

A study was made of attitudes of clinical geneticists regarding the age at which minors should be allowed to undergo a carrier test and the reasons they provide to explain their answer.

Methods:

European clinical institutions where genetic counselling is offered to patients were contacted. 177 (63%) of the 287 eligible respondents answered a questionnaire.

Results:

Clinical geneticists were significantly more in favour of providing a carrier test to a younger person if the request was made together with the parents than if the adolescent requested the test personally. Although a large fraction of respondents (16%–30%) were “neither unwilling nor willing” to provide a carrier test to a 16-year-old adolescent who requested the test personally, for most disorders slightly more clinical geneticists were “very willing” or “willing”.

Conclusion:

Age is not the only decisive element when considering the participation of adolescents in decisions affecting their health. The clinical geneticists referred to cognitive, emotional and sexual maturity and the support of parents as crucial elements in their comments regarding when to tell children about their genetic risk or to allow adolescents to request a carrier test.
Payment for research participation: a coercive offer?
Authors: Wertheimer A , Miller F G
Published: April 2008

Payment for research participation has raised ethical concerns, especially with respect to its potential for coercion. We argue that characterising payment for research participation as coercive is misguided, because offers of benefit cannot constitute coercion. In this article we analyse the concept of coercion, refute mistaken conceptions of coercion and explain why the offer of payment for research participation is never coercive but in some cases may produce undue inducement.
Effect of internal confinement on compression strength of frozen sand
Authors: Ladanyi Branko , Morel Jean-François
Published: April 2008

When a dense granular material with a viscoplastic matrix, such as ice, is submitted to uniaxial or triaxial compression, it is considered that one portion of its observed strength is due to the internal confinement resulting from tensile stresses generated in the matrix when it tends to oppose the dilation. Recently, a conceptual model of compression strength behaviour of such dilatant materials was developed by the senior author. This paper presents the model and describes an experimental study intended to check its validity. For this purpose, a series of triaxial compression tests on both frozen and unfrozen sand at carefully controlled densities was performed. The test results give a clear support to the theoretical predictions of the contribution of dilatancy hardening to the strength of a dense frozen sand. Key words: frozen sand, compression strength, triaxial compression tests, pore ice, cavitation, dilatancy hardening, conceptual model.
A normalizing relation for granular materials
Authors: Wong Colin L. Y.
Published: April 2008

It is hypothesized that a normalized shear stress – strain curve for granular materials can be obtained by accounting fully for the effects of volume change. In this sense, volume change behavior is a factor that controls the shear stress – strain behavior of a granular material. This hypothesis is applied to Rowe's stress-dilatancy theory to include slip, rolling, rearrangement, and crushing strains, and a theoretical normalizing relation is obtained. The relation is demonstrated to be reasonably correct for the published test data utilized in this study. Differing fabrics of a granular material at the same void ratio can be corrected for by the normalizing relation. The hypothesis is also applied to simple shear behavior and an empirical normalizing relation is obtained.On the basis of the success of the normalizing relation, it is suggested that the volume change rate at 4% axial strain may be, in relation to shear behavior, a more appropriate characterizing parameter than void ratio. However, owing to the long-standing use and acceptance of void ratio, the concept of a reference void ratio, determined by specific sample preparation and testing procedures, is introduced as a characterizing parameter for granular materials. Key words: volume change, dilatancy, normalization, fabric, stress, strain, deformation, sand, granular material.
Characterization of putative membrane protein genes of the ‘Candidatus Phytoplasma asteris’, chrysanthemum yellows isolate
Authors: Galetto Luciana , Fletcher Jacqueline , Bosco Domenico , Turina Massimo , Wayadande Astri , Marzachì Cristina
Published: April 2008

To characterize potentially important surface-exposed proteins of the phytoplasma causing chrysanthemum yellows (CY), new primers were designed based on the conserved regions of 3 membrane protein genes of the completely sequenced onion yellows and aster yellows witches’ broom phytoplasmas and were used to amplify CY DNA. The CY genes secY, amp, and artI, encoding the protein translocase subunit SecY, the antigenic membrane protein Amp and the arginine transporter ArtI, respectively, were cloned and completely sequenced. Alignment of CY-specific secY sequences with the corresponding genes of other phytoplasmas confirmed the 16S rDNA-based classification, while amp sequences were highly variable within the ‘Candidatus Phytoplasma asteris’. Five CY partial sequences were cloned into the pRSetC expression vector, and 3 of the encoded protein fragments (Amp 64/651, Amp 64/224, ArtI 131/512) were expressed as fusion antigens for the production of CY-specific polyclonal antibodies (A416 against Amp 64/224; A407 against ArtI 131/512). A416 recognized, in Western blots, the full-length Amp from CY-infected plants (periwinkle, daisy) and insect vectors ( Euscelidius variegatus , Macrosteles quadripunctulatus ). A416 also reacted to European aster yellows, to primula yellows phytoplasmas, to northern Italian strains of ‘Ca. Phytoplasma asteris’ from lettuce and gladiolus, but it did not react to American aster yellows phytoplasma.
Field Testing: Interpretation of the Cone Penetration Test
Authors: Wroth C. P.
Published: April 2008

The paper criticises the time it took to produce BS 5930, and its inadequate coverage of
in situ
testing of soils, both on and offshore. The urgency of correcting these omissions is emphasised. Additional material should not only deal with new equipment and experimental methods, but also take account of recent developments in understanding soil behaviour so that the recommended methods of interpretation are soundly based.
Field Testing: The Standard Penetration Test
Authors: Thorburn S.
Published: April 2008

This introductory lecture discusses the international use of the standard penetration test (SPT) and presents the proposals for International Reference Test Procedures. The application of the SPT as a means of assessing the strength and stiffness of weak rocks is mentioned together with the reliance upon the test at the present time for estimating the liquefaction potential of saturated fine grained non-cohesive soils. The various aspects of the execution of the SPT are discussed which can provide variable and unrepresentative values of resistance (Nvalues).

The principle of measuring energy losses and making adjustments to theNvalues is introduced as a basis for ensuring comparability of test results.

Reference is made to the general descriptions of the SPT given in BS 5930:1981 and to the lack of clear guidance in this British Standard.
Laboratory Testing: Assessing BS 5930
Authors: Hight D. W.
Published: April 2008

Established patterns of soil behaviour are used to illustrate: the divergence between parameters from laboratory and
in situ
tests; the changes in effective stress caused by sampling; and the influence of initial effective stress,
p
′
0
on the measured strength and deformation parameters for cohesive soils.

Current practice in onshore site investigation continues to make use of the unconsolidated undrained triaxial test in which

p
′
0

is not controlled. Variations in

p
′
0

after sampling and subsequent handling are shown to contribute to the scatter in undrained compression strength data.

A plea is made for BS 5930 to encourage the measurement of effective stress in all undrained triaxial tests; to recognise the non-linear nature of soils; and to urge integration of laboratory and
in situ
tests.
Rock Descriptions
Authors: Hawkins A. B.
Published: April 2008

The paper critically reviews the description and classification of rocks for engineering purposes given in BS 5930. It makes a number of recommendations. These are concerned principally with the naming of carbonate rocks, weathering terms, the use of saturated strengths, correlation factors for use with point load strengths, the use of solid core rather than axial core measurements for ROD and not using a legend when the core recovery is less than 80%. The paper introduces the concept of an RQD
300
and proposes the use of a lithological quality designation (LQD
100
and LQD
300
). A change is suggested in the descriptive word order.