bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation and Usefulness of the Sperm Quality Analyzer (SQA II‐C) for Bull Semen Analysis
Authors: Hoflack G , Rijsselaere T , Maes D , Dewulf J , Opsomer G , de Kruif A , Van Soom A
Published: June 2005

Contents

In this study, an upgrade version of the Sperm Quality Analyzer (SQA), the SQA‐IIC was tested for the assessment of bull semen quality. In Expt 1, the device showed good repeatability of measurements within and between capillaries, as evidenced by the low coefficients of variation (CVs; <13%) at concentrations between 35 and 705 × 106 spermatozoa/ml. In Expt 2, 10 semen concentrations (1–1000 × 106/ml) were stored in HEPES TALP for 48 h at room temperature. A time‐dependent decrease in sperm motility index (SMI) values was noticed. SMI values increased linearly with increasing sperm concentrations, but remained constant around 500, corresponding to a concentration of approximately 50 × 106/ml. For sperm concentrations below 50 × 106/ml, SMI values were highly correlated with concentration (p < 0.05) and with semen parameters, expressing the overall semen quality (p < 0.05; Expt 3). In Expt 4, a correlation of only 0.44 (p < 0.05) between SMI values of frozen–thawed semen samples of 35 bulls and the corrected 56‐day non‐return rate (56dNRRc) was found. Prediction of the 56dNRRc based on the SMI value of a semen sample was inaccurate. The present study indicates that the SQA‐IIC is suitable for a rapid screening of bull semen diluted to a concentration of approximately 50 × 106/ml. Furthermore, the device seems inappropriate for fertility prediction.
Expression of Oestrogen Receptors α and β and of Aromatase in the Testis of Immature and Mature Boars
Authors: Mutembei HM , Pesch S , Schuler G , Hoffmann B
Published: June 2005

Contents

The boar testis secretes high amounts of oestrogens. In order to test for a likely local significance, we investigated the expression of oestrogen receptors (ER) in immature and mature boar testes using immunohistochemistry (IHC), in vitro and in situ reverse transcription‐polymerase chain reaction (RT‐PCR). Samples were from 25 boars castrated at ages of 50, 100, 150, 200 and 250 days. Mouse monoclonal primary antibodies against porcine ERα (clone HT227), human ERβ1 (clone PPG5/10) and human P450 aromatase (clone SM1671P) were used. Expression of the mRNA was tested utilizing primers specific for the respective porcine mRNA sequences. ER immunoreactivity was exclusively localized to the nuclei. In immature boars, 90.6 ± 1.2% of prespermatogonia and 71.0 ± 2.6% of the Leydig cells showed a strong staining for ERα; 95.5 ± 3.5% of the prespermatogonia but none of the Leydig and Sertoli cells were ERβ‐positive. In mature boars a strong staining for the ERβ was observed in virtually all Sertoli, Leydig and germ cells, except for the elongating/ed spermatids, which were clearly negative; for the ERα, strong immunoreaction signals were restricted to spermatogonia and primary spermatocytes with 93.6 ± 2.7% of these cells being positive; distinctly less intensive signals were observed in 51.4 ± 0.27% of the secondary spermatocytes, round spermatids and Leydig cells. In vitro RT‐PCR was positive for both receptors and results of in situ RT‐PCR matched those obtained by IHC. P450 aromatase immunoreaction was restricted to the cytoplasm of Leydig cells. These findings suggest that testicular ER may be important factors contributing to onset and maintenance of spermatogenesis in the boar.
Patient with Leriche's syndrome and concomitant superior mesenteric aneurysm: Evaluation with contrast‐enhanced three‐dimensional magnetic resonance angiography, computed tomography angiography and digital subtraction angiography
Authors: Chan HHL , Tai KS , Yip LKC
Published: June 2005

Conventional angiography is regarded as the gold standard in vascular imaging but it is invasive, and difficulty may be encountered in the evaluation of aortic occlusion disease. Superior mesenteric artery aneurysm is an uncommon disease, which can result in life‐threatening haemorrhage after rupture. With the rapid development of computed tomography angiography (CTA) and magnetic resonance angiography (MRA), high‐quality images of the vascular system can be obtained in a non‐invasive manner. We report a case of Leriche's syndrome with concomitant superior mesenteric aneurysm using contrast‐enhanced 3‐D CTA and MRA, with digital subtraction angiography correlation.
Incidental finding of meningioma on bone scintigraphy
Authors: Thakorlal A , Wong DC , Anderson RJ
Published: June 2005

An incidental finding of an intracranial posterior fossa meningioma detected by bone scintigraphy is presented. Most of the published literature on the diagnosis of meningioma is on the use of CT and MRI. There is limited published literature on the detection of meningioma with bone scintigraphy.
Empiric validation of the Rural Australian Medical Undergraduate Scholarship ‘rural background’ criterion
Authors: Laven Gillian A. , Wilkinson David , Beilby Justin J. , McElroy Heather J.
Published: June 2005

Objective:  Rural Australian Medical Undergraduate Scholarships (RAMUS) provide $10 000 per annum to selected medical students with a rural background. Eligibility criteria include having lived in a rural community for five consecutive or eight cumulative years. We sought to validate the above‐specified criterion using data from the Australian National Rural Background Study.

Design:  National case control study stratified by jurisdiction.

Participants:  Two thousand four hundred and fourteen Australian‐trained rural and urban general practitioners (GPs).

Main outcome measure:  Whether the RAMUS rural background criterion was met or not.

Results:  Doctors who met the RAMUS rural background criterion were more likely to be in rural practice (odds ratio = 2.50; 95% confidence interval, 1.97–3.18) than those who did not. This was true for all jurisdictions (except for the Northern Territory) and ranged from 1.95 for South Australia to 3.57 for Victoria.

Conclusion:  Rural GPs are more likely to fulfil the RAMUS rural background criterion, supporting the existence of the RAMUS scheme.
The evaluation of a model of primary mental health care in rural Tasmania
Authors: Campbell Alistair
Published: June 2005

Abstact

Objective:  The aim of this study was to evaluate the effectiveness of a primary care mental health service.

Design:  The study used a naturalistic longitudinal design to follow groups of participants who received intervention from a rural mental health worker, or ‘usual’ mental health service, or no treatment, over a period of 12 months.

Setting:  The service was evaluated in a rural primary care setting.

Participants:  One hundred and forty‐five primary care patients.

Outcome measures:  Changes in symptomatology were assessed using the SCL‐90R summary scales, and changes in quality of life were assessed using the EuroQOL.

Results:  Those participants treated by the primary mental health worker showed significant improvements in symptoms and quality of life compared to both the usual and no‐treatment groups.

Conclusion:  There are few studies evaluating mental health services in rural settings. This study demonstrated that a particular model of primary mental health care was more effective than usual mental health care and no treatment at resolving symptoms and improving quality of life.
Is the originality of a species measurable?
Authors: Pavoine Sandrine , Ollier Sébastien , Dufour Anne‐Béatrice
Published: June 2005

In this paper, we introduce the concept of ‘originality of a species within a set’ in order to indicate the average rarity of all the features belonging to this species. Using a phylogenetic tree of 70 species of New World terrestrial Carnivora, we suggest measuring the originality by a probability distribution. This maximizes the expected number of features shared by two species randomly drawn from the set. By using this new index, we take account of branch lengths whereas current indices of originality focus on tree topology. As a supplement to Nee and May's optimizing algorithm, we find that originality must be one of the criteria used in conservation planning.
Alarm pheromone mediates production of winged dispersal morphs in aphids
Authors: Kunert Grit , Otto Susanne , Röse Ursula S. R. , Gershenzon Jonathan , Weisser Wolfgang W.
Published: June 2005

The aphid alarm pheromone (E)‐β‐farnesene (EBF) is the major example of defence communication in the insect world. Released when aphids are attacked by predators such as ladybirds or lacewing larvae, aphid alarm pheromone causes behavioural reactions such as walking or dropping off the host plant. In this paper, we show that the exposure to alarm pheromone also induces aphids to give birth to winged dispersal morphs that leave their host plants. We first demonstrate that the alarm pheromone is the only volatile compound emitted from aphid colonies under predator attack and that emission is proportional to predator activity. We then show that artificial alarm pheromone induces groups of aphids but not single individuals to produce a higher proportion of winged morphs among their offspring. Furthermore, aphids react more strongly to the frequency of pheromone release than the amount of pheromone delivered. We suggest that EBF leads to a ‘pseudo crowding’ effect whereby alarm pheromone perception causes increased walking behaviour in aphids resulting in an increase in the number of physical contacts between individuals, similar to what happens when aphids are crowded. As many plants also produce EBF, our finding suggests that aphids could be manipulated by plants into leaving their hosts, but they also show that the context‐dependence of EBF‐induced wing formation may hinder such an exploitation of intraspecific signalling by plants.
Cheaters, diffusion and nutrients constrain decomposition by microbial enzymes in spatially structured environments
Authors: Allison Steven D.
Published: June 2005

Extracellular enzymes allow microbes to acquire carbon and nutrients from complex molecules and catalyse the rate‐limiting step in nutrient mineralization. Because the factors regulating enzyme production are poorly understood, I used a simulation model to examine how competition, nutrient availability and spatial structure affect microbial growth and enzyme synthesis. In simulations where enzyme‐producing microbes competed with cheaters (who do not synthesize enzymes but take‐up product), higher enzyme costs favoured cheaters, while lower rates of enzyme diffusion favoured producers. Cheaters and producers coexisted in highly organized spatial patterns at intermediate enzyme costs and diffusion rates. Simulations with varying nutrient inputs showed that nitrogen supply can limit carbon mineralization, microbial growth and enzyme production because of the nitrogen‐demanding stoichiometry of enzymes (C : N = c.3.5 : 1). These results suggest that competition from cheaters, slow diffusion and nitrogen limitation may constrain microbial foraging and the enzymatic decomposition of complex compounds in natural environments.
Duelling timescales of host movement and disease recovery determine invasion of disease in structured populations
Authors: Cross Paul C. , Lloyd‐Smith James O. , Johnson Philip L. F. , Getz Wayne M.
Published: June 2005

The epidemic potential of a disease is traditionally assessed using the basic reproductive number,R0. However, in populations with social or spatial structure a chronic disease is more likely to invade than an acute disease with the sameR0, because it persists longer within each group and allows for more host movement between groups. Acute diseases ‘perceive’ a more structured host population, and it is more important to consider host population structure in analyses of these diseases. The probability of a pandemic does not arise independently from characteristics of either the host or disease, but rather from the interaction of host movement and disease recovery timescales. TheR*statistic, a group‐level equivalent ofR0, is a better indicator of disease invasion in structured populations than the individual‐levelR0.
The ecology of restoration: historical links, emerging issues and unexplored realms
Authors: Young T. P. , Petersen D. A. , Clary J. J.
Published: June 2005

Restoration ecology is a young academic field, but one with enough history to judge it against past and current expectations of the science's potential. The practice of ecological restoration has been identified as providing ideal experimental settings for tests of ecological theory; restoration was to be the ‘acid test’ of our ecological understanding. Over the past decade, restoration science has gained a strong academic foothold, addressing problems faced by restoration practitioners, bringing new focus to existing ecological theory and fostering a handful of novel ecological ideas. In particular, recent advances in plant community ecology have been strongly linked with issues in ecological restoration. Evolving models of succession, assembly and state‐transition are at the heart of both community ecology and ecological restoration. Recent research on seed and recruitment limitation, soil processes, and diversity–function relationships also share strong links to restoration. Further opportunities may lie ahead in the ecology of plant ontogeny, and on the effects of contingency, such as year effects and priority effects. Ecology may inform current restoration practice, but there is considerable room for greater integration between academic scientists and restoration practitioners.
Comparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancer
Authors: Tekkis P. P. , Heriot A. G. , Smith J. , Thompson M. R. , Finan P. , Stamatakis J. D. ,   the Association of Coloproctology of Great Britain and Ireland
Published: June 2005

Objective  To study circumferential margin involvement (CMI) in patients undergoing restorative, compared with nonrestorative, surgery for rectal cancer.

Data source  Descriptive multicentre study, using routinely collected clinical data from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) Bowel Cancer Audit database. The study encompassed 1403 newly diagnosed patients with rectal cancer undergoing either restorative (anterior resection (AR)), or nonrestorative (abdominoperineal excision of rectum (APER) or Hartmann's procedure), surgery. Operations were carried out in 39 hospitals during a variable period between April 1999 to March 2002. A logistic regression analysis was used to control for variables associated with circumferential margin involvement.

Results  One thousand and thirty‐six patients satisfied the inclusion criteria. The average CMI was 12.5% (range 0–33.3% between hospitals). CMI for anterior resection was 7.5% (n = 629) compared with a CMI of 16.7% for APER (n = 306) and a CMI of 31.7% for Hartmann's procedure (n = 101); P ≤ 0.001. CMI for patients undergoing curative surgery was 7.1% (423 anterior resections, CMI 3.8% (n = 16); 181 APER, CMI 13.3% (n = 24); 29 Hartmann's procedure, CMI 17.2%). On multivariate analysis, having controlled for Dukes' stage and operative intent, the CMI was significantly different between APER and AR (odds ratio 3.3, 95%CI 2.0–5.4), but less so between Hartmann's procedure and AR (odds ratio 2.2, 95%CI 1.1–4.2).

Conclusions  APER is associated with a significantly higher CMI than anterior resection. Attention to surgical technique, with a wide perineal dissection and the use of pre‐operative adjuvant therapy, may reduce CMI in patients undergoing APER.
Fast track open ileo‐colic resections for Crohn's disease
Authors: Andersen J. , Kehlet H.
Published: June 2005

Objective  Introduction of multimodal rehabilitation programmes after open colonic surgery for noninflammatory bowel disease has reduced hospital stay to about 2–3 days, but no data are available from open ileo‐colic surgery for Crohn's disease with multimodal rehabilitation regimens. Therefore, the aim of study was to assess outcome after ileo‐colic resections for Crohn's disease with multimodal rehabilitation.

Materials and methods  Thirty‐two consecutive ileo‐colic resections for Crohn's disease in 29 patients received epidural analgesia and enforced postoperative oral nutrition and mobilization with a scheduled stay of 2 days.

Results  Median time to defaecation was 2.5 days and postoperative hospital stay was 3 days. During a 30‐day postoperative follow‐up there was two re‐admissions, one for mechanical bowel obstruction (9 days) and one because of fever and vomiting (6 days). Except for one wound abscess, one cystitis and one pneumonia, no other complications occurred.

Conclusion  Fast‐track multimodal rehabilitation in open ileo‐colic resections for Crohn's disease reduces hospital stay and with low morbidity and readmission rate.
Almost all five year disease free survivors are cured following rectal cancer surgery, but longer term follow‐up detects some late local and systemic recurrences
Authors: Moore E. , Heald R. J. , Cecil T. D. , Sharpe G. D. , Sexton R. , Moran B. J.
Published: June 2005

Background  The necessity, timing and benefits of follow‐up after rectal cancer surgery remain controversial, with two years traditionally considered adequate to detect most local recurrences. This unit has a policy of lifetime follow‐up, and this paper investigates, at 23 years, the value of prolonged surveillance.

Method  Six hundred and sixty consecutive patients undergoing surgery for rectal cancer were prospectively followed‐up between 1978 and 2002, and local or systemic recurrence recorded. This analysis was performed on the 509/660 (76%) patients who underwent potentially curative surgery.

Results  Total mesorectal excision (TME) was performed in 422/509 (83%) patients, mesorectal transection in 78 (15%), and local excision in 9 (2%). Follow‐up ranged from 1 to 23 years (mean = 9.7). Seven (1.4%) patients had local recurrence alone, 11 (2.2%) local plus systemic, and 86 (17%) systemic recurrence alone. Of the local recurrences 3 (17%) became evident within 1 year, 9 (50%) within 2 years, 16 (89%) within 5 years, and 2 (11%) presented after 5 years, at 5.6 and 5.8 years. Of the systemic recurrences 26 (27%) became evident within 1 year, 57 (59%) within 2 years, 93 (96%) within 5 years, and 4 (4%) presented after 5 years at 5.3, 5.3, 5.4 and 7.9 years.

Conclusion  This long‐term surveillance of patients undergoing curative surgery for rectal cancer demonstrates that most local and systemic recurrences occur within 5 years. Almost half occurred more than 2 years after surgery. However, those centres wishing to set standards of care, or evaluate current or new therapies in rectal cancer treatment, should be aware that unexpected late recurrences occasionally develop.
Postoperative complications in patients irradiated pre‐operatively for rectal cancer: report of a randomised trial comparing short‐term radiotherapy vs chemoradiation
Authors: Bujko K. , Nowacki M. P. , Kępka L. , Olędzki J. , Bębenek M. , Kryj M. ,   the Polish Colorectal Study Group
Published: June 2005

Objective  The primary outcome was sphincter preservation. No benefit was found with chemoradiation. The aim of this report is to analyse postoperative complications, which were the secondary outcome.

Material and methods  Patients with resectable T3–4 low rectal carcinoma were randomised to receive either pre‐operative 5 × 5 Gy irradiation with subsequent total mesorectal excision (TME) performed within 7 days or chemoradiation (50.4 Gy, 1.8 Gy per fraction plus bolus 5‐fluorouracil and leucovorin) followed by TME after 4–6 weeks.

Results  Three hundred and five patients (153 in 5 × 5 Gy group and 152 in chemoradiation group) were analysed. The rates of patients with postoperative complications for the 5 × 5 Gy group and for the chemoradiation group were 27 vs 21%, respectively (P = 0.27). If the values were expressed in terms of number of complications, the rates were 31 vs 22%, respectively (P = 0.06). The corresponding values for severe complications were 10 vs 11% (P = 0.85) of patients with complications and 12 vs 11% (P = 0.85) of events.

Conclusion  The study did not demonstrate a statistically significant difference in the rate of postoperative complications after short‐course pre‐operative radiotherapy compared with full course chemoradiation.
The ileo neo rectal anastomosis (INRA) in patients with familial adenomatous polyposis: clinical results at two years
Authors: Strijbos S. A. M. , Hueting W. E. , Schipper M. E. I. , Oostvogel H. J. M. , Van Vroonhoven TH. J. M. V. , Gooszen H. G. , Van Laarhoven C. J. H. M.
Published: June 2005

Background  Ileo neo rectal anastomosis (INRA) is a promising alternative for patients with familial adenomatous polyposis (FAP) to restorative proctocolectomy with its morbidity and unpredictable functional outcome to colectomy with ileo rectal anastomosis (IRA) with the continuing risk of rectal cancer. The aims of the present study were to evaluate the function of the neorectum, to assess the morbidity and complications of the operation and to determine the incidence of neorectal polyps.

Methods  Data of all patients having INRA, including bowel function and complications, were prospectively recorded. The reservoir capacity was determined repeatedly by physiologic tests. The anal sphincter complex was assessed by manometry and ultrasound examination. Evaluation of the neorectal mucosa was performed by endoscopy.

Results  Six patients underwent the INRA procedure for FAP. Median defaecation frequency two years postoperatively was 5.5/24 h (range 4–7) including 1/night (range 0–2). Endoscopic examination showed normal mucosa and no evidence of polyp formation in all patients.

Conclusion  INRA affords a good functional reservoir and is accompanied by few reservoir‐related complications. At a minimum follow up period of two years, no growth of polyps in the neorectum occurred.
One‐stage resection without colonic lavage in emergency surgery of the left colon
Authors: Patriti A. , Contine A. , Carbone E. , Gullà N. , Donini A.
Published: June 2005

Objective  Intra‐operative colonic lavage is a widespread procedure introduced to decompress and clean the colon of its faecal load during emergency surgery of the left colon in order to perform a safe anastomosis. This type of lavage is never performed at our institution. The aim of this study was to evaluate the safety and acceptability of emergency left‐sided colectomy without colonic lavage in a consecutive series of patients admitted at our department for perforation and obstruction of the left colon.

Patients and methods  All 44 patients (29 with obstruction and 15 with perforation) on whom a one‐stage left‐sided colon resection was performed without colonic lavage between January 1998 and June 2004 were evaluated in a retrospective review. During this period all patients with acute disease of the left colon underwent a one stage resection without colonic lavage. The only exclusion criteria for anastomosis were: haemodynamic instability, ASA > 3, unresectable tumour. Death, anastomotic leakage and wound infection were main outcome measures.

Result  The leak rate was 4.5% and mortality 2.3% due to one case of postoperative myocardial infarction. A 16% morbidity rate was recorded due to 4 wound infections and 3 minor complications.

Conclusion  The procedure is safe. The low morbidity and mortality of one stage resection without colonic lavage can justify future prospective studies enrolling a large number of patients to compare its results with those obtained by one stage resection with colonic lavage.
Do forceps biopsies truthfully reflect the nature of endoscopically uncovered polypoid lesions of the colon?
Authors: Stermer E. , Bejar J. , Miselevich I. , Goldstein O. , Keren D. , Lavy A. , Boss J. H. , Keren D.
Published: June 2005

Background  Total excision of colonic polyps is not always attainable and in some patients it is clinically contraindicated. Also, a resected polyp may be lost at any step between its endoscopic removal and its embedding in paraffin. The aim of this study was to compare the histological features of colonic polyps as analysed by the study of biopsy‐forceps obtained samples with those assessed on scrutinizing the totally resected growths.

Patients and methods  This prospective study included a cohort of 59 patients in whom, in the course of an elective colonoscopy, a total excision of a 6 mm‐sized or larger polyp was called for. Sizeable biopsies were obtained by means of an Olympus Multibyte forceps prior to the total polypectomy. Subsequent to the study of the polypectomy specimens, the forceps biopsy samples were submitted for histological examination. The pathologists were blinded as to the source of the tissue they were studying. The diagnoses rendered by evaluating the biopsy samples and polypectomy specimens of each patient were contrasted with each other.

Results  Major discrepancies between the histological features of the fragments captured by the biopsy‐forceps and the factual nature of the totally removed polyps were uncovered in 11 (18.6%) of 59 cases. Intriguingly, the grade of the tumours was underrated in all the 11 cases, as judged by contrasting the tentative diagnoses of the forceps‐biopsies with the decisive diagnoses of the polypectomies. Importantly, 2 adenocarcinomas would have been missed by just looking at the forceps‐retrieved sample.

Conclusions  In our experience, a discordance of 18.6% is to be expected between the diagnoses rendered after examining forceps‐biopsies of and totally excised colonic polyps. Nevertheless, it is advisable to procure biopsies prior to the excision of the growths, because on those occasions in which patients' growths cannot be removed or have not been retrieved for one reason or another, a small forceps‐captured tissue sample correctly reflects the characteristics of the polyp in 81.4% of the cases. Finally, the biopsies may be discarded in the event that total removal was successful.
Ligasure™vs conventional diathermy haemorrhoidectomy: long‐term follow‐up of a randomised clinical trial
Authors: Peters C. J. , Botterill I. , Ambrose N. S. , Hick D. , Casey J. , Jayne D. G.
Published: June 2005

Objective  Ligasure™ haemorrhoidectomy has short‐term benefits over conventional diathermy haemorrhoidectomy. The current study aimed to determine the long‐term efficacy of Ligasure™ haemorrhoidectomy.

Subjects and methods  Forty patients, previously randomised to Ligasure™ or diathermy haemorrhoidectomy in 2002, were invited to participate in the study. Haemorrhoidal symptoms and patient satisfaction were recorded. Incontinence was quantified and sphincter anatomy and function assessed by endoanal ultrasound and anorectal manometry.

Results  Thirty (75%) patients participated in the study (14 Ligasure™, 16 conventional). There was no difference in age, sex distribution, or length of follow‐up (Ligasure™: 37 months; conventional: 36 months) between the groups. Both techniques achieved good symptom control, but with a trend to less recurrent bleeding following Ligasure™. Incontinence scores and patient satisfaction were similar. A significant difference was observed in internal sphincter thickness (Ligasure™: 2.5 mm, 2.2–2.8 (mean, 95%CI) vs conventional: 1.88 mm, 1.7–2.1, P = 0.005) and rectal urge sensation (Ligasure™: 284 mls, 211–378 vs conventional: 173 mls, 129–217, P = 0.08).

Conclusion  Ligasure™ is as effective as conventional diathermy haemorrhoidectomy in achieving long‐term symptom control. Less radical haemorrhoidal excision with the Ligasure™ could explain the differences in internal sphincter thickness and urge sensation, and might make it the preferred method for patients with compromised sphincter function.
Progress, epistemology and human health and welfare: what nurses need to know and why
Authors: Betts Clinton E.
Published: June 2005

Abstract Human Progress is often understood to be a rather natural and obvious truth of human existence. That this is not necessarily so, is indicative of the pervasive social, psychological, and educational inculcation that sustains its ubiquitous acceptance. Moreover, the uncritical and ill‐informed understanding of Progress as an unquestioned expression of human beneficence has serious consequences for those concerned with the health and welfare of people. It is argued in this paper that, much of what we might consider deleterious in the socio‐political milieu that now confronts us is, to a significant extent, a matter of progressive ideological epistemology and its ensuing manner of human institutionalization. Part one contends that the current socio‐political structure of the current postmodern affairs is in reality that of a pervasive postmodern economic ideology. Part two provides a brief overview of the historical and philosophical development of Progress as an idea, including some of the profound effects wrought by it on human affairs in the contemporary world. Finally, Part three presents a discussion of the influential effects of the philosophy of Progress on the epistemology of human health and welfare intervention, specifically that of nursing and its claim to a holistic ethic of Caring.
Shifting from preconceptions to pure wonderment
Authors: Porr Caroline
Published: June 2005

Abstract  The author reflects upon her role as a public health nurse striving to attain practice authenticity. Client assessment and nursing interventions were seemingly sufficient until she became curious about ‘Who is this person sitting across from me?’ and ‘What are her experiences in the world as a lone parent living in poverty at the margins of society?’ The author begins to think that she could shift from mere client investigation to pure wonderment about the Other by imagining herself as a researcher, an explorer of another's life world. Ultimately this process enables her to enhance the ‘caring’ in her practice with the knowledge gained of the perceptions and meanings impoverished clients assigned to their everyday lives. Jurgen Habermas’ theory of communicative competence serves as the reference map guiding exploration. The author uses Habermas’ theoretical principles of intersubjective mutuality – the validity claims of comprehensibility, truth, sincerity, and legitimacy. Comprehensibility embodies understanding, an attitude of unconditional acceptance, and care respect of another's individual person and self‐defined reality. Intersubjective mutuality also requires that one dwell in the moment with the Other, satisfied that communication is founded on truth. Sincerity implies fostering the Other's expression of authentic self apart from oppressive distracters. Lastly, legitimacy reconciles the author's altruistic pursuit to know the Other's ontological truth with the reality of the present world.
US and Canadian Dietary Reference Intakes (DRIs) for the macronutrients, energy and physical activity
Authors: Yon B. A. , Johnson R. K.
Published: May 2005

Summary  The Food and Nutrition Board of the Institute of Medicine (IOM), in conjunction with Health Canada, released the sixth in a series of reports on dietary reference values for the intake of macronutrients and energy by Americans and Canadians. This report established Dietary Reference Intakes (DRIs) for carbohydrate, fibre, fat, fatty acids, cholesterol, protein, amino acids, energy and physical activity. The DRIs replace the USA's Recommended Dietary Allowances (RDAs) last updated in 1989, and Canada's Recommended Nutrient Intakes (RNIs), last published in 1990. A panel of 21 US and Canadian research scientists, clinicians and epidemiologists with expertise in energy, protein and amino acids, carbohydrate, fibre, sugar, lipids, physical activity and life‐stage nutrition were appointed to begin the process of reviewing observational and experimental studies published primarily in peer‐reviewed journals. The DRIs are based on scientifically grounded relationships between nutrient intake and the prevention of chronic disease, as well as the maintenance of good health. The purpose of this paper is to highlight a number of the definitions, new approaches, and key findings as they apply to the DRIs for the macronutrients, energy and physical activity.
Rethinking Social Security in Latin America
Authors: Gill Indermit , Packard Truman , Pugatch Todd , Yermo Juan
Published: June 2005

In the past decade, many Latin American governments have radically restructured their old age income security systems, following the lead of Chile, which undertook its major pension reform in 1981. The defining characteristic of the reforms has been a shift in the basis of public pensions from social to individual responsibility: instead of the widely used system that “collectivized” or pooled the risk of being without the capacity to earn while aged, numerous countries in the region have adopted a system that relies on individual savings accounts. The reforms have maintained a role for a modified version of public pooling; this combination of individual and social savings to finance pensions is known as the “multipillar” approach. This article is based on a report prepared for the Office of the Chief Economist of the Latin America and Caribbean Region of the World Bank (Gill, Packard and Yermo, 2004).1 The report recognizes that the system of individual accounts, the essential aspect of the reform, has been a necessary and positive development, and one that is consistent with the economics of insurance and social welfare objectives. Beyond this recognition, however, the results of reform are much more complex. Each country has implemented its own version of the multipillar system. The article therefore draws on country evidence in order to determine: How has the new approach to public pensions in Latin America fared? In particular, have the changes left workers and their families in reform countries better off? The first section provides a brief description of the reforms. The second discusses the main macroeconomic concerns and effects. The third describes the impact on coverage levels, and other social welfare implications. The fourth evaluates the stagnation of coverage levels and presents various possible explanations. The fifth makes specific proposals to improve the multipillar pension system in Latin America. The last section concludes.
A New Approach to Social Assistance: Latin America's Experience with Conditional Cash Transfer Programmes
Authors: Rawlings Laura B.
Published: June 2005

Conditional cash transfers are a departure from more traditional approaches to social assistance that represents an innovative and increasingly popular channel for the delivery of social services. Conditional cash transfers provide money to poor families contingent upon certain behaviour, usually investments in human capital such as sending children to school or bringing them to health centres on a regular basis. They seek both to address traditional short‐term income support objectives and promote the longer‐term accumulation of human capital by serving as a demand‐side complement to the supply of health and education services. Evaluation results reveal that this innovative design has been quite successful in addressing many of the failures in delivering social assistance such as poor poverty targeting, disincentive effects and limited welfare impacts. There is clear evidence of success from the first generation of programmes in Brazil, Colombia, Mexico and Nicaragua in increasing enrolment rates, improving preventive healthcare and raising household consumption. Despite this promising evidence, many questions remain unanswered about conditional cash transfer programmes, including the replicability of their success under different
Income Protection Through Direct Employment Programmes: Recent Concepts and Examples from Latin America
Authors: Reinecke Gerhard
Published: June 2005

The risk of unemployment in Latin America is high. Unemployment insurance exists only in a few countries; coverage is small, and virtually non‐existent in the informal economy. For this reason social protection policies for unemployed workers, defined in the broad sense, have addressed and strengthened the role of direct employment programmes and assistance through cash subsidies. This article describes the main features (financing and administration) of direct employment programmes in the region and their objectives, and evaluates their functioning in terms of targets and coverage, costs and impact. Available studies show that the net direct impact of such programmes on unemployment rates and on beneficiaries' incomes is in most cases relatively low. Nevertheless, in some cases they have helped to lower levels of unemployment and poverty, and have indirect positive effects that are more difficult to measure, such as incentives to economic recovery resulting from the chain effect on consumption of beneficiaries buying goods. For this reason direct employment programmes remain a fully valid mechanism, especially in social emergencies.
Lactate determination in vaginal fluids: a new method in the diagnosis of prelabour rupture of membranes
Authors: Wiberg‐Itzel Eva , Cnattingius Sven , Nordström Lennart
Published: June 2005

Objectives  To assess whether lactate determination in vaginal fluids, ‘Lac test’, can be used as a diagnostic test for prelabour rupture of membranes (PROM) and to derive the best cutoff value for a positive test.

Design  Prospective observational study.

Setting  Labour ward at Söder Hospital in Stockholm, a large clinical service.

Population  Women living in the centre of Stockholm, the capital of Sweden.

Methods  We selected 200 cases with a history of suspect PROM for determination of lactate concentrations in vaginal fluid. In 100 of these cases, actim PROM tests were also analysed.

Main outcome measures  Sensitivity, specificity, positive and negative predictive values, likelihood ratios (LR) and Kappa indices in the identification of visible amniotic fluid at speculum examination.

Results  A lactate concentration ≥4.5 mmol/L was found to be the best cutoff value for a positive test. The ‘Lac test’ had a sensitivity of 86%, specificity 92%, positive and negative predictive values of 92% and 87%, respectively. Corresponding values for the actim PROM test were 60%, 98%, 97% and 71%. LR for a positive ‘Lac test’ was 10.75 and for a negative test 0.15. Corresponding values for the PROM test were 30.0 and 0.4, respectively. The Kappa index was higher for the ‘Lac test’ as compared with the actim PROM test (78% and 59%, respectively).

Conclusion  Lactate determination is a valid test in cases with a history of suspect PROM and may even be a better predictor than the actim PROM test.
Does regular cervical screening protect women from microinvasive squamous cell carcinoma of the cervix? A retrospective case–control study
Authors: Sykes Peter H. , Reddy Jessamine , Peddie David J.
Published: June 2005

Objectives  To compare the smear histories of women with microinvasive squamous cell carcinoma (SCC) of the cervix to those of women with cervical intraepithelial neoplasia grade 3 (CIN3).

Design  Retrospective case–control study.

Setting  A large public hospital gynaecology unit.

Sample  Twenty‐nine consecutive women with microinvasive SCC FIGO stage 1A1 (cases). Fifty‐five age‐matched controls with histologically confirmed CIN3 (controls).

Methods  The cases and controls were selected from institutional databases; smear histories and other information was retrieved from hospital notes or following consent from other records.

Main outcome measures  The time from index smear to prior screening smear and participation in the National Screening Programme (NCSP).

Results  Only 35% of cases compared with 78% controls had a smear in the last 3 years (P= 0.00008.) Cases had a longer median interval between the abnormal smear that resulted in diagnosis and the previous screening smear (4 years) compared with controls (2 years). Cases were less likely to be enrolled in the NCSP (65%) prior to their index smear than controls (85%).

Conclusion  Delayed interval screening was more frequent in women with 1A1 SCC than CIN3.
Transabdominal amnioinfusion in preterm premature rupture of membranes: a randomised controlled trial
Authors: Tranquilli Andrea Luigi , Giannubilo Stefano Raffaele , Bezzeccheri Valeria , Scagnoli Caterina
Published: June 2005

Objective  To evaluate the role of transabdominal amnioinfusion in improving the perinatal outcomes of pregnancies complicated by preterm premature rupture of membranes (pPROM).

Design  A randomised controlled trial.

Setting  A teaching hospital in Italy, obstetric unit.

Population  Women with singleton pregnancies complicated by pPROM, between 24 + 0 and 32 + 6 weeks of gestation.

Methods  Patients were randomised 24 hours after admission to our referral hospital, to expectant management with transabdominal amnioinfusion or expectant management only.

Main outcome measures  The effects of transabdominal amnioinfusion on pPROM–delivery interval and on perinatal outcomes.

Results  Of the 65 women with pPROM 34 met the inclusion criteria. Seventeen women were assigned to amnioinfusion (the amnioinfusion group) and the other 17 to expectant management. Compared with the control group (median: 8 days; range: 3–14), the pPROM–delivery period was significantly longer in women who underwent amnioinfusion (median: 21 days; range: 15–29) (P < 0.05). Women with amnioinfusion were less likely to deliver within seven days since pPROM (RR: 0.18; range: 0.04–0.69 95% CI) or within two weeks (RR: 0.46; range: 0.21–1.02 95% CI). In the amnioinfusion group the neonatal survival was significantly higher at each gestational age (P < 0.01, Yates's correction for Log Rank Test) with a reduction in pulmonary hypoplasia.

Conclusions  We demonstrated that compared with standard expectant management the treatment with transabdominal amnioinfusion after pPROM resulted in significant prolongation of pregnancy and better neonatal outcomes.
Cost‐effectiveness of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early‐onset group B streptococcal disease
Authors: van den Akker‐van Marle M.E. , Rijnders M.E.B. , van Dommelen P. , Fekkes M. , van Wouwe J.P. , Amelink‐Verburg M.P. , Verkerk P.H.
Published: June 2005

Objective  To estimate the costs and effects of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early‐onset group B streptococcal (GBS) disease in the Netherlands. The treatment strategies include a risk‐based strategy, a screening‐based strategy, a combined screening/risk‐based strategy and the current Dutch guideline.

Design  Cost‐effectiveness analysis based on decision model.

Setting  Obstetric care system in the Netherlands.

Population/Sample  Hypothetical cohort of 200,000 neonates.

Methods  A decision analysis model was used to compare the costs and effects of different treatment strategies with no treatment. Baseline estimates were derived from literature and a survey among parents of children affected by GBS disease. The analysis was performed from a societal perspective, and costs and effects were discounted at a percentage of 3%.

Main outcome measures  Cost per quality adjusted of life‐year (QALY).

Result  The risk‐based strategy will prevent 352 cases of early‐onset GBS for €5.0 million, indicating a cost‐effectiveness ratio of €7600 per QALY gained. The combined screening risk‐based strategy has comparable results. The current Dutch guideline resulted in lower effects for higher costs. The screening‐based strategy shows the highest reduction in cases of early‐onset GBS, however, at a cost‐effectiveness ratio of €59,300 per QALY gained. Introducing the polymerase chain reaction (PCR) test may lead to a more favourable cost‐effectiveness ratio.

Conclusion  In the Dutch system, the combined screening/risk‐based strategy and the risk‐based strategy have reasonable cost‐effectiveness ratios. If it becomes feasible to add the PCR test, the cost‐effectiveness of the combined screening/risk‐based strategy may even be more favourable.
Methionine‐deficient diet extends mouse lifespan, slows immune and lens aging, alters glucose, T4, IGF‐I and insulin levels, and increases hepatocyte MIF levels and stress resistance
Authors: Miller Richard A. , Buehner Gretchen , Chang Yayi , Harper James M. , Sigler Robert , Smith‐Wheelock Michael
Published: May 2005

A diet deficient in the amino acid methionine has previously been shown to extend lifespan in several stocks of inbred rats. We report here that a methionine‐deficient (Meth‐R) diet also increases maximal lifespan in (BALB/cJ × C57BL/6 J)F1 mice. Compared with controls, Meth‐R mice have significantly lower levels of serum IGF‐I, insulin, glucose and thyroid hormone. Meth‐R mice also have higher levels of liver mRNA for MIF (macrophage migration inhibition factor), known to be higher in several other mouse models of extended longevity. Meth‐R mice are significantly slower to develop lens turbidity and to show age‐related changes in T‐cell subsets. They are also dramatically more resistant to oxidative liver cell injury induced by injection of toxic doses of acetaminophen. The spectrum of terminal illnesses in the Meth‐R group is similar to that seen in control mice. Studies of the cellular and molecular biology of methionine‐deprived mice may, in parallel to studies of calorie‐restricted mice, provide insights into the way in which nutritional factors modulate longevity and late‐life illnesses.
Equilibrium of acidifying and alkalinizing metabolic acid–base disorders in cirrhosis
Authors: Funk Georg‐Christian , Doberer Daniel , Österreicher Christoph , Peck‐Radosavljevic Markus , Schmid Monika , Schneeweiss Bruno
Published: May 2005

Background and Aims: Conflicting results exist with regard to metabolic acid–base status in liver cirrhosis, when the classic concept of acid–base analysis is applied. The influence of the common disturbances of water, electrolytes and albumin on acid–base status in cirrhosis has not been studied. The aim of this study was to clarify acid–base status in cirrhotic patients by analyzing all parameters with possible impact on acid–base equilibrium.

Patients and Methods: Fifty stable cirrhotic patients admitted to a university hospital. Arterial acid–base status was analyzed using the principles of physical chemistry and compared with 10 healthy controls.

Results: Apart from mild hypoalbuminemic alkalosis, acid–base state was normal in Child–Pugh A cirrhosis. Respiratory alkalosis was the net acid–base disorder in Child–Pugh B and C cirrhosis with a normal overall metabolic acid–base state (Base excess−1.0 (−3.6 to 1.6) vs 1.1 (−0.2 to 1.1) mmol/l, P=0.136, compared with healthy controls, median (interquartile range)). Absence of an apparent metabolic acid–base disorder was based on an equilibrium of hypoalbuminemic alkalosis and of dilutional acidosis and hyperchloremic acidosis.

Conclusion: A balance of offsetting acidifying and alkalinizing metabolic acid–base disorders leaves the net metabolic acid–base status unchanged in cirrhosis.