bluuebunny/crossref_metadata_2025 huggingface dataset:
‘He did what? Well that wasn't handed over!’ Communicating risk in mental health
Authors: MILLAR R. , SANDS N.
Published: July 2012

Accessible summary

This paper reports on a study that was conducted in an acute psychiatric unit investigating how and what information is communicated at nursing handovers that relates to a patients risk status.

Nursing handovers are conducted in an ad hoc manner and may not effectively communicate information required for management of patient risks.

A consistent and evidenced‐based approach to mental health nursing handovers is required, in order to promote best nursing practice.

Mental health inpatient units are dynamic, complex environments that provide care for patients with heterogeneous ages, diagnoses and levels of acuity. These environments commonly expose clinicians and patients to many potential risks. Despite extensive research into risk assessment, prediction and management, no study has investigated how risk information is communicated at handover in acute mental health settings. Given the pivotal role handover plays in informing risk management, this evidence gap is significant. This paper reports on a study that investigated the practices of communicating risk at handover in an Australian acute mental health inpatient unit. The aim of this research was to identify the frequency and type of risk information communicated between nursing shifts, and the methods by which this communication was performed. A secondary aim was to identify effective and ineffective risk communication practices. This study involved an observational design method using a 14‐item Clinical Audit Tool derived from handover principles outlined by World Health Organization. Five hundred occasions of patient handover were observed. Few risk information items were observed to be communicated in any method. Risk communication practice was inconsistent, and a key recommendation from the study is the use of standardized handover tools that ensures risk information is adequately reported.
Integrating an evidence‐based intervention into clinical practice: ‘transitional relationship model’
Authors: FORCHUK C. , MARTIN M.‐L. , JENSEN E. , OUSELEY S. , SEALY P. , BEAL G. , REYNOLDS W. , SHARKEY S.
Published: July 2012

Accessible summary

The transitional relationship model (TRM) facilitates the discharge of psychiatric clients from hospital to community by providing hospital staff involvement until a therapeutic relationship has been established with a community care provider as well as peer support.

Psychiatric wards at six hospital sites implemented the TRM in three waves. Monthly summaries, progress reports, meeting minutes and focus group discussions were reviewed in order to uncover facilitators and barriers to TRM implementation.

Factors that facilitated TRM implementation included: educational modules for staff and peer training, the presence of on‐site champions, and supportive documentation systems. Barriers included: feeling swamped/overwhelmed, death by process, team dynamics and changes in champions.

Implementation strategies suggested by the initial hospital wards were used to enhance implementation on subsequent wards, leading to positive outcomes. This study highlights the need to address work environment issues when implementing healthcare interventions, particularly for interprofessional teams.

The transitional relationship model (TRM) facilitates the discharge process by providing peer support and hospital staff involvement until a therapeutic relationship has been established with a community care provider. A quasi‐experimental, action‐oriented research design was employed in which psychiatric wards at six hospital sites implemented the model in three waves. Helpful strategies were identified by each wave of wards for consideration by subsequent wards. Using an ethnographic approach, qualitative data were examined to uncover experiences and perceptions of TRM implementation and to help identify key issues that were supporting or hampering implementation. Specific strategies that facilitate the implementation of TRM include: (1) the use of educational modules for on‐ward hospital staff training and peer training; (2) presence of on‐site champions; and (3) supportive documentation systems. Issues identified as barriers to implementation included: (1) feeling drowned, swamped and overwhelmed; (2) death by process; (3) team dynamics; and (4) changes in champions. Staged large‐scale implementation of the TRM allowed for iterative improvements to the model leading to positive outcomes. This study highlights the need to address work environment issues, particularly interprofessional teams.
Role of IL‐28B and inosine triphosphatase polymorphisms in efficacy and safety of Peg‐Interferon and ribavirin in chronic hepatitis C compensated cirrhosis with and without oesophageal varices
Authors: Di Marco V. , Calvaruso V. , Grimaudo S. , Ferraro D. , Pipitone R. M. , Di Stefano R. , Craxì A.
Published: July 2012

Summary.  Genetic factors can influence the outcome of antiviral therapy in chronic hepatitis C (HCV). We evaluated the role of interleukin‐28B single nucleotide polymorphisms (SNPs) and inosine triphosphatase (ITPA) gene variants in HCV cirrhosis treated with Peg‐Interferon and ribavirin. A prospective cohort of 233 patients with compensated cirrhosis received 1–1.5 μg/kg/week of Peg‐Interferon alpha‐2b plus 1000–1200 mg/day of RBV for 48 weeks. A sustained virologic response (SVR) was achieved in 27% of patients. On multivariate logistic analysis, the absence of oesophageal varices (OR 3.64 CI 95% 1.27–10.44 P = 0.016), infection with genotype 2 or 3 (OR 4.06, CI 95% 1.08–15.26, P = 0.038), C/C alleles of rs12979860 SNP (OR 7.04, CI 95% 2.40–20.72, P < 0.001) and rapid virologic response (RVR) (OR 78.29, CI 95% 16.07–381.29, P < 0.001) were independently associated with SVR. Patients who experienced post‐treatment relapse received lower total doses of Peg‐Interferon (52.0 ± 15.8 μg/kg vs 65.7 ± 13.3 μg/kg, P < 0.001) and lower total dose of RBV (3829 ± 1210 mg vs 4709 ± 954 mg, P < 0.001) than patients who achieved an SVR. ITPA variants predictive of high ITPase activity were associated with reduction of haemoglobin ≥3 g/dL in the first 4 weeks (P < 0.001), and with reduction of haemoglobin <10 g/dL (P = 0.03) on treatment. In conclusion, combination therapy with Peg‐Interferon and RBV in patients with HCV cirrhosis must be guided by virus genotype, severity of portal hypertension, favourable IL‐28B polymorphisms and ITPA variants, and RVR on treatment.
Metabolic profiling of the methylerythritol phosphate pathway reveals the source of post‐illumination isoprene burst from leaves
Authors: LI ZIRU , SHARKEY THOMAS D.
Published: July 2012

The methylerythritol phosphate (MEP) pathway in plants produces the prenyl precursors for all plastidic isoprenoids, including carotenoids and quinones. The MEP pathway is also responsible for synthesis of approximately 600 Tg of isoprene per year, the largest non‐methane hydrocarbon flux into the atmosphere. There have been few studies of the regulation of the MEP pathway in plants under physiological conditions. In this study, we combined gas exchange techniques and high‐performance liquid chromatography–tandem mass spectrometry (HPLC‐MS‐MS) and measured the profile of MEP pathway metabolites under different conditions. We report that in the MEP pathway, metabolites immediately preceding steps requiring reducing power were in high concentration. Inhibition of the MEP pathway by fosmidomycin caused deoxyxylulose phosphate accumulation in leaves as expected. Evidence is presented that accumulation of MEP pathway intermediates, primarily methylerythritol cyclodiphosphate, is responsible for the post‐illumination isoprene burst phenomenon. Pools of intermediate metabolites stayed at approximately the same level 10 min after light was turned off, but declined eventually under prolonged darkness. In contrast, a strong inhibition of the second‐to‐last step of the MEP pathway caused suppression of isoprene emission in pure N2. Our study suggests that reducing equivalents may be a key regulator of the MEP pathway and therefore isoprene emission from leaves.
Screening of patients with tuberculosis for diabetes mellitus in China
Authors: Li Liang , Lin Yan , Mi Fengling , Tan Shouyong , Liang Bing , Guo Chaojun , Shi Lian , Liu Li , Gong Fang , Li Yuanyuan , Chi Jingyu , Zachariah Rony , Kapur Anil , Lönnroth Knut , Harries Anthony D.
Published: July 2012

Objective  There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and this study aimed to assess feasibility and results of screening patients with TB for DM within the routine healthcare setting of six health facilities.

Method  Agreement on how to screen, monitor and record was reached in May 2011 at a stakeholders’ meeting, and training was carried out for staff in the six facilities in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012.

Results  There were 8886 registered patients with TB. They were first asked whether they had DM. If the answer was no, they were screened with a random blood glucose (RBG) followed by fasting blood glucose (FBG) in those with RBG ≥ 6.1 mm (one facility) or with an initial FBG (five facilities). Those with FBG ≥ 7.0 mm were referred to DM clinics for diagnostic confirmation with a second FBG. Altogether, 1090 (12.4%) patients with DM were identified, of whom 863 (9.7%) had a known diagnosis of DM. Of 8023 patients who needed screening for DM, 7947 (99%) were screened. This resulted in a new diagnosis of DM in 227 patients (2.9% of screened patients), and of these, 226 were enrolled to DM care. In addition, 575 (7.8%) persons had impaired fasting glucose (FBG 6.1 to <7.0 mm). Prevalence of DM was significantly higher in patients in health facilities serving urban populations (14.0%) than rural populations (10.6%) and higher in hospital patients (13.5%) than those attending TB clinics (8.5%).

Conclusion  This pilot project shows that it is feasible to screen patients with TB for DM in the routine setting, resulting in a high yield of patients with known and newly diagnosed disease. Free blood tests for glucose measurement and integration of TB and DM services may improve the diagnosis and management of dually affected patients.
Clinical and molecular characterization of neonatal diabetes and monogenic syndromic diabetes in Asian Indian children
Authors: Jahnavi S , Poovazhagi V , Mohan V , Bodhini D , Raghupathy P , Amutha A , Suresh Kumar P , Adhikari P , Shriraam M , Kaur T , Das AK , Molnes J , Njolstad PR , Unnikrishnan R , Radha V
Published: July 2012

Mutations in the pancreatic ATP sensitive K+ channel proteins [sulfonyluea receptor 1 (SUR1) and inward rectifier K+ channel Kir6.2 (Kir6.2), encoded by ATP‐binding cassette transporter subfamily C member 8 (ABCC8) and potassium channel J11 (KCNJ11), respectively], are the most common cause of neonatal diabetes. We describe the clinical presentation and molecular characterization of Asian Indian children with neonatal diabetes mellitus and monogenic syndromes of diabetes. We sequenced KCNJ11, ABCC8 and insulin (INS) genes in 33 unrelated Indian probands with onset of diabetes below one year of age. A total of 12 mutations were identified which included ABCC8 mutations in seven, KCNJ11 mutations in three and INS mutations in two children. The Asp212Tyr mutation in ABCC8 was novel. We also detected two novel mutations (Val67Met and Leu19Arg) in children with syndromic forms of diabetes like Berardinelli Seip syndrome [1‐acyl‐sn‐glycerol‐3‐phosphate acyltransferase beta (AGPAT2)] and Fanconi Bickel syndrome [solute carrier family 2A2 (SLC2A2)]. Children carrying the KCNJ11 (Cys42Arg, Arg201Cys) and ABCC8 (Val86Ala, Asp212Tyr) mutations have been successfully switched over from insulin therapy to oral sulfonylurea. Our study is the first large genetic screening study of neonatal diabetes in India.
Effects of Exposure to Environmental Chemicals During Pregnancy on the Development of the Male and Female Reproductive Axes
Authors: Bellingham M , Fiandanese N , Byers A , Cotinot C , Evans NP , Pocar P , Amezaga MR , Lea RG , Sinclair KD , Rhind SM , Fowler PA
Published: July 2012

Contents

There is a large body of literature describing effects of environmental chemicals (ECs), many of them anthropogenic with endocrine‐disrupting properties, on development in rodent laboratory species, some of which lead to impaired reproduction and adverse health. This literature joins extensive human epidemiological data and opportunistic wildlife findings on health effects of ECs. In contrast, the effect of endocrine disruption on foetal development and reproductive performance in domestic species is less extensively documented. This applies both to domestic farm and to companion species even though the former is critical to food production and the latter share our homes and many aspects of the modern developed human lifestyle. In domestic species, the nature of chemicals exposure in utero and their consequences for animal health and production are poorly understood. A complication in our understanding is that the pace of development, ontogeny and efficiency of foetal and maternal hepatic and placental activity differs between domestic species. In many ways, this reflects the difficulties in understanding human exposure and consequences of that exposure for the foetus and subsequent adult from epidemiological and largely rodent‐based data. It is important that domestic species are included in research into endocrine disruption because of their (i) wide variety of exposure to such chemicals, (ii) greater similarity of many developmental processes to the human, (iii) economic importance and (iv) close similarities to developed world human lifestyle in companion species.
Effects of Maternal Diet and Exposure to Bisphenol A on Sexually Dimorphic Responses in Conceptuses and Offspring
Authors: Rosenfeld CS
Published: July 2012

Contents

Whereas sexual differentiation is considered as the onset of differentiation of the male or female gonads, mounting evidence indicates that sex differences in developmental programming are established as early as the zygotic stage. Genetic and epigenetic differences between the sexes might govern how each responds to shifts in their early environment, including in the uterus or culture dish, as in the case of in vitro cultured pre‐implantational embryos. Even if no differences are evident between the sexes at birth, divergent conceptus responses to surrounding changes, such as maternal diet and exposure to endocrine disrupting compounds (EDC), such as bisphenol A (BPA), might predispose one sex over the other to later adult‐onset diseases, otherwise termed developmental origin of health and disease (DOHaD). Overall, males subjected to less than optimal in utero conditions tend to be at greater risk for various diseases, including neurobehavioural disorders. As the placenta is the primary nutrient acquisition and communication organ between the dam and foetus, its ability to adapt rapidly to environmental shifts might buffer the conceptus against environmental insults. The placenta of one sex over the other might possess greater ability to respond to environmental fluctuations. In utero environmental changes, including maternal nutrient excess or reduction or exposure to the EDC, BPA, might govern sex‐dependent behavioural alterations. In sum, this review examines the evidence to date that male and female zygotes and conceptuses diverge in their responses to shifting environmental conditions and whether these contrasting sexually dimorphic responses underpin later DOHaD outcomes, namely neurobehavioural changes.
Domestic Animal Models for Biomedical Research
Authors: Bähr A , Wolf E
Published: July 2012

Contents

Experimental animals in biomedical research provide insights into disease mechanisms and models for determining the efficacy and safety of new therapies and for discovery of corresponding biomarkers. Although mouse and rat models are most widely used, observations in these species cannot always be faithfully extrapolated to human patients. Thus, a number of domestic species are additionally used in specific disease areas. This review summarizes the most important applications of domestic animal models and emphasizes the new possibilities genetic tailoring of disease models, specifically in pigs, provides.
Livestock Induced Pluripotent Stem Cells
Authors: Lu Y , Mumaw JL , West FD , Stice SL
Published: July 2012

Contents

Chimeric animals generated from livestock‐induced pluripotent stem cells (iPSCs) have opened the door of opportunity to genetically manipulate species for the production of biomedical models, improving traits of agricultural importance and potentially providing a system to test novel iPSC therapies. The potential of pluripotent stem cells in livestock has long been recognized, with many attempts being chronicled to isolate, culture and characterize pluripotent cells from embryos. However, in most cases, livestock stem cells derived from embryonic sources have failed to reach a pluripotent state marked by the inability to form chimeric animals. The in‐depth understanding of core pluripotency factors and the realization of how these factors can be harnessed to reprogram adult cells into an induced pluripotent state has changed the paradigm of livestock stem cells. In this review, we will examine the advancements in iPSC technology in mammalian and avian livestock species.
Induced Pluripotent Stem Cells from Pigs and Other Ungulate Species: An Alternative to Embryonic Stem Cells?
Authors: Ezashi T , Telugu BPVL , Roberts RM
Published: July 2012

Contents

Robust embryonic stem cell (ESC) lines from livestock species have been difficult to derive and maintain, and unlike mouse ESC, have not contributed to our ability to understand directed differentiation in vitro. Nor have such cells yet provided a simpler means than pronuclear injection to manipulate the genomes of agriculturally important species, such as cattle, sheep and pigs. Induced pluripotent stem cells (iPSC) generated by reprogramming somatic cells, such as fibroblasts, with a set of stemness genes, most usually but not exclusively POU5F1, SOX2, KLF4 and c‐MYC, offer an alternative to ESC in these regards, as they exhibit a pluripotent phenotype resembling that of ESC, yet are readily generated in the laboratory. Accordingly, such cells, in association with cloning technologies, may be useful for introducing complex genetic changes into livestock, although this potential has yet to be demonstrated. Porcine iPSC may be especially valuable because the pig is a prime biomedical model for tissue transplantation. In general, iPSC from livestock, like those from humans, are of the epiblast type and depend upon FGF2 and activin/nodal signalling systems to maintain their pluripotency and growth. Recent experiments, in which newly reprogrammed porcine and bovine cells were selected on a LIF‐based medium in presence of specific protein kinase inhibitors, have allowed iPSC cells of the naïve type, resembling the more amenable blastocyst‐derived mouse ESC and iPSC to be isolated. However, hurdles still remain if such cells are to achieve their biotechnological promise.
Recent Advances in Stem and Germ Cell Research: Implications for the Derivation of Pig Pluripotent Cells
Authors: Alberio R , Perez AR
Published: July 2012

Contents

Pluripotent stem cells have the unique capacity to contribute to all the tissues of an adult animal after transfer into a host embryo. How pluripotency is acquired during early development and how it is maintained in stem cells have attracted the interest of many scientists for over three decades. Much progress in our understanding of how stem cells arise in culture and the signals required for homoeostasis has enabled the derivation of pluripotent cells in multiple species. Here, we discuss recent developments in stem cell biology that will impact the generation of pluripotent cells from different embryonic origins and will contribute to increase our capacity for generating transgenic animals.
Gonadotropin‐Releasing Hormone Targeting for Gonadotroph Ablation: An Approach to Non‐surgical Sterilization
Authors: Struthers RS
Published: July 2012

Contents

Surgical sterilization is the mainstay of dog and cat population control, but its use is still often limited by the costs and effort involved, especially in developing countries. An ideal non‐surgical sterilant that is safe, effective, permanent, administered as a single injection and capable of being manufactured inexpensively could have a significant impact on the world‐wide dog and cat overpopulation problem. One approach towards developing such an agent is the targeting of pituitary gonadotrophic cells with cytotoxic agents using gonadotropin‐releasing hormone (GnRH). GnRH is a peptide that binds to high‐affinity receptors selectively expressed on gonadotrophs and some types of cancers. Both small molecules and proteins have been conjugated to GnRH analogues to generate targeted cytotoxic and imaging agents. Although most of these efforts have focused on development of human cancer therapeutics, available reproductive studies in rats and dogs suggest that current compounds do not have sufficient therapeutic windows for complete gonadotroph ablation, in part owing to poor stability of peptide targeting sequences. The only reported longer‐term study of gonadotroph ablation in dogs reported suppression of serum testosterone for 8 months, but endocrine function then recovered, raising important questions about the mechanism of reproductive suppression and its recovery. Although studies to date suggest that this is a potentially attractive approach to non‐surgical sterilization, ideal agents are yet to be developed, and important mechanistic questions remain to be answered.
Breeding or Assisted Reproduction? Relevance of the Horse Model Applied to the Conservation of Endangered Equids
Authors: Smits K , Hoogewijs M , Woelders H , Daels P , Van Soom A
Published: July 2012

Contents

Many wild equids are at present endangered in the wild. Concurrently, increased mechanization has pushed back the numbers of some old native horse breeds to levels that are no longer compatible with survival of the breed. Strong concerns arose in the last decade to preserve animal biodiversity, including that of rare horse breeds. Genome Resource Banking refers to the cryostorage of genetic material and is an approach forex situconservation, which should be applied in combination within situconservation programmes. In this review, we propose that, owing to the great reproductive similarity among the different members of the genus Equus, the domestic horse can be used to optimize cryopreservation and embryo production protocols for future application in wild equids. We will give this hypothesis a scientific underpinning by listing successful applications of epididymal sperm freezing, embryo freezing, intracytoplasmic sperm injection, oocyte vitrification and somatic cell nuclear transfer in domestic horses. Some ART fertilization methods may be performed with semen of very low quality or with oocytes obtained after the death of the mare.
The Critical Roles of Progesterone Receptor (PGR) in Ovulation, Oocyte Developmental Competence and Oviductal Transport in Mammalian Reproduction
Authors: Akison LK , Robker RL
Published: July 2012

Contents

Progesterone is critical for successful ovulation in the ovary and for the multi‐faceted role of the oviduct in mammalian reproduction. Its effects are mediated by progesterone receptor (PGR), which is highly expressed in the ovary, specifically granulosa cells of preovulatory follicles in response to the luteinizing hormone (LH) surge that occurs just prior to ovulation, and in the oviduct, predominantly luminal epithelial cells but also muscle cells. This review will summarize research which shows that progesterone, via the actions of PGR, plays a key role in the functions of these cells and in the important periovulatory events of oocyte release, acquisition of oocyte developmental competence and oviductal transport of the newly formed embryo. PGR is a nuclear receptor that regulates the expression of many downstream target genes. However, although much is known about its expression characteristics in ovarian and oviductal cells, there is still much to unravel about the mechanisms by which PGR exerts its control over these important reproductive processes, particularly in the oviduct.
Mechanisms Linking Metabolic Status and Disease with Reproductive Outcome in the Dairy Cow
Authors: Wathes DC
Published: July 2012

Contents

Culling for infertility remains the main reason for disposal of dairy cows, limiting productive lifespan. In extreme cases, ovulation is inhibited, preventing the possibility of conception. More often cows do conceive, but fail to remain pregnant owing to intrinsic problems in the embryo and/or to a poor‐quality reproductive tract environment. Both aspects have a genetic component and are also influenced by management practices affecting nutrition and health. The relative importance of these factors varies among heifers, first‐lactation and older cows. A common theme, however, is that an internal signalling system exists which reduces fertility when the cow is in an unsuitable metabolic state to sustain a pregnancy. This may be directly related to nutrient shortage caused by inadequate feed intake, or because available nutrients are being prioritized towards growth or milk production, away from reproduction. Evidence is presented for the involvement of the somatotrophic axis (GH, IGF1, insulin, IGFBP2) and leptin as key metabolic signalling molecules. Another emerging theme is the interaction between metabolism and disease that affects the fertility. Common examples include (i) calf diseases causing inadequate heifer growth and increased age at first calving; (ii) poor peripartum energy status reducing the capacity of the uterus to involute and mount an effective immune response, thereby increasing the likelihood of endometritis; and (iii) development of mastitis after conception, a contributory factor to both early and late embryo mortality. Finally, recent evidence suggests that times of metabolic stress cause mitochondrial damage that also contributes to a reduction in longevity.
Environmental Endocrine Disruptors in Farm Animal Reproduction: Research and Reality
Authors: Magnusson U
Published: July 2012

Contents

In this review, possible comparative advantages of studying endocrine disruption in farm animals vs laboratory rodents are discussed. First, using farm animals, the generality of findings in laboratory rodents are challenged. Farm animals may in certain aspects be better models for humans than laboratory rodents, and sometimes there might be methodological advantages in using farm animals. Second, there are several in vitro studies based on cell‐culture systems from sows and cows where the effects of chemicals on sex steroid secretion can be measured and maturation and fertilization of oocytes may be assessed. These in vitro systems are powerful tools for dissecting the mechanisms of action for endocrine‐disrupting chemicals. Third, in a set of recent in vivo studies using sheep, goats and pigs, in which very different exposure regimens to endocrine‐disrupting chemicals have been used, a full panel of reproductive parameters pertinent to farm animals were assessed. Clinically, it is suggested that endocrine disruption in farm animals should be considered when impaired reproduction could be linked to change in source of feed or pasture. Finally, epigenetic and toxicogenomic approaches can be particularly rewarding in elucidating endocrine disruption in future farm animal studies.
Sperm Interaction with the Female Reproductive Tract
Authors: Druart X
Published: July 2012

Contents

Sperm transit in the female tract is a critical event for the success of fertilization. From their deposition in the vagina to final migration in the oviduct, sperm pass through the different compartments of the genital tract in which they encounter different environments. The cervix and the uterotubal junction (UTJ) are two barriers with different relative importance according to the species. The protein composition, the degree of glycosylation and the hydration of the cervical mucus change during the oestrous cycle. Several sperm surface proteins are associated with their migration through the cervical mucus and the UTJ. Data regarding the interaction of sperm with secretions of the epithelial tissue lining the different compartments of the female genital tract during the sperm transit are reviewed, with a particular emphasis on the migration of sperm through the cervix.
Enhancing Insemination Performance in Pigs Through Controlled Release of Encapsulated Spermatozoa
Authors: Faustini M , Vigo D , Spinaci M , Galeati G , Torre ML
Published: July 2012

Contents

Encapsulation of boar semen is a novel technique that allows insemination to be performed as a single intervention without the need to dilute the semen. The research reviewed in this paper shows that spermatozoa encapsulated in alginate are able to achieve the same fertility as two or three inseminations per oestrus using standard techniques and unencapsulated cells. The use of encapsulated spermatozoa is currently limited by the need for longer semen processing time and wastage of disposable material (catheters, plastic bottles, etc.). In this review, the advantages, the drawbacks and the future possibilities for artificial insemination with encapsulated spermatozoa in the sow are discussed, with the aim of applying this promising new methodology for the optimization of sow reproductive performance.
Seminal Plasma Components in Camelids and Comparisons with Other Species
Authors: Kershaw‐Young CM , Maxwell WMC
Published: July 2012

Contents

Camelid semen is characterized by a highly viscous, low‐volume ejaculate with a low concentration of spermatozoa that exhibit low progressive motility. The viscous seminal plasma is currently the major impediment to the development of assisted reproductive technologies (ARTs) in camelids. To advance ARTs such as sperm cryopreservation and artificial insemination in camelids, it is necessary to identify the cause of the viscosity and gain an understanding of the role of seminal plasma components on sperm function and fertility. Numerous compounds and proteins have been identified as mediators of sperm function and predictors of fertility in other livestock species, and understanding the importance of specific proteins has progressed the success of ARTs in these species. Current knowledge on the components of camelid seminal plasma is outlined, together with the implications of these components for the development of ARTs in camelids. The cause of semen viscosity, as well as proteins that are present in camelid seminal plasma, is described for the first time. Seminal plasma components are compared with those of other species to hypothesize their role in sperm function and fertility.
Immunity and Inflammation in the Uterus
Authors: Turner ML , Healey GD , Sheldon IM
Published: July 2012

Contents

Microbes often infect the uterus and particularly the endometrium of animals. Infections are most commonly associated with natural service, pregnancy and the post‐partum period, leading to inflammation with the elaboration of cytokines, chemokines and prostaglandins. Clinical diseases such as metritis, endometritis and abortion are important causes of infertility. The adaptive immune response to infection has been characterized previously, so the present review aims to highlight the emerging role for innate immunity in the endometrium. The detection of microbes and the innate immune response depends on the detection of pathogen‐associated molecular patterns by pattern recognition receptors. The main families of pattern recognition receptors are Toll‐like receptors (TLRs), nucleotide oligomerization domain‐like receptors, retinoic acid‐inducible gene I‐like receptors and C‐type lectin receptors. These receptors are most often expressed by hematopoietic cells, but the epithelial and stromal cells of the endometrium also possess functional receptors. For example, endometrial cells express TLR4 for recognition of the lipopolysaccharide endotoxin of Gram‐negative bacteria, leading to secretion of IL‐6, IL‐8 and prostaglandin E2. It is likely that the epithelial and stromal cells provide a first line of defence in the endometrium to alert hematopoietic cells to the presence of microbes within the uterus.
Food for thought: Enabling and constraining factors for effective rural eating disorder service delivery
Authors: Weber Mim , Davis Kierrynn
Published: July 2012

Objective:  This study examined the effectiveness of an assessment and referral model of eating disorder service delivery in the Northern Rivers of New South Wales and its potential as a model for rural service delivery.

Design:  A qualitative evaluative research design used brief and extended semistructured interviews with clients, and surveys and semistructured extended interviews with service providers who either referred clients to the service or to whom clients were referred.

Setting:  A sole practitioner service based in a small non‐government women's health service in rural New South Wales.

Participants:  Clients of the service, all but one of whom was woman; service providers including general practitioners, private practice psychologists and social workers, dietitians, mental health service workers.

Major outcome measures:  Participant identified enabling and constraining factors which contributed to the effectiveness of the service model.

Results:  Whilst all service providers and most clients found the assessment process to be beneficial, they identified a number of constraining factors in the referral part of the service which undermined the effectiveness of the model of service delivery, especially for those with more complex or severe presentations.

Conclusions:  For a rural ED service to be effective, a number of enabling factors must be present including the capacity to provide: treatment services as well as assessment; a multidisciplinary team approach to assessment and treatment; and expert consultation and training to generalist practitioners, counsellors, hospital wards and other service providers.
Helping and hindering: Perceptions of enablers and barriers to collaboration within a rural South Australian mental health network
Authors: Crotty Mikaila M. , Henderson Julie , Fuller Jeffrey D.
Published: July 2012

Objective:  To evaluate clinicians’ perceptions of what helps and hinders the delivery of mental health care across a service network in a rural setting.

Design:  Qualitative, semistructured interviews were conducted with 10 individuals who work in one rural mental health care service network.

Setting:  A regional centre in rural South Australia involving representatives of the mental health team, general practice, hospital, community health and nongovernment organisations.

Results:  Clinicians’ perceptions of barriers and enablers to working within their mental health care network were explored. Participants showed a strong shared commitment to effective mental health care delivery and a good understanding of the services that each offers. Interview data suggested that working relationships between local services could be perceived as stronger when a personal or historical element is recognisable. Similarly, the notion of familiarity and community involvement were perceived as facilitators in this network. A perceived barrier for participants was the failure to attract staff with mental health experience, leading to dependence upon the dedication and commitment of existing service providers.

Conclusions:  Collaboration is especially necessary in rural areas, where access to health care services is known to be difficult. The informality of relationships between service providers was shown to be the main facilitator in the network. This is both a strength as it promotes the communication between services and service providers that is essential for successful collaboration, yet is also a threat to the sustainability of the network based on the difficulties of staff recruitment and retention to rural settings.
Electronic records suggest suboptimal management of chronic kidney disease in general practice
Authors: Pilotto Louis S. J. , Ball Partick A. , Smithard Jane M. , Kennedy David R. J.
Published: July 2012

Objective:  To examine electronic records of GP management of chronic kidney disease.

Design:  Cross‐sectional study.

Setting:  Thirteen general practices.

Participants:  Fifteen thousand four hundred and fiftteen active patients aged 50 years and over.

Main outcome measure:  Recorded estimated glomerular filtration rate (eGFR) and diabetes, and rate of prescribing of angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers (ACE/ARBs).

Results:  Six thousand and fifty‐nine (39%) patients had hypertension and 1859 (12%), diabetes. Two thousand six hundred and eighty‐nine (17%) patients were recorded with eGFR < 60 mL min–1 (1.73 m2)–1, while 3344 (22%) did not have an eGFR result recorded. Hypertension, diabetes and eGFR <60 mL min–1 (1.73 m2)–1 were shown to be significantly related to prescribing of ACE/ARBs; however, 31% of known diabetics and 23% of diabetics with an eGFR < 60 mL min–1 (1.73 m2)–1 are not recorded as receiving ACE or ARB therapy. Forty‐two per cent of patients with eGFR < 60 mL min–1 (1.73 m2)–1, are also not recorded as receiving ACE or ARB therapy. There was a 23% variation in the rates of prescribing of ACE/ARBs by practice for patients with diabetes and eGFR < 60 mL min–1 (1.73 m2)–1.

Conclusion:  The overall recording of eGFR and the recorded prescribing of ACE or ARB therapy in known diabetics and patients with eGFR < 60 mL min–1 (1.73 m2)–1appear suboptimal. Also, the variations in prescribing between practices require further investigation.
Health behaviours and outcomes associated with fly‐in fly‐out and shift workers in Western Australia
Authors: Joyce S. J. , Tomlin S. M. , Somerford P. J. , Weeramanthri T. S.
Published: July 2012

Aims

To examine the association of health behaviours and outcomes with employment type in the West Australian adult population.

Methods

Cross‐sectional study of employed adults aged 16 years and over using self‐reported information collected in the WA Health and Wellbeing Surveillance System between 2008 and 2010. A total of 380 fly‐in fly‐out (FIFO) workers, 913 shift workers and 10 613 workers of other employment types were identified.

Results

FIFO workers exhibited similar health behaviours to shift workers but had a different sociodemographic profile. Compared with other employment types, FIFO workers were significantly more likely to be current smokers, drink alcohol at risky levels, and be overweight or obese, after adjusting for age, sex and survey sampling strategies. They were less likely to report current mental health problems.

Conclusions

Self‐reported health behaviours of FIFO workers differ from other employment types. FIFO workers are expected to increase in number over the next decade, as the mining and resources sector expands in Australia. Our findings suggest that health interventions, whether in the workplace or clinical settings, need to be informed by the demographic mix of the cohort of workers on entry as they are not a homogenous group, and targeted towards specific employment patterns (length of shifts and type of employment) to improve their current and future well‐being.
Hydroxychloroquine in lupus: emerging evidence supporting multiple beneficial effects
Authors: Tang C. , Godfrey T. , Stawell R. , Nikpour M.
Published: July 2012

Due to multiple beneficial effects, including control of disease activity, reduction in cardiovascular events and improved survival, hydroxychloroquine is now recommended long‐term for all patients with systemic lupus erythematosus. However, patients must be made aware of the possible risk of retinal toxicity and have eye examinations to monitor for this complication. As hydroxychloroquine becomes more widely used in systemic lupus erythematosus, physicians must also be aware of rare but serious adverse effects, including neuromyotoxicity and cardiotoxicity.
How receptive are patients to medical students in Australian hospitals? A cross‐sectional survey of a public and a private hospital
Authors: Tiong M. K. , Levinson M. R. , Oldroyd J. C. , Staples M. P.
Published: July 2012

Background

Medical student numbers in Australian universities have more than doubled since 2000. There are concerns about the ability for existing clinical training sites to accommodate this increase in student numbers, and there have been calls to increase training in private hospitals. The receptiveness of patients in private hospitals will influence the success of such placements.

Aims

We aimed to evaluate whether patients in a private hospital are as receptive to medical students as patients in a public hospital.

Methods

Cross‐sectional survey of patients conducted at a private and a public teaching hospital in Melbourne, Australia. Main outcome measures were willingness to allow a medical student to participate in an interview, physical examination and procedures (electrocardiogram, venepuncture and digital rectal examination), and patient attitudes towards medical students as assessed by a series of 20 attitude statements and a summative attitude score.

Results

Patients at the private hospital were more willing than patients at the public hospital to allow a medical student to take their history unsupervised (112/146, 76.7% vs 90/141, 63.8%; P = 0.02). The distribution of patient willingness did not otherwise differ between hospitals for physical examination or procedures. There was no difference in the mean attitude score between hospitals (15.3 ± 0.8 private vs 15.4 ± 1.2 public, P = 0.38), and responses differed between hospitals for only four of the 20 attitude statements.

Conclusions

Our findings suggest that patients in a private hospital are at least as receptive to medical students as patients in a public hospital.
Comparison between perceptual assessments of nasality and nasalance scores
Authors: Brunnegård Karin , Lohmander Anette , van Doorn Jan
Published: July 2012

Abstract  Background: There are different reports of the usefulness of the Nasometer™ as a complement to listening, often as correlation calculations between listening and nasalance measurements. Differences between findings have been attributed to listener experience and types of speech stimuli.

Aims: To compare nasalance scores from the Nasometer with perceptual assessments, for the same and different Swedish speech stimuli, using three groups of listeners with differing levels of experience in judging speech nasality.

Methods & Procedures: To compare nasalance scores and blinded listener ratings of randomized recordings using three groups of listeners and two groups of speakers. Speakers were either classified as having hypernasal speech or speech with typical speech resonance. Listeners were speech–language pathologists (SLPs) working predominantly with resonance disorders, other SLPs and untrained listeners.

Outcomes & Results: Correlations (rs) between hypernasality ratings and nasalance scores for each listener group and speech stimuli were calculated. For both groups of SLPs all correlations between perceptual ratings and nasalance scores were significant at p= 0.01. The correlations between the nasalance scores and ratings by listeners in the SLP groups were higher than those for the untrained listener group regardless of stimulus type. Post‐hoc Mann–Whitney U‐tests showed that the only difference that was significant was expert SLP group versus untrained listener group. Secondly, correlations between perceptual ratings and oral stimulus nasalance scores were higher when the perceptual ratings were based on spontaneous speech rather than on the oral stimulus. However, a Wilcoxon signed rank test showed that the difference was not significant. A third finding was that correlations between oral stimulus nasalance scores and perceptual scores were higher than those between mixed stimulus nasalance scores and perceptual scores. A Wilcoxon signed rank test showed that the difference was significant.

Conclusions & Implications: The Nasometer might be useful for the SLP with limited experience in assessing resonance disorders in differentiating between hyper‐ and hyponasality. With listener reliability for ratings of hypernasality still being an issue, the use of a nasalance score as a complement to the perceptual evaluation will also aid the expert SLP. It will give an alternative way of quantifying speech resonance and might help in especially hard to judge cases.
Assessing lexicon: validation and developmental data of the Picture Naming Game (PiNG), a new picture naming task for toddlers
Authors: Bello A. , Giannantoni P. , Pettenati P. , Stefanini S. , Caselli M. C.
Published: July 2012

Abstract  Background: Understanding lexical abilities in infants and toddlers is important, yet no single tool can be used.

Aims: To perform a validation of a new tool (known as the Picture Naming Game, or ‘PiNG’) for assessing lexical comprehension and production in toddlers and to obtain developmental trends for Italian children.

Methods & Procedures: PiNG consists of four subtests: Noun Comprehension (NC), Noun Production (NP), Predicate Comprehension (PC) and Predicate Production (PP), each containing 20 lexical targets. It was administered to 388 children with typical development aged 19–37 months. The short form of the Italian version of the MacArthur–Bates Communicative Development Inventories (MB‐CDI), previously completed by parents of participants, was used for the validation of PiNG.

Outcomes & Results: For the validation study, reliability, internal consistency and concurrent validity were analysed. The reliability was optimal for NC, NP and PP, and satisfactory for PC. Split‐half analysis showed a fair internal consistency for all of the subtests. Concurrent validity was verified through the correlation with MB‐CDI using Pearson's correlation coefficient, which was significant even after having controlled for age. To describe the developmental trends, data are provided for 1‐month age intervals. The comprehension subtests showed a rapid increase at younger ages, with children reaching a plateau slightly earlier for the NC (at 30 months versus 33 months for the PC). The increase in the production subtests was gradual; PP appeared to be the most difficult subtest, administrable starting at the age of 24 months. When we analysed, as potential confounders for developmental trends, gender, parents’ educational level, and the way in which the subtests were administered, no differences were found, except for a better performance for girls in the NP subtest.

Conclusions & Implications: Overall, the results suggest that PiNG is suitable for children in the age range considered to evaluate language abilities. It can be used together with other tools with clinical and theoretical objectives also to describe lexical abilities in atypical populations, such as children with cognitive and/or language impairment, as well as with late‐talking children. Finally, the four subtests can be administered separately or combined, which provides flexibility in clinical use, in that the individual child's linguistic and/or cognitive characteristics and level can be taken into consideration.