bluuebunny/crossref_metadata_2025 huggingface dataset:
A multienvironment conditional probability density function model for turbulent reacting flows
Authors: Fox R. O. , Raman V.
Published: November 2004

The multienvironment conditional probability density function (MECPDF) model was first proposed by Fox [Computational Models for Turbulent Reacting Flows (Cambridge University Press, Cambridge, 2003)] as a simple extension of multienvironment probability density function models for turbulent reacting flows. Like the conditional moment closure (CMC) and the laminar flamelet model (LFM), the MECPDF model describes the reacting scalars conditioned on the value of the mixture fraction. However, unlike CMC and LFM, the new model provides a consistent description of conditional fluctuations in both the scalar dissipation rate and the reacting scalars, and hence can be used to model partial extinction and reignition in homogeneous turbulent reacting flows. In this work, a general derivation of the MECPDF model is presented for a single reaction-progress variable using the direct quadrature method of moments. Extensions of the model to multiple reaction-progress variables and conditioning on the mixture-fraction vector are also discussed. After deriving the model, the closure assumptions are validated using direct simulations for pure diffusion of two randomly distributed, initially correlated scalar fields. Two homogeneous applications are then considered: nonreactive mixing starting from nontrivial initial conditions, and reactive mixing with partial extinction and reignition.
Molecular simulation study of effect of molecular association on vapor-liquid interfacial properties
Authors: Singh Jayant K. , Kofke David A.
Published: November 2004

Vapor-liquid interfacial properties of square-well associating fluids are studied via transition-matrix Monte Carlo simulation. Results for one-site and two-site association models are presented. Coexistence properties, surface tension, cluster distribution, density profile, and orientation profile are presented. Molecular association affects the interfacial properties and cluster fractions more than it affects the bulk densities. We observe that the surface tension exhibits a maximum with respect to association strength. This behavior is in agreement with the recent study of Peery and Evans [J. Chem. Phys. 114, 2387 (2001)] for one site system using a square-gradient approach.
On the resolvent and spectral functions of a second order differential operator with a regular singularity
Authors: Falomir H. , Muschietti M. A. , Pisani P. A. G.
Published: November 2004

We consider the resolvent of a second order differential operator with a regular singularity, admitting a family of self-adjoint extensions. We find that the asymptotic expansion for the resolvent in the general case presents unusual powers of λ which depend on the singularity. The consequences for the pole structure of the ζ function, and for the small-t asymptotic expansion of the heat kernel, are also discussed.
Influence of inertia on eddies created in films creeping over strongly undulated substrates
Authors: Wierschem A. , Aksel N.
Published: November 2004

We present an experimental study of gravity driven films flowing down a sinusoidal bottom profile of high amplitude. Eddies that are created in the valleys of the undulated bottom profile under creeping flow conditions are modified as inertia becomes significant. We find that the eddies become tilted and their size increases depending on the Froude number. Surface waves, which are generated from natural noise beyond a certain Froude number, induce an oscillation and a breakup of the separatrix by the turnstile-lobe mechanism. This leads to a material exchange between the eddy and the overlying film. We show how the surface waves are coupled to the eddies and discuss the time scales associated with the material exchange of suspended particles.
The 15-K neutron structure of saccharide-free concanavalin A
Authors: Blakeley M. P. , Kalb (Gilboa) A. J. , Helliwell J. R. , Myles D. A. A.
Published: November 2004

The positions of the ordered hydrogen isotopes of a protein and its bound solvent can be determined by using neutron crystallography. Furthermore, by collecting neutron data at cryo temperatures, the dynamic disorder within a protein crystal is reduced, which may lead to improved definition of the nuclear density. It has proved possible to cryo-cool very large Con A protein crystals (>1.5 mm
3
) suitable for high-resolution neutron and x-ray structure analysis. We can thereby report the neutron crystal structure of the saccharide-free form of Con A and its bound water, including 167 intact D
2
O molecules and 60 oxygen atoms at 15 K to 2.5-Å resolution, along with the 1.65-Å x-ray structure of an identical crystal at 100 K. Comparison with the 293-K neutron structure shows that the bound water molecules are better ordered and have lower average
B
factors than those at room temperature. Overall, twice as many bound waters (as D
2
O) are identified at 15 K than at 293 K. We note that alteration of bound water orientations occurs between 293 and 15 K; such changes, as illustrated here with this example, could be important more generally in protein crystal structure analysis and ligand design. Methodologically, this successful neutron cryo protein structure refinement opens up categories of neutron protein crystallography, including freeze-trapped structures and cryo to room temperature comparisons.
A comparison of the effects of cheese and butter on serum lipids, haemostatic variables and homocysteine
Authors: Biong Anne S. , Müller Hanne , Seljeflot Ingebjørg , Veierød Marit B. , Pedersen Jan I.
Published: November 2004

Milk fat contains considerable amounts of saturated fatty acids, known to increase serum cholesterol. Little is known, however, about the relative effect of different milk products on risk factors for CHD. The aim of the present study was to compare the effects of Jarlsberg cheese (a Norwegian variety of Swiss cheese) with butter on serum lipoproteins, haemostatic variables and homocysteine. A controlled dietary study was performed with twenty-two test individuals (nine men and thirteen women) aged 23–54 years. The subjects consumed three isoenergetic test diets, with equal amounts of fat and protein, and containing either cheese (CH diet), butter+calcium caseinate (BC diet) or butter+egg-white protein (BE diet). The study was a randomised cross-over study and the subjects consumed each diet for 3 weeks, with 1 week when they consumed their habitual diet in between. Fasting blood samples were drawn at baseline and at the end of each period. Serum was analysed for lipids and plasma for haemostatic variables and homocysteine. Total cholesterol was significantly lower after the CH diet than after the BC diet (−0.27 mmol/l;P=0.03), while the difference in LDL-cholesterol was found to be below significance level (−0.22 mmol/l;P=0.06). There were no significant differences in HDL-cholesterol, triacylglycerols, apo A-I, apo B or lipoprotein (a), haemostatic variables and homocysteine between the diets. The results indicate that, at equal fat content, cheese may be less cholesterol increasing than butter.
Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults
Authors: Stratton Rebecca J. , Hackston Annemarie , Longmore David , Dixon Rod , Price Sarah , Stroud Mike , King Claire , Elia Marinos
Published: November 2004

The ‘malnutrition universal screening tool’ (‘MUST’) for adults has been developed for all health care settings and patient groups, but ease of use and agreement with other published tools when screening to identify malnutrition requires investigation. The present study assessed the agreement and the prevalence of malnutrition risk between ‘MUST’ and a variety of other tools in the same patients and compared the ease of using these tools. Groups of patients were consecutively screened using ‘MUST’ and: (1) MEREC Bulletin (MEREC) and Hickson and Hill (HH) tools (fifty gastroenterology outpatients); (2) nutrition risk score (NRS) and malnutrition screening tool (MST; seventy-five medical inpatients); (3) short-form mini nutritional assessment (MNA-tool; eighty-six elderly and eighty-five surgical inpatients); (4) subjective global assessment (SGA; fifty medical inpatients); (5) Doyle undernutrition risk score (URS; fifty-two surgical inpatients). Using ‘MUST’, the prevalence of malnutrition risk ranged from 19–60% in inpatients and 30% in outpatients. ‘MUST’ had ‘excellent’ agreement (κ 0.775–0.893) with MEREC, NRS and SGA tools, ‘fair–good’ agreement (κ 0.551–0.711) with HH, MST and MNA-tool tools and ‘poor’ agreement with the URS tool (κ 0.255). When categorisation of malnutrition risk differed between tools, it did not do so systematically, except between ‘MUST’ and MNA-tool (P=0.0005) and URS (P=0.039). ‘MUST’ and MST were the easiest, quickest tools to complete (3–5 min). The present investigation suggested a high prevalence of malnutrition in hospital inpatients and outpatients (19–60% with ‘MUST’) and ‘fair–good’ to ‘excellent’ agreement beyond chance between ‘MUST’ and most other tools studied. ‘MUST’ was quick and easy to use in these patient groups.
Hypoglycaemic and anorexigenic activities of an α-amylase inhibitor from white kidney beans (Phaseolus vulgaris) in Wistar rats
Authors: Tormo M. A. , Gil-Exojo I. , de Tejada A. Romero , Campillo J. E.
Published: November 2004

An inhibitor of α-amylase was isolated and purified from an extract of white kidney beans (Phaseolus vulgaris). The acute oral administration of the inhibitor (50 mg/kg body weight) to adult Wistar rats together with a starch load (2 g/kg body weight suspended in NaCl (9 g/l)) reduced the increase in glycaemia over the basal value (NaCl, 222 (SEM 49); inhibitor, 145 (SEM 16) mmol/l×180 min;P<0.05) without modifying the insulin response. On administering the inhibitor orally (50 mg/kg body weight dissolved in NaCl (9 g/l)) for 21 d to rats fed on a standard diet, a decline was observed in the glycaemia values on day 0 (NaCl, 5.53 (SEM 0.12); inhibitor, 5.25 (SEM 0.16) mmol/l) relative to those obtained on days 10 (NaCl, 5.00 (SEM 0.14); inhibitor, 4.60 (SEM 0.08) mmol/l;P<0.05) and 21 (NaCl, 5.22 (SEM 0.22); inhibitor, 4.50 (SEM 0.12) mmol/l;P<0.01) of treatment, without modifying the plasma concentration of insulin. There was found to be a significant anorexigenic action of the inhibitor; there was reduced food intake (NaCl, 23.07 (SEM 0.31); inhibitor, 19.50 (SEM 0.49) g/d;P<0.01), a reduced weight gain (NaCl, 52 (SEM 3); inhibitor, −1.33 (SEM 8.9) g/21 d;P<0.01), as well as changes in the activity of some intestinal enzymes such as maltase (NaCl, 87 (SEM 7); inhibitor, 127 (SEM 11) U/g proteins;P<0.05). The present study has shown, for the first time, that the prolonged administration of an α-amylase inhibitor reduces blood glucose levels and body-weight gain in Wistar rats.
Comparison of predicted body fat percentage from anthropometric methods and from impedance in university students
Authors: Arroyo Marta , Rocandio Ana M. , Ansotegui Laura , Herrera Hector , Salces Itziar , Rebato Esther
Published: November 2004

The objective of the present study was to compare different methods for evaluating body fat percentage (BF%) (anthropometric methods and bioelectrical impedance analysis) in university students. Subjects were 653 healthy students whose mean age, body height, body weight and BMI were 21·1 (SD 2·5) years, 166·0 (SD 8·4) cm, 62·8 (SD 11·0) kg and 22·7 (SD 3·1) kg/m2, respectively. Results showed that BMI is a poor predictor of body fatness since the sensitivity was low in comparison with the reference method (Siri equation). The lowest values of BF% were obtained using the reference method (Siri equation) (21·8 (SD 6·8)%). The two methods with the highest agreement were Siri and Lean (mean difference, −0·5), followed by Brozek (mean difference, −1·4) and Deurenberg (mean difference, −1·5). The largest mean difference for BF% was between Siri and impedance (−4·5). Although the methods and/or equations used in the present study have been commonly utilised to estimate BF% in young adults, the results must be interpreted with caution in the diagnosis and monitoring of overweight and obesity.
Stunted children gain less lean body mass and more fat mass than their non-stunted counterparts: a prospective study
Authors: Martins P. A. , Hoffman D. J. , Fernandes M. T. B. , Nascimento C. R. , Roberts S. B. , Sesso R. , Sawaya A. L.
Published: November 2004

The aim of the present study was to analyse the changes in body composition of stunted children during a follow-up period and to test the hypothesis of a tendency to accumulate body fat as a consequence of undernutrition early in life. We selected fifty boys and girls aged 11 to 15, who were residents of slums in São Paulo, Brazil. Twenty were stunted (S) and thirty had normal stature (NS). The children's nutritional status and body composition were assessed through anthropometry and dual-energy X-ray absorptiometry, at the beginning of the present study and after 3 years, and changes in lean mass (LM and LM%) and fat mass (FM and FM%) were calculated. Stunted boys accumulated more body fat (FM%: S=1·62%, NS=−3·40%;P=0·003) and gained less lean mass (LM%: S=−1·46, NS=3·21%;P=0·004). Stunted girls gained less lean mass (S=7·87 kg, NS=11·96 kg;P=0·032) and had significantly higher values of FM% at follow-up when compared with their baseline values (P=0·008), whereas non-stunted girls had a non-significant difference in FM% over time (P=0·386). These findings are important to understand the factors involved in the increased prevalence of overweight and obesity among poor populations, which appear to be associated with hunger during infancy and/or childhood.
R-Ras Controls Membrane Protrusion and Cell Migration through the Spatial Regulation of Rac and Rho
Authors: Wozniak Michele A. , Kwong Lina , Chodniewicz David , Klemke Richard L. , Keely Patricia J.
Published: November 2004

Although it is known that the spatial coordination of Rac and Rho activity is essential for cell migration, the molecular mechanisms regulating these GTPases during migration are unknown. We found that the expression of constitutively activated R-Ras (38V) blocked membrane protrusion and random migration. In contrast, expression of dominant negative R-Ras (41A) enhanced migrational persistence and membrane protrusion. Endogenous R-Ras is necessary for cell migration, as cells that were transfected with siRNA for R-Ras did not migrate. Expression of R-Ras (38V) decreased Rac activity and increased Rho activity around the entire cell periphery, whereas expression of dominant negative R-Ras (41A) showed the converse, suggesting that R-Ras can spatially activate Rho and inactivate Rac. Consistent with this role, endogenous R-Ras localized and was preferentially activated at the leading edge of migratory cells in response to adhesion. The effects of R-Ras on cell migration are mediated by PI3-Kinase, as an effector mutant that uncouples PI3-Kinase binding from R-Ras (38V) rescued migration. From these data, we hypothesize that R-Ras plays a key role in cell migration by locally regulating the switch from Rac to Rho activity after membrane protrusion and adhesion.
Mitotic Regulation of Protein 4.1R Involves Phosphorylation by cdc2 Kinase
Authors: Huang Shu-Ching , Liu Eva S. , Chan Siu-Hong , Munagala Indira D. , Cho Heidi T. , Jagadeeswaran Ramasamy , Benz Edward J.
Published: November 2004

The nonerythrocyte isoform of the cytoskeletal protein 4.1R (4.1R) is associated with morphologically dynamic structures during cell division and has been implicated in mitotic spindle function. In this study, we define important 4.1R isoforms expressed in interphase and mitotic cells by RT-PCR and mini-cDNA library construction. Moreover, we show that 4.1R is phosphorylated by p34cdc2kinase on residues Thr60 and Ser679 in a mitosis-specific manner. Phosphorylated 4.1R135isoform(s) associate with tubulin and Nuclear Mitotic Apparatus protein (NuMA) in intact HeLa cells in vivo as well as with the microtubule-associated proteins in mitotic asters assembled in vitro. Recombinant 4.1R135is readily phosphorylated in mitotic extracts and reconstitutes mitotic aster assemblies in 4.1R-immunodepleted extracts in vitro. Furthermore, phosphorylation of these residues appears to be essential for the targeting of 4.1R to the spindle poles and for mitotic microtubule aster assembly in vitro. Phosphorylation of 4.1R also enhances its association with NuMA and tubulin. Finally, we used siRNA inhibition to deplete 4.1R from HeLa cells and provide the first direct genetic evidence that 4.1R is required to efficiently focus mitotic spindle poles. Thus, we suggest that 4.1R is a member of the suite of direct cdc2 substrates that are required for the establishment of a bipolar spindle.
Requirement of theCaenorhabditis elegansRapGEFpxf-1andrap-1for Epithelial Integrity
Authors: Berkel W. Pellis-van , Verheijen M.H.G. , Cuppen E. , Asahina M. , de Rooij J. , Jansen G. , Plasterk R.H.A. , Bos J. L. , Zwartkruis F.J.T.
Published: November 2004

The Rap-pathway has been implicated in various cellular processes but its exact physiological function remains poorly defined. Here we show that the Caenorhabditis elegans homologue of the mammalian guanine nucleotide exchange factors PDZ-GEFs, PXF-1, specifically activates Rap1 and Rap2. Green fluorescent protein (GFP) reporter constructs demonstrate that sites of pxf-1 expression include the hypodermis and gut. Particularly striking is the oscillating expression of pxf-1 in the pharynx during the four larval molts. Deletion of the catalytic domain from pxf-1 leads to hypodermal defects, resulting in lethality. The cuticle secreted by pxf-1 mutants is disorganized and can often not be shed during molting. At later stages, hypodermal degeneration is seen and animals that reach adulthood frequently die with a burst vulva phenotype. Importantly, disruption of rap-1 leads to a similar, but less severe phenotype, which is enhanced by the simultaneous removal of rap-2. In addition, the lethal phenotype of pxf-1 can be rescued by expression of an activated version of rap-1. Together these results demonstrate that the pxf-1/rap pathway in C. elegans is required for maintenance of epithelial integrity, in which it probably functions in polarized secretion.
Analysis of a Spindle Pole Body Mutant Reveals a Defect in Biorientation and Illuminates Spindle Forces
Authors: Yoder Tennessee J. , McElwain Mark A. , Francis Susan E. , Bagley Joy , Muller Eric G.D. , Pak Brian , O'Toole Eileen T. , Winey Mark , Davis Trisha N.
Published: November 2004

The spindle pole body (SPB) is the microtubule organizing center in Saccharomyces cerevisiae. An essential task of the SPB is to ensure assembly of the bipolar spindle, which requires a proper balancing of forces on the microtubules and chromosomes. The SPB component Spc110p connects the ends of the spindle microtubules to the core of the SPB. We previously reported the isolation of a mutant allele spc110-226 that causes broken spindles and SPB disintegration 30 min after spindle formation. By live cell imaging of mutant cells with green fluorescent protein (GFP)-Tub1p or Spc97p-GFP, we show that spc110-226 mutant cells have early defects in spindle assembly. Short spindles form but do not advance to the 1.5-μm stage and frequently collapse. Kinetochores are not arranged properly in the mutant cells. In 70% of the cells, no stable biorientation occurs and all kinetochores are associated with only one SPB. Examination of the SPB remnants by electron microscopy tomography and fluorescence microscopy revealed that the Spc110-226p/calmodulin complex is stripped off of the central plaque of the SPB and coalesces to from a nucleating structure in the nucleoplasm. The central plaque components Spc42p and Spc29p remain behind in the nuclear envelope. The delamination is likely due to a perturbed interaction between Spc42p and Spc110-226p as detected by fluorescence resonance energy transfer analysis. We suggest that the force exerted on the SPB by biorientation of the chromosomes pulls the Spc110-226p out of the SPB; removal of force exerted by coherence of the sister chromatids reduced fragmentation fourfold. Removal of the forces exerted by the cytoplasmic microtubules had no effect on fragmentation. Our results provide insights into the relative contributions of the kinetochore and cytoplasmic microtubules to the forces involved in formation of a bipolar spindle.
Coral reef sedimentation on Rodrigues and the Western Indian Ocean and its impact on the carbon cycle
Authors: Rees Siwan A. , Opdyke Bradley N. , Wilson Paul A. , Fifield L. Keith
Published: November 2004

Coral reefs in the southwest Indian Ocean cover an area ofca.18530 km2compared with a global reef area of nearly 300000 km2. These regions are important as fishing grounds, tourist attractions and as a significant component of the global carbon cycle. The mass of calcium carbonate stored within Holocene neritic sediments is a number that we are only now beginning to quantify with any confidence, in stark contrast to the mass and sedimentation rates associated with pelagic calcium carbonate, which have been relatively well defined for decades. We report new data that demonstrate that the reefs at Rodrigues, like those at Réunion and Mauritius, only reached a mature state (reached sea level) by 2–3 ka: thousands of years later than most of the reefs in the Australasian region. Yet field observations show that the large lagoon at Rodrigues is already completely full of carbonate detritus (typical lagoon depth less than 1 m at low spring tide). The presence of aeolian dunes at Rodrigues indicates periodic exposure of past lagoons throughout the Pleistocene. The absence of elevated Pleistocene reef deposits on the island indicates that the island has not been uplifted. Most Holocene reefs are between 15 and 20 m in thickness and those in the southwest Indian Ocean appear to be consistent with this observation. We support the view that the CO2flux associated with coral–reef growth acts as a climate change amplifier during deglaciation, adding CO2to a warming world. southwest Indian Ocean reefs could have added 7–10% to this global flux during the Holocene.
TheOxford English DictionaryToday
Authors: Simpson John , Weiner Edmund , Durkin Philip
Published: November 2004

The long link between the Philological Society and theOxford English Dictionaryis in little need of repetition. The following series of interlinked pieces were delivered at a meeting of the Society in June 2003 which marked the occasion of the 75th anniversary of the completion of the first edition of the dictionary.
Review article: the pathophysiology of gastro‐oesophageal reflux disease − oesophageal manifestations
Authors: Castell D. O. , Murray J. A. , Tutuian R. , Orlando R. C. , Arnold R.
Published: November 2004

The pathogenesis of gastro‐oesophageal reflux disease (GERD) is multifactorial, involving transient lower oesophageal sphincter relaxations (TLESRs) as well as other lower oesophageal sphincter (LES) pressure abnormalities. GERD is associated with a decrease in LES pressure, which can be provoked by factors such as foods (fat, chocolate, etc.), alcohol, smoking and medications. These factors have also been shown to increase TLESRs. As a result, reflux of acid, bile, pepsin and pancreatic enzymes occurs, leading to oesophageal mucosal injury, which can potentially progress to oesophageal adenocarcinoma in a minority of patients with Barrett's metaplasia. In addition, duodenogastric contents can also contribute to oesophageal injury. Other factors contributing to the pathophysiology of GERD include hiatal hernia, poor oesophageal clearance, delayed gastric emptying and impaired mucosal defensive factors. Hiatal hernia has a permissive role in the pathogenesis of reflux oesophagitis by promoting LES dysfunction. Delayed gastric emptying, resulting in gastric distension, can significantly increase the rate of TLESRs, contributing to postprandial GER. The mucosal defensive factors have an important role in GERD. When excessive acid causes a breakdown in oesophageal epithelial defenses, epithelial resistance may be reduced. Nocturnal GERD is associated with prolonged acid exposure and proximal extent of acid contact, which elevates the risk for oesophageal damage and GERD‐related complications. In sum, GERD is a complex problem caused by many factors that are exacerbated when the patient is in the supine position.
Review article: supra‐oesophageal manifestations of gastro‐oesophageal reflux disease and the role of night‐time gastro‐oesophageal reflux
Authors: Fass R. , Achem S. R. , Harding S. , Mittal R. K. , Quigley E.
Published: November 2004

Gastro‐oesophageal reflux disease (GERD) has been associated with a variety of supra‐oesophageal symptoms, including asthma, laryngitis, hoarseness, chronic cough, frequent throat clearing and globus pharyngeus. GERD may be overlooked as the underlying mechanism for these symptoms because typical GERD symptoms may be absent, despite abnormal oesophageal acid exposure. Two basic mechanisms linking GERD with laryngeal symptoms have been proposed: direct contact of gastric acid with the upper airway, in some cases due to micro‐aspiration, and a vagovagal reflex triggered by acidification of the distal portion of the oesophagus. Gastro‐oesophageal reflux (GER) during sleep is believed to be an important mechanism for the development of supra‐oesophageal complications of GERD, such as asthma and idiopathic pulmonary fibrosis (IPF). Several physiological changes during sleep, including prolonged oesophageal acid contact time, decreased upper oesophageal sphincter pressure, increased gastric acid secretion, decreased salivation, decreased swallowing and a decrease in conscious perception of acid, render an individual more susceptible to reflux‐induced injury. Supra‐oesophageal symptoms often improve in response to aggressive acid‐suppressive therapy. However, many unanswered questions remain regarding the appropriate approach to diagnosis and treatment of patients with GERD‐related supra‐oesophageal symptoms. In this article we review the relationship between supra‐oesophageal symptoms and GERD and, where possible, highlight the evidence supporting the role of night‐time reflux as a contributing factor to these symptoms.
The participation of children and young people in decisions about UK service development
Authors: Cavet J. , Sloper P.
Published: November 2004

Background  The involvement of children and young people in decisions regarding service development is well supported in government policy and underpinned by the UN Convention on the Rights of the Child. Information on the extent, nature and outcomes of children and young people's participation can inform further development in this area.

Methods  Systematic literature searches, plus contact with professional networks, were used to gather and review evidence on children and young people's participation.

Results  There is a rapidly developing body of information describing and analysing innovative practices in this field. However, there is also a smaller, but substantial, amount of evidence demonstrating the limited extent of current involvement. A good deal of guidance is now available about how to promote the involvement of children and young people. However, the basis of this advice is not always clear, and more evidence about children's views and their experience of participation in public decision‐making is required. Issues identified as barriers to change included adult attitudes and intransigence, lack of training for key adults, lack of clarity leading to tokenism, the nature of organizations (i.e. their formality, complexity, bureaucracy and internal politics) and the short‐term nature of much funding. The evidence suggests that good practice includes a listening culture among staff, clarity, flexibility, adequate resources, skills development and training for staff and participating children and young people, inclusion of marginalized groups, feedback and evaluation. There is only limited evidence that children and young people's involvement in public decision‐making leads to more appropriate services, although there is evidence that participating children and young people benefit in terms of personal development and that staff and organizations learn more about their views.

Conclusions  The value of the participation of children and young people in public decision‐making is now well accepted, and is recognized in the standards set in the Children's National Service Framework. However, there is an urgent need for internal and external evaluations of children‘s involvement.
Psycho‐educational interventions for children with chronic disease, parents and siblings: an overview of the research evidence base
Authors: Barlow J. H. , Ellard D. R.
Published: November 2004

Background  The role of psycho‐educational interventions in facilitating adaptation to chronic disease has received growing recognition and is in keeping with policy developments advocating greater involvement of patients in their own care. The purpose of this paper is to provide an overview of the current literature regarding the effectiveness of psycho‐educational interventions for children and adolescents with chronic disease, their parents and siblings.

Methods  Electronic searches were conducted using AMED, CINAHL, Cochrane Database, DARE, HTA, MEDLINE, NHS EED, PsycLIT, PsycINFO, and PubMED. Inclusion criteria were systematic reviews, meta‐analyses and overviews based on traditional reviews of published literature. The titles of papers were reviewed, abstracts were obtained and reviewed, and full copies of selected papers were obtained.

Results  No reviews of psycho‐educational interventions were found for either parents or siblings. Twelve reviews of interventions for children and adolescents were identified: chronic disease in general (three); chronic pain (one); asthma (three); chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) (one); diabetes (two); juvenile idiopathic arthritis (JIA) (one) and one informational intervention for paediatric cancer patients. The main focus was on disease management (particularly in asthma and diabetes) with less attention being paid to psychosocial aspects of life with a chronic condition. Overall, there is evidence of effectiveness for interventions incorporating cognitive‐behavioural techniques on variables such as self‐efficacy, self‐management of disease, family functioning, psychosocial well‐being, reduced isolation, social competence, knowledge, hope, pain (for chronic headache), lung function (asthma), days absent from school (asthma), visits to A & E (asthma), fatigue (CFS), and metabolic control (diabetes). A number of gaps and limitations were identified across all disease categories, such as inadequate description of interventions, small sample sizes, and lack of evidence regarding cost‐effectiveness.

Conclusion  This overview has highlighted the need to extend the evidence base for psycho‐educational interventions, particularly in a UK context. It is essential that effective interventions are implemented and embedded in service provision in order to maximize empowerment through self‐care for children, adolescents and their parents.
A literature review to identify interventions to improve the use of medicines in children
Authors: Costello I. , Wong I. C. K. , Nunn A. J.
Published: November 2004

Background  It is estimated that 200 million prescriptions for children and adolescents were issued in the UK during 2002. Therefore, it is important for the National Service Framework for Children (NSFC) to include advice on managing medicines effectively for children. This literature review was performed at the request of the NSFC Medicines External Working Group in order to provide underpinning evidence in the development of advice on managing medicines.

Methods  Detabases, websites and conference abstracts were searched systematically to identify information on managing medicines in children in 2003. This article reported the results on medication review, concordance, enhanced medicines access through community pharmacy services and the use of medicines in schools.

Results and conclusions  Although there is little evidence specific to paediatrics, the objectives and rationale of medication review could be expected to apply to chronic diseases in children. Issues such as polypharmacy, wastage, repeat prescriptions and medication problems could be similar. The benefits seen in adults may also occur in children, and medication review may possibly have a role in the management of medicines in children. There is an obvious role for pharmacists in ensuring the safety of over‐the‐counter medications and provision of information and education to parents, carers and adolescents. Evaluation and provision of necessary education and training to community pharmacists is needed, even in the most basic paediatric issues such as sugar‐free medications. The evidence suggests that treatment compliance and adherence are generally lower in children than in adults, particularly in adolescents as they approach independence. Those with learning disabilities and infants are likely to be at risk of non‐compliance, although little work has been done in these populations. Children and adolescents need appropriate parental and professional support in taking control of their medication and treatment. The management of medicines in school would appear to be far from ideal. Further research into school‐based medicines education and outreach clinics would also be beneficial.
The impact of day care on socially disadvantaged families: an example of the use of process evaluation within a randomized controlled trial
Authors: Toroyan T. , Oakley A. , Laing G. , Roberts I. , Mugford M. , Turner J.
Published: November 2004

Aim  This paper describes a process evaluation that was conducted alongside a randomized controlled trial of out‐of‐home pre‐school day care. The evaluation aimed to: (1) describe the intervention; (2) document the day care received by participating families; (3) describe the social context of the trial; and (4) provide data to assist in the interpretation of trial outcomes.

Methods  The setting for the trial was an out‐of‐home day care Centre in Hackney, East London. Process data were collected through the use of questionnaires, interviews, and researcher field‐notes. Data from questionnaires were collected from 120 mothers and included data on 143 children. Interviews were undertaken with 21 participating mothers. Staff also completed questionnaires and the Head of the Centre was interviewed. The quality of care provided was assessed using the Early Childhood Environment Rating Scale.

Results  Process data collected during the trial suggest that the day care provided was education‐led, flexible in catering to families’ needs, and was of a very high quality. The social context of the trial resulted in financial pressures, which may well have influenced the intervention provided. Data collected through in‐depth interviews suggested that it may be the flexibility of day care that is particularly important in allowing women to return to paid employment, but that the loss of benefits when starting work may have meant no increase in household income.

Conclusion  The paper illustrates the value of conducting a process evaluation alongside a randomized trial, particularly where complex interventions are involved. In this case, where the intervention was not provided by the research team, the evaluation allowed an insight into the content of a multifaceted intervention, which is useful in interpreting the trial's results, and in explaining the possible effects of the social context on the intervention.
The effect of income inequality and macro‐level social policy on infant mortality and low birthweight in developed countries – a preliminary systematic review
Authors: Spencer N.
Published: November 2004

Objective  To carry out a preliminary systematic review of literature to address the question – among rich nations (or states within nations) what is the evidence that income inequality and differences in macro‐level social policy affect rates of infant mortality and low birthweight (LBW)?

Study design A systematic literature review.

Search strategy  Medline database (1968–August 2003) was searched for empirical studies of the relationship between macro‐level economic and social policies in rich nations and rates of infant mortality (IMR) and LBW. Cross‐national comparison of infant mortality and LBW that did not compare the effects of macro‐level economic and social policies was excluded from the review as were studies including less developed countries. Keywords representing IMR and LBW were entered into Medline along with exposures related to international comparison and macro‐level policy. Abstracts obtained from the initial search were reviewed for relevant studies. Full papers of potentially relevant studies were obtained and reviewed for inclusion. Secondary search of papers cited in included papers was undertaken. For this review, papers were not excluded on the basis of quality although methodological limitations were commented on and taken into account in interpreting the results. Summary statistics were not estimated.

Results  Twelve studies, fulfilling the inclusion criteria, were identified. Ten studies examined the association of IMR with income inequality, eight of which reported a statistically significant positive association with higher levels of inequality after adjustment for a range of variables. Six studies reported significant positive associations of IMR with other indicators of less re‐distributive social and economic policy. Associations with LBW were reported in four studies; three showed significant positive associations with higher levels of income inequality and one showed no association with low levels of parental leave entitlement. Methodological differences, particularly the wide range of variables used to adjust for confounding, make interpretation of the findings difficult.

Conclusions  The results of this review represent a preliminary attempt to summarize the literature linking macro‐level economic and social policies in rich nations with IMR and LBW. The findings, taking account of the methodological limitations of the review and of the included studies, suggest a statistically significant association between IMR and higher income inequality and other indicators of less re‐distributive social policy. Only three studies examined the association of income inequality with LBW and, although they suggest a significant association, further studies will be needed to confirm this finding.
The social and economic consequences of childhood asthma across the lifecourse: a systematic review
Authors: Milton B. , Whitehead M. , Holland P. , Hamilton V.
Published: November 2004

Background  Asthma prevalence rates are high, and may be increasing in the Western world, particularly among children. The aim of this study was to evaluate the longer‐term social and economic consequences of having asthma as a child and to determine whether adverse consequences are more severe for poorer children.

Methods Results from published and unpublished, quantitative and qualitative studies were synthesized narratively to examine the impact of childhood‐onset asthma on school attendance, academic achievement and employment in adulthood. The question of whether the impact differed for different social groups was also examined.

Findings  Twenty‐nine good quality studies were identified, including in total 12 183 children with asthma or wheeze. Compared with asymptomatic children, those with asthma missed more days of school (additional absence as a result of asthma ranged from 2.1 to 14.8 days). Studies of academic achievement found that children with asthma performed as well as their healthy peers. The existing evidence on labour market performance is sparse, but there is an indication that people with asthma during childhood experience disadvantage in later employment. In an examination of consequences by social position, children with asthma from deprived areas were more likely to miss school than their more affluent peers, and minority ethnic children were also more likely to have poor school attendance. The only qualitative study suggested that children with asthma strove to participate fully in every aspect of their daily lives.

Interpretation  Although asthma limits children's daily activities and affects their social activities, this research synthesis found little evidence of major, adverse long‐term social and economic consequences in studies reviewed. Further longitudinal research using comparison groups is needed to fill key gaps in the existing evidence base.
Spatial and temporal trends in abundance of Atlantic salmon, Salmo salar, in Newfoundland with emphasis on impacts of the 1992 closure of the commercial fishery
Authors: Dempson J. B. , O'Connell M. F. , Schwarz C. J.
Published: November 2004

Closure of the Newfoundland commercial Atlantic salmon, Salmo salar L., fishery in 1992 was the most restrictive measure introduced to help rebuild depressed local stocks of salmon. Here, the effects of the closure are evaluated by analysing trends in abundance since 1984, and estimates of survival in both freshwater and marine environments derived from enumeration of salmon at fish counting facilities. While freshwater production of smolts generally has been maintained, marine survival rates remain low (2–10%), and highly variable. Overall, total stock size differs little from that prior to the closure of the commercial salmon fishery. Spawning escapements have increased by a factor of 2 or 3 in some rivers, but in other areas total returns are lower on average than those prior to the fishery closure. Factors other than exploitation are contributing to lack of stock recovery, resulting in continued conservation concerns.
Nurses’ attitudes, behaviours and perceived barriers towards pressure ulcer prevention
Authors: Moore Zena , Price Patricia
Published: November 2004

Background.  Pressure ulcers are not a plague of modern man; they have been known to exist since ancient Egyptian times. However, despite the increasing expenditure on pressure ulcer prevention, pressure ulcers remain a major health care problem. Although nurses do not have the sole responsibility for pressure ulcer prevention, nurses have a unique opportunity to have a significant impact on this problem.

Aims and objectives.  The specific aims of the study were to identify:

• Staff nurses’ attitudes towards pressure ulcer prevention.

• The behaviour of staff nurses’ in relation to pressure ulcer prevention.

• Staff nurses’ perceived barriers towards pressure ulcer prevention.

Design.  A cross‐sectional survey method was used.

Methods.  A randomly selected sample of staff nurses (n = 300) working in an acute care setting in an urban location was invited to participate. Data were collected using a prepiloted questionnaire. Data analysis was carried out using SPSS version 10 and SPSS Text Smart version 1.1.

Results.  The nurses surveyed demonstrated a positive attitude towards pressure ulcer prevention. However, prevention practices were demonstrated to be haphazard and erratic and were negatively affected by lack of time and staff. These barriers prevented the nurses’ positive attitude from being reflected into effective clinical practice. Education, although poorly accessed, or made available, was rarely cited as impeding practice in this area.

Conclusion.  This study suggests that positive attitudes are not enough to ensure that practice change takes place, reinforcing the complex nature of behavioural change. Implementation strategies should introduce ways in which key staff can be empowered to overcome barriers to change.

Relevance to clinical practice.  This study provides a unique exploration of Irish nurses’ attitudes, behaviours and perceived barriers towards pressure ulcer prevention, thereby contributing to the body of knowledge on this subject. As tissue viability is a new and emerging speciality, this information will contribute to evidence based practice in this area of patient care and will form the basis for the development of an educational strategy for pressure ulcer prevention and management.
Inter‐rater reliability of the EPUAP pressure ulcer classification system using photographs
Authors: Defloor Tom , Schoonhoven Lisette
Published: November 2004

Background.  Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested.

Aims and objectives.  The purpose of this paper is to examine the inter‐rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs.

Design.  Survey was among pressure ulcer experts.

Methods.  Fifty‐six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter‐rater reliability was calculated.

Results.  The multirater‐Kappa for the entire group of experts was 0.80 (P < 0.001). Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers).

Conclusions.  The inter‐rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear.

Relevance to clinical practice.  The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer Classification software package has been developed to facilitate learning.