bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecosphere, biosphere, or Gaia? What to call the global ecosystem
Authors: Huggett R. J.
Published: March 2003

The terms biosphere, ecosphere, and Gaia are used as names for the global ecosystem. However, each has more than one meaning. Biosphere can mean the totality of living things residing on the Earth, the space occupied by living things, or life and life‐support systems (atmosphere, hydrosphere, lithosphere, and pedosphere). Ecosphere is used as a synonym of biosphere and as a term for zones in the universe where life as we know it should be sustainable. Gaia is similar to biosphere (in the sense of life and life‐support systems) and ecosphere (in the sense of biosphere as life and life‐support systems), but, in its most extreme form, refers to the entire planet as a living entity. A case is made for avoiding the term Gaia (at least as a name for the planetary ecosystem), restricting biosphere to the totality of living things, and adopting the ecosphere as the most apt name for the global ecosystem.
Structure and stand development in three subalpine Norway spruce (Picea abies (L.) Karst.) stands in Paneveggio (Trento, Italy)
Authors: Motta R. , Nola P. , Piussi P.
Published: March 2003

1. Three permanent plots (100×0 m) were established in the subalpine Norway spruce (Picea abies (L.) Karst.) forest of Paneveggio in the spring of 1993, to begin a long‐term forest ecosystem research project. The main purpose of these plots was to provide information about subalpine Norway spruce stand dynamics and to provide suggestions for close‐to‐nature silviculture.

2. The three stands were selected to represent the most common forest structures in the Paneveggio forest. The first stand is close to forestry roads, has a relatively regular and continuous canopy, and thinning and cutting operations only ended in the 1980s; the second stand is far from forest roads and has developed without anthropogenic influence for several decades; the third one is located at the present upper limit of the pure spruce forest and, apparently, was heavily used in the past as a pasture.

3. The first step in the investigation was to describe the structure and to study the history of the three stands using both written evidence from manage‐ ment plans and biological archives from tree rings.

4. The stands in plots 1 and 2 began to establish after a disturbance that removed part of the previous stands according to dendroecological studies, which are partially supported by written evidence. The remaining parts of these stands were eliminated by two major disturbances that occurred during the following decades. Written records about the use of the forest lead us to assume that the initial disturbances that occurred in the two stands were logging activities as a part of a group shelterwood system. The stand in plot 2 has developed without significant human interference for about half a century as confirmed by the presence of many dead trees. The stand in plot 3 consists of old trees that were part of an open stand and a secondary population that established after cessation of grazing.

5. The study has confirmed that dendroecological techniques can be used to identify occurrence and intensity of previous disturbance in forests stands, although at Paneveggio it is difficult to distinguish between natural and anthropogenic disturbances in the tree ring record. The presence of human activity necessitates investigation of multiple lines of evidence.

6. Paneveggio's forest management plans were useful in the interpretation of the data obtained through dendroecological analysis, although events did not always correspond because data from the management plans (yearly thinning, felling, wind‐throw damage) never gave stand‐level details, but applied to areas of several hectares. Despite these limitations, the information included in the management plans is of crucial importance in studying stand history and only by using all these sources of information is it possible to delineate the most important features of the history and disturbance that affected the origin and subsequent growth of the forest stands.
Hurricane Gilbert and structural changes in a tropical forest in south‐eastern Mexico
Authors: Sánchez Sánchez O. , Islebe G. A.
Published: March 2003

This paper describes structural change and damage to the natural tree vegetation in the Dr Alfredo Barrera Marín Botanical Garden, following Hurricane Gilbert in September, 1988. Post‐hurricane data were compared with pre‐hurricane data from the same plots, focusing mainly on composition and structure. Near complete defoliation of trees and plants of the understorey occurred and average foliage loss was estimated to be 4.5 t/ha. The density of trees decreased by 33%, and the basal area decreased by 12%. Small diameter trees accounted for the great majority of losses and trees in the largest diameter classes survived best. The average height of trees in the lower canopy decreased by 6% and for those in the upper canopy by 9%. The frequency of understorey plants decreased by 51% and their cover decreased by 70%. Floristic richness decreased only slightly after the hurricane.
Factors determining mammal species richness on habitat islands and isolates: habitat diversity, disturbance, species interactions and guild assembly rules
Authors: Fox Barry J. , Fox Marilyn D.
Published: March 2003

For over three decades the equilibrium theory of island biogeography has galvanized studies in ecological biogeography. Studies of oceanic islands and of natural habitat islands share some similarities to continental studies, particularly in developed regions where habitat fragmentation results from many land uses. Increasingly, remnant habitat is in the form of isolates created by the clearing and destruction of natural areas. Future evolution of a theory to predict patterns of species abundance may well come from the application of island biogeography to habitat fragments or isolates.

In this paper we consider four factors other than area and isolation that influence the number and type of mammal species coexisting in one place: habitat diversity, habitat disturbance, species interactions and guild assembly rules. In all examples our data derive from mainland habitat, fragmented to differing degrees, with different levels of isolation.

Habitat diversity is seen to be a good predictor of species richness. Increased levels of disturbance produce a relatively greater decrease in species richness on smaller than on larger isolates. Species interactions in the recolonization of highly disturbed sites, such as regenerating mined sites, is analogous to island colonization. Species replacement sequences in secondary successions indicate not just how many, but which species are included. Lastly, the complement of species established on islands, or in insular habitats, may be governed by guild assembly rules. These contributions may assist in taking a renewed theory into the new millennium.
Increased surfactant protein D in rat airway goblet and Clara cells during ovalbumin‐induced allergic airway inflammation
Authors: Kasper M. , Sims G. , Koslowski R. , Kuß H. , Thuemmler M. , Fehrenbach H. , Auten R. L.
Published: March 2003

Background Structural remodelling of airways in asthma that follows inflammation may be affected by surfactant protein D (SP‐D)‐mediated effects on the immune response.

Objective To determine potential sites of SP‐D interaction with the pulmonary immune response, we examined the distribution of immunoreactive SP‐D in an experimental model of allergen‐induced airway inflammation using immunohistochemistry, biochemical methods and in situ hybridization.

Methods The experimental model used subcutaneous injection of ovalbumin in adult rats, which induced an airway response to inhaled nebulized ovalbumin. Three groups of rats (ovalbumin, ovalbumin + dexamethasone and saline) were challenged thrice weekly for 3 weeks. A fourth group of seven rats (naive) were taken from the same delivery of rats as the other groups. Lungs were then lavaged to determine total cell count, eosinophil count, ovalbumin‐specific IgE by enzyme‐linked immunosorbent assay and SP‐D by immunoblot. Tissue samples were fixed and embedded, and sections were studied for the infiltration of eosinophils and for expression of SP‐D protein by histochemistry and mRNA by in situ hybridization.

Results Ovalbumin induced perivascular and peribronchiolar eosinophilia which could be prevented by dexamethasone treatment. In addition, the ovalbumin‐specific IgE levels in serum and bronchoalveolar lavage fluid of ovalbumin‐challenged animals were enhanced. Increased amount of SP‐D in lavage and tissue, particularly in type II pneumocytes, in Clara cells and, surprisingly, in hyperplastic goblet cells of inflamed lungs was found. SP‐D mRNA was detected in goblet cells as well as in type II pneumocytes and Clara cells. Dexamethasone treatment did not affect level of SP‐D immunoreactivity.

Conclusion SP‐D accumulation is increased in this model of allergen‐induced eosinophilia, both in upper and lower airways. The increase is unaffected by dexamethasone.
Identification of shared and unique immunoglobulin E epitopes of the highly conserved tropomyosins in Blomia tropicalis and Dermatophagoides pteronyssinus
Authors: Yi F. C. , Cheong N. , Shek P. C. L. , Wang D. Y. , Chua K. Y. , Lee B. W.
Published: March 2003

Background Tropomyosin belongs to a class of highly conserved proteins in invertebrates and vertebrates. The invertebrate tropomyosins are allergenic in man with high IgE cross‐reactivity and have been therefore referred to as pan‐allergens.

Objectives This study aimed to clone and identify the IgE epitopes of tropomyosin from Blomia tropicalis (Blo t 10) mite. Cross‐reactivity between the IgE epitopes of Blo t 10 and Der p 10 was also evaluated.

Methods Blo t 10 was isolated using mouse anti‐Der p 10 antibodies. Allergenicity of the cloned Blo t 10 was confirmed by skin prick test (SPT) and enzyme‐linked immunosorbent assay (ELISA). Dose‐dependent inhibition assay was performed to determine the degree of IgE cross‐reactivity between Blo t 10 and Der p 10. Overlapping polymerase chain reaction‐derived cDNA were generated and expressed as glutathione‐S‐transferase (GST) recombinant proteins in Escherichia coli and used to identify shared and unique IgE epitopes of Blo t 10 and Der p 10.

Results The cloned Blo t 10 shared up to 96% amino acid identity to tropomyosin of other mites. SPT and ELISA IgE‐immunoassay showed recombinant Blo t 10 sensitization rates of between 20% and 29% in atopic subjects. Results of SPT and dose‐dependent inhibition assays showed that some allergic individuals had unique IgE epitopes for Blo t 10. IgE epitope mapping of Blo t 10 revealed that the epitopes were mainly located at N‐ and C‐termini of the molecule. The results of ELISA inhibition assays of overlapping recombinant fragments indicated that the unique IgE epitopes of Blo t 10 were located at the C‐terminal.

Conclusion Although Blo t 10 and Der p 10 are highly conserved (shared 95% amino acids identity) and significantly cross‐reactive, unique IgE epitopes do exist. The results suggest the potential deficiency of using only one of these highly conserved allergens as diagnostic or therapeutic reagents.
Cutaneous sarcoidosis in black South Africans
Authors: Jacyk Witold K.
Published: March 2003

Background It has been observed that, in the USA, sarcoidosis is more common in African–Americans than in other races. It has also been noted that sarcoidosis in

African–Americans is characterized by more severe extrapulmonary involvement and more exuberant skin lesions. There is little information on sarcoidosis in black Africans.

Methods Fifty‐four black South African patients with cutaneous lesions of sarcoidosis proven by biopsy were prospectively studied. Dermatologic and ophthalmologic examinations and chest X‐rays were performed in all patients. Other investigations relevant in the diagnosis of extracutaneous sarcoidosis were also performed in a variable number of patients.

Results In 40 patients (71%), systemic sarcoidosis was found with lung, eye, and acral bone involvement being most common. Great variations in the morphology of skin lesions were observed. In one‐quarter of patients, atypical cutaneous lesions (hypopigmented, ichthyosiform, lymphedematous, mutilating, ulcerative, verrucous) were found. Lupus pernio, once thought to be confined to Northern Europe, was observed in five patients in the subtropical milieu of South African Transvaal. Sarcoidal dactylitis with nail changes was seen in eight patients. Fibrinoid necrosis was found in 12% of the biopsies.

Conclusions Sarcoidosis in black South Africans is characterized by extensive cutaneous involvement. The lesions are morphologically extremely variable, frequently atypical, and often demonstrate fibrinoid necrosis on histology.
Risk assessment for nonindigenous pests: 1. Mapping the outputs of phenology models to assess the likelihood of establishment
Authors: Jarvis Claire H. , Baker Richard H. A.
Published: March 2003

This paper demonstrates the use of phenology models mapped over the landscape as a tool in support of risk assessments for nonindigenous plant pests. Drawing on the relationship between pest development and temperature, the approach uses gridded sequential interpolated temperatures at a resolution of 1 km, linked with phenology models, to predict the potential for a pest to develop throughout the landscape. The potential for establishment of Colorado beetle (Leptinotarsa decemlineata) in England and Wales was used as an illustration.

The likelihood of the pest completing a single generation during a 30‐year period (1961–90) was computed. Summaries of phenology, based firstly upon point temperature series from weather stations and secondly upon temperatures interpolated across the landscape, were compared. The results revealed that the use of point data led to a 70% likelihood of over‐estimating the area at risk from year to year. In the case of average long‐term risk however, the point‐based and landscape‐wide distributions of establishment potential were similar.

We demonstrate how the use of phenology models running on a daily time scale provides date based results, so allowing outputs to be tied in with periods in the cropping cycle. The application of daily data in computing the phenological results, unlike the main body of published work on pest risk assessment which uses averaged monthly data, reflects more fully the underlying variability and degrees of sensitivity of the pest to changes in weather.
Italian forum of Europa Donna: a survey of breast cancer associations
Authors: Mosconi Paola , Kodraliu Gentiana
Published: March 2003

Europa Donna is the first European woman's movement against breast cancer. It is a coalition of breast cancer associations and individual women and is active in 20 nations. Europa Donna is not intended to replace existing organizations. Rather, it provides a focus for the exchange of information and experiences between members and serves as a moving force for combined action. It promotes public awareness of breast cancer, advances in research and good clinical practice. In Italy there are more than 200 active breast cancer associations. The Italian forum of Europa Donna was formed in 1996. Between June and September 1996 a postal survey was conducted to research the characteristics and activities of the various breast cancer associations in Italy in order to help, inform and promote future initiatives of the Italian forum of Europa Donna. A total of 213 breast cancer associations were sent a postal questionnaire. Ninety‐five of them (44.6%) participated in the survey. The results show that the breast cancer associations in Italy vary markedly in terms of their structure and organization. The associations perceive a variety of deficiencies in the prevention, diagnosis and treatment of breast cancer within the Italian National Health Service and they offer a wide range of services themselves. Their views of the relevance of the 10 goals of Europa Donna vary. In this paper, we discuss the implications of the low rate of participation in the survey and the heterogeneity of the breast cancer associations' structures, activities and views for the future activities of the Italian forum of Europa Donna.
Patient empowerment in the United States: a critical commentary
Authors: Roberts Kathleen Johnston
Published: March 2003

Whilst there is no consensus amongst analysts regarding how best to define ‘patient empowerment’, at the very least, this concept entails a re‐distribution of power between patients and physicians. Empowered patients attempt to take charge of their own health and their interactions with health care professionals. Empowerment can occur at different levels (micro, meso, and macro) and patients have different ideas about what it means to ‘take charge’ and ‘be empowered’. Some patients simply want to be given information about their conditions whilst others want to have full control over all medical decision‐making. Some empirical evidence suggests that active patient participation in health care is associated with better patient outcomes. This field is ripe for future studies which both help to develop theoretical models of patient empowerment and articulate the conditions under which patient empowerment occurs.
Regulated competition and citizen participation: lessons from Israel
Authors: Chinitz David
Published: March 2003

Objective

To investigate the relationship between health system structure and citizen participation, in particular whether increased reliance on competition encourages or depresses citizen involvement.

Setting

The case of Israel’s ongoing health reform, based on regulated competition among sick funds, is examined.

Design

Interviews with government officials and representatives of consumer groups; analysis of policy documents, judicial rulings, public surveys and journalistic accounts.

Results

The Israeli reform is based in large measure on a regulated competition model, in which citizens have free choice among highly regulated competing sick funds. At the same time, the reform process has been accompanied by legal, institutional and political frameworks, as well as significant interest group activity, all aimed at increasing public input into processes of health policy making and implementation. The Israeli case, it is argued, lends support to the proposition that citizen participation (voice) and individual choice (exit) are complementary, rather than alternative, modes of ensuring citizen influence over health services. The question is whether the development of multiple avenues for citizen involvement represents disarray or a healthy social learning process regarding the running of the health system.

Conclusion

This paper expresses cautious optimism that citizen participation is a projection of a healthy social learning process, and suggests directions for public policy to encourage this outcome.
Development and evaluation of a decision aid for patients with stage IV non‐small cell lung cancer
Authors: Fiset Valerie , O’Connor Annette M. , Evans William , Graham Ian , DeGrasse Catherine , Logan Jo
Published: March 2003

Although guidelines for treating stage IV non‐small cell lung cancer suggest that the patient’s values should be considered in decision‐making, there are no practical tools available to assist them with their decision‐making.

Objective

To develop and evaluate a decision aid that incorporates patient values.

Design and sample

(1) Before/after evaluation with patients referred to a regional cancer centre. (2) Mailed survey of thoracic surgeons and respirologists in Ontario.

Intervention

An audio‐tape guided individuals to review a booklet describing stage IV non‐small cell lung cancer, its impact and possible coping strategies, treatment options, benefits and risks, and examples of the decision‐making of others. Patients then used a worksheet to consider and communicate personal issues involved in the choice, including: personal values using a ‘weigh‐scale’; questions; preferred role in decision‐making; and predisposition.

Measures

(1) Patient questionnaires eliciting knowledge, the decision, decisional conflict and acceptability of the decision aid. (2) Physician questionnaires eliciting attitudes toward the decision aid.

Results

(1) Twenty of 30 patients used the aid in decision‐making. Users thought that the aid was acceptable and significantly improved their knowledge about options and outcomes (P < 0.001), and reduced their decisional conflict (P < 0.001). (2) The majority of the 29 physicians who reviewed the decision aid found it acceptable, were comfortable providing it to patients and said that they were likely to use it.

Conclusion

The decision aid is a useful and acceptable adjunct to personal counselling.
Clinical decision‐making in the context of chronic illness
Authors: Watt Susan
Published: March 2003

This paper develops a framework to compare clinical decision making in relation to chronic and acute medical conditions. Much of the literature on patient‐physician decision making has focused on acute and often life‐threatening medical situations in which the patient is highly dependent upon the expertise of the physician in providing the therapeutic options. Decision making is often constrained and driven by the overwhelming impact of the acute medical problem on all aspects of the individual’s life. With chronic conditions, patients are increasingly knowledgeable, not only about their medical conditions, but also about traditional, complementary, and alternative therapeutic options. They must make multiple and repetitive decisions, with variable outcomes, about how they will live with their chronic condition. Consequently, they often know more than attending treatment personnel about their own situations, including symptoms, responses to previous treatment, and lifestyle preferences. This paper compares the nature of the illness, the characteristics of the decisions themselves, the role of the patient, the decision‐making relationship, and the decision‐making environment in acute and chronic illnesses. The author argues for a different understanding of the decision‐making relationships and processes characteristic in chronic conditions that take into account the role of trade‐offs between medical regimens and lifestyle choices in shaping both the process and outcomes of clinical decision‐making. The paper addresses the concerns of a range of professional providers and consumers.
Lessons learned from the Decision Board: a unique and evolving decision aid
Authors: Whelan Tim , Gafni Amiram , Charles Cathy , Levine Mark
Published: March 2003

One session of the conference was devoted to the presentation of different types of decision aids. This paper reports the experience and lessons learned through the development and use of the Decision Board. This is a uniquely interactive decision aid administered by the clinician during the medical consultation. The instrument has been developed in a number of clinical contexts, primarily regarding treatment options for cancer patients. Studies have shown the instrument to improve patient understanding and facilitate the shared decision‐making process. Randomized trials are ongoing, evaluating the addition of the Decision Board to the traditional medical consultation. The instrument continues to evolve to meet patients’ need for information and flexibility in presentation. Computer‐based versions of the Decision Board are currently being developed.
Supporting and resourcing treatment decision‐making: some policy considerations
Authors: Entwistle Vikki A.
Published: March 2003

This paper considers some of the policy implications of issues raised during a conference about treatment decision‐making in the clinical encounter held in Hamilton, Ontario in May 1999. Policies promoting patient participation in treatment decision‐making need to be flexible enough to ensure that they are appropriate across the range of contexts in which health care decisions are made and acceptable to people with diverse preferences and abilities. They should also be formulated in consideration of other health policies and of available resources. Policies of informing people and involving them in decisions about their care are unlikely to be simple to implement. Various strategies might be needed to support them. These include the development of appropriate skills among health professionals and in the general population, the use of interventions to encourage people to play more active roles in decisions about their health care, the provision of decision aids for people facing specific decisions and the provision and accreditation of more general information resources and services. If information and other facilitators of patient participation in decision‐making are seen as integral to good quality health care, then funding should be made available for them. This will, however, have opportunity costs. Policy makers’ decisions about how much health care funding should be invested in which strategies should be underpinned by good research evidence about the effects that different types of intervention have on a range of outcomes for individuals, health care systems and populations. The knowledge on which current policies are based is limited. The development of future policies will be enhanced if policy makers invest in critical conceptual thinking, reflective practice, imaginative development work and good quality evaluative research.
Life after hospital closure: users’ views of living in residential ‘resettlement’ projects. A case study in consumer‐led research
Authors: McCourt Christine A.
Published: March 2003

Objective

To conduct a user‐led and focused study of the views and experiences of former psychiatric hospital patients in community‐based residential projects four years after hospital closure. The aims of the study were to assess residents’ views about their current living arrangements, their opportunities to give their views and their interest in a formal user‐group such as a residents’ council or citizen advocacy scheme.

Design

A small‐scale, qualitative study designed to enable users to voice their own views and experiences in their own words, conducted by a project group of psychiatric service users/survivors.

Setting and participants

All eight residential ‘re‐provision’ projects in the area were included, with a total potential sample of 65 residents. All residents were invited to take part and a total of 26 were interviewed, although a larger number of residents together with residential care staff took part in initial ‘house’ meetings to discuss the study.

Methods

Semi‐structured, open‐ended interviews with all residents willing to participate, researcher participation in ‘house meetings’, researchers’ personal reflection and discussion.

Results and conclusions

On the whole, residents were content with community living arrangements and preferred these to hospital, although levels of satisfaction varied across different residential projects. Residents lacked awareness of rights to and means of voicing concerns and making choices about major issues in their lives. They showed greater interest in individualized rather than group advocacy. Ideally, research and evaluation, to be truly user‐focused, should be long‐term and continuous in order to involve participants more fully, and should anticipate the structures and processes needed to act on findings.
Reassurance through surveillance in the face of clinical uncertainty: the experience of women at risk of familial breast cancer
Authors: Parsons Evelyn P. , Beale Valerie , Bennett Helen , Jones Jo , Lycett Emma J
Published: March 2003

Objective

To identify the main issues raised by clinicians when they are counselling women at risk of breast cancer and explore the response of a group of women 1 year after counselling.

Design

A qualitative study which involved the thematic analysis of a series of transcripts from clinical consultations, semi‐structured interviews and focus groups.

Participants

First, a series of clinical consultations (n=153), involving seven clinicians, were randomly selected during a Medical Research Council funded study of genetic assessment (TRACE). Second, a group of women (n=43), involved in the TRACE study, were interviewed, or joined a focus group, 1 year after their genetic assessment.

Conclusions

There was evidence that, although the clinical consultations were embedded with multiple messages of uncertainty, the women’s accounts did not reflect this. The women talked about the reassurance they had found because they had met with an expert and become members of the surveillance society. The authors highlight the tension that exists because of the difference between lay expectations about on‐going surveillance and the realities of collective service provision.
‘Do I don’t I call the doctor’: a qualitative study of parental perceptions of calling the GP out‐of‐hours
Authors: Houston Anna M. , Pickering Ann J.
Published: March 2003

The purpose of this study was to investigate how parents use the GP out‐of‐hours service. There was a lack of information about how parents managed childhood illness and what strategies they put in place to help them to cope before calling the GP. The investigation of parental perceptions was based on a qualitative design using in‐depth interviews of 29 families from a semi‐rural location in the south‐east of England. All parents said they found dealing with a sick child out‐of‐hours stressful and were concerned to make the right decision for their child. Furthermore, parents usually employed a reasonable strategy in attempting to manage the child’s illness. This study demonstrated that the decision to call the doctor was not taken lightly. Many parents had implemented useful strategies prior to calling the doctor. However, most parents were also aware of their limitations and feared doing the wrong thing. It would seem that on occasion this fear combined with factors such as a lack of social support and loss of parental confidence resulted in calling the doctor out of hours to seek ‘peace of mind’. A rethink is needed among health professionals about the ‘problem’ of out‐of‐hours calls. GPs could actively seek to empower parents by educating them about minor illness during visits and consultations. It is not enough to offer reassurance to parents that their children are fine. Health visitors and other health professionals who come into contact with young families may help to educate and empower.
Is informed choice in genetic testing a different breed of informed decision‐making? A discussion paper
Authors: Emery Jon
Published: March 2003

Traditionally genetic counselling has promoted a non‐directive approach to patients’ decision‐making but the feasibility of this has been questioned. Unlike most branches of medicine, which are shifting away from a paternalistic model, genetic counselling is approaching shared decision‐making from a different perspective. There are certain features of genetic counselling and genetic testing which may complicate the drive towards shared decision‐making and informed choice: 1. Genetic test results can have broader implications than non‐genetic test results. 2. Genetic test results may be perceived by the patient differently to non‐genetic test results. 3. Carrier status for autosomal recessive conditions may be difficult for patients to conceptualize. 4. Decisions in genetic counselling are often multiple and sequential. 5. Most information in genetic counselling is based on probabilities and uncertainties. Each of these features is discussed in relation to achieving shared decision‐making in genetic testing and the implications for genetic counsellors are described. The points raised, however, have broader implications for medicine as several of the features, although central to genetic testing, are not entirely unique. Lessons learnt from genetic testing and genetic counselling in achieving shared decision‐making could help develop methods of promoting informed choice in other medical arenas such as cancer screening.
Shaping the trajectory of patients with venous ulceration in primary care
Authors: Husband Linda L.
Published: March 2003

Objective To explore the patient’s experience of venous ulceration and how it is shaped within primary care.

Design Qualitative grounded theory study.

Participants and setting Thirty‐nine patients, 33 nurses and 14 general practitioners in a major health district in England.

Results The findings indicate that patients with the chronic condition of venous hypertension are handled in an anomalous way within primary care when they present with ulcers on their lower limbs. The trajectory projections for the patients are not developed from the usual basis of a medically defined condition‐specific diagnosis but from a symptom‐specific diagnosis. This leads to an unusual context of care where there is a serious but unrecognized conflict of focus between the nurses and their patients. The nurses in this study tended to set priorities related to the ulcer and to the underlying pathology, whereas the patients wanted help in pain management and in normalizing their lives. The patients eventually came to a position of ‘guarded alliance’2that in this study took one of three forms: adapting and enduring, emphasizing the positive, or negotiating for comfort.

Conclusion The acute care approach applied to patients with this chronic condition led to a situation where the professionals usurped the self‐care potential of the patients and navigated rather than piloted them through an acute phase of an underlying chronic illness. This in turn, led to poor quality of life for many of the patients and to frustration for the nurses who were failing to achieve the outcomes they desired. Both perspectives need to be encapsulated into the treatment approach for patients with this condition: healing the ulcer and normalizing the patients’ lives can and should form the basis of care.
Do Internet interventions for consumers cause more harm than good? A systematic review
Authors: Bessell Tracey L. , McDonald Steve , Silagy Chris A. , Anderson Jeremy N. , Hiller Janet E. , Sansom Lloyd N.
Published: March 2003

Objective To systematically review the effect of consumer use of online health information on decision‐making, attitudes, knowledge, satisfaction and health outcomes and utilization.

Search strategy Electronic databases searched included the Cochrane Controlled Trials Register, MEDLINE, PREMEDLINE (to 14 March 2001), CINAHL, Australian Medical Index, Health and Society, National Institutes of Health Clinical Trials Database and CenterWatch.

Inclusion criteria All post‐1995 comparative studies (including controlled studies, before and after studies, and interrupted time series analyses) of Internet users vs. non‐Internet users and other communications mediums, and Internet characteristics such as e‐mail vs. other communication mediums, were included. Outcomes included consumer decision‐making, attitudes, knowledge, satisfaction and measurable changes in health status or health utilization.

Data extraction and synthesis One reviewer screened all papers then two reviewers independently assessed studies against the selection criteria and any discrepancies were resolved by discussion with a third reviewer. No attempt was made to combine the data for further statistical analysis.

Main results We identified 10 comparative studies. Studies evaluated the effectiveness of using the Internet to deliver a smoking cessation programme, cardiac and nutrition educational programmes, behavioural interventions for headache and weight loss, and pharmacy and augmentative services. All studies showed some positive effects on health outcomes, although the methodological quality of many studies was poor.

Conclusions Despite widespread consumer Internet use to obtain health‐care information, there is almost a complete lack of evidence of any effects this may have on health outcomes.
The effect of qualitative vs. quantitative presentation of probability estimates on patient decision‐making: a randomized trial
Authors: Man‐Son‐Hing Malcolm , O'Connor Annette M. , Drake Elizabeth , Biggs Jennifer , Hum Valerie , Laupacis Andreas
Published: March 2003

Background  Given the greater uncertainty surrounding probability estimates associated with qualitative (use of words or phrases) descriptions, the use of quantitative (numerical) information to communicate the risks and benefits of therapies is recommended but the impact of its use in decision aids is unexplored.

Objective  Using stroke prevention in atrial fibrillation as an example, to compare the impact of quantitative vs. qualitative descriptions of probability risk estimates in decision aids on the clinical decision‐making process.

Design  Randomized trial with a 2 × 2 factorial design.

Subjects  A total of 198 volunteers aged 60–80 years.

Setting  Outpatient clinics of a university‐affiliated, tertiary‐care teaching hospital.

Methods  Participants were asked to imagine that they had atrial fibrillation, and using a decision aid, were then randomized to two ways of receiving pertinent risk information regarding the probability of stroke and major bleeding when taking warfarin, aspirin or no therapy: (1) quantitatively, in which the 2‐year probabilities of stroke and major haemorrhage were presented both numerically and graphically with 100 faces (e.g. 8 of 100), and (2) qualitatively in which these probabilities were presented with the use of verbal phrases (e.g. very low, moderate).

Outcome measures  Primary: decisional conflict. Secondary: participants' choices, knowledge and expectations of outcomes using qualitative and quantitative scales.

Results  Participants reviewing quantitative risk information scored better on the informed subscale of the decisional conflict scale (P < 0.05) and, as expected, were better able to estimate numerically their chance of stroke and bleeding when taking warfarin, aspirin or no medication. For the low risk arm, there were no significant differences in treatment choices for the qualitative and quantitative groups. For the moderate risk arm, treatment choices between the two groups were significantly different (P = 0.01), with those in the quantitative group more likely to make an actual choice and to choose therapies at the extremes of effectiveness (warfarin and no treatment). There were no significant differences between the quantitative and qualitative groups in their ability to rank‐order their stroke risk when taking warfarin, aspirin and no treatment, overall knowledge about atrial fibrillation and its treatment, and other dimensions of decisional conflict (all P‐values >0.05).

Conclusions  For participants without the disease in question, this study found that providing sufficient quantitative risk information makes them feel more informed, which sometimes affects their treatment choices. Further studies are necessary to confirm these findings for patients making actual clinical decisions.
Phosphorylation and dephosphorylation of histidine residues in proteins
Authors: Klumpp Susanne , Krieglstein Josef
Published: March 2003

Protein phosphorylation is a key mechanism for intracellular signal transduction in both prokaryotic and eukaryotic cells. Vertebrate proteins are prevalently phosphorylated on side chains that contain a hydroxyl group, such as serine, threonine and tyrosine residues. In the past decade, however, an increasing number of examples of histidine phosphorylation has been described. Because acid treatment of phosphoproteins during purification and detection of phosphoamino acid analysis is routine, O‐phosphomonoesters have been studied more often, and the existence of acid‐labile phosphates has been largely overlooked. The latter class of N‐phosphoamidates may well be more widespread than is generally believed, even though the O‐phosphates remain the major class in terms of quantity and extent of distribution in proteins. Phosphohistidine currently is estimated to be 10‐ to 100‐fold more abundant than phosphotyrosine, but less abundant than phosphoserine [Matthews, H.R. (1995) Pharmac. Ther.67, 323–350.]. This minireview briefly summarizes the extensive knowledge of the key mechanisms and functions of phosphohistidine in bacteria. It also describes the still limited, yet increasing, data from homologs of the bacterial two‐component system. Finally, novel mechanisms of phosphorylation and dephosphorylation of histidine residues not related to the two‐component system are described.
Structural and functional characterization of a C‐type lectin‐like antifreeze protein from rainbow smelt (Osmerus mordax)
Authors: Achenbach John C. , Ewart K. Vanya
Published: March 2003

Antifreeze proteins (AFPs) are produced by several cold‐water fish species. They depress physiological freezing temperatures by inhibiting growth of ice crystals and, in so doing, permit the survival of these fish in seawater cooler than their normal freezing temperatures. The type II AFP from rainbow smelt (Osmerus mordax), which is a member of the C‐type lectin superfamily, was characterized in terms of its Ca2+‐binding quaternary structure and the role of its single N‐linked oligosaccharide. The protein core of the smelt AFP, shown through sequence homology to be a C‐type lectin carbohydrate‐recognition domain, was found to be protease resistant. Smelt AFP was also shown to bind Ca2+, as determined by ruthenium red staining and a conformational change on Ca2+ binding detected by intrinsic fluorescence. The N‐linked oligosaccharide was found to have no effect on protease resistance, dimerization, or antifreeze activity. Thus its role, if any, in the antifreeze function of this protein remains unknown. Smelt AFP was also shown to be a true intermolecular dimer composed of two separate subunits. This dimerization did not require the presence of N‐linked oligosaccharide or bound Ca2+. Smelt AFP dimerization has implications for the effective solution concentration and measurement of its activity. This finding may also lead to new interpretation of the mechanism of ice‐growth inhibition by this AFP.
Structure of the O‐polysaccharide and classification of Proteus mirabilis strain G1 in Proteus serogroup O3
Authors: Sidorczyk Zygmunt , Zych Krystyna , Toukach Filip V. , Arbatsky Nikolay P. ,   Agnieszka Zablotni, Shashkov Alexander S. , Knirel Yuriy A.
Published: March 2003

The O‐chain polysaccharide of the lipopolysaccharide (LPS) of a previously nonclassified strain of Proteus mirabilis termed G1 was studied by sugar analysis and 1H and 13C NMR spectroscopy, including 2D COSY, TOCSY, rotating‐frame NOE (ROESY), H‐detected 1H,13C HMQC, and heteronuclear multiple‐bond correlation (HMBC) experiments. The following structure of the polysaccharide was established:

where d‐GalA6(l‐Lys) stands for Nα‐(d‐galacturonoyl)‐ l‐lysine.

The structure of the O‐polysaccharide of P. mirabilis G1 is similar, but not identical, to that of P. mirabilis S1959 and OXK belonging to serogroup O3. Immunochemical studies with P. mirabilis G1 and S1959 anti‐(O‐polysaccharide) sera revealed close LPS‐based serological relatedness of P. mirabilis G1 and S1959, and therefore it was suggested to classify P. mirabilis G1 in serogroup O3 as a subgroup. P. mirabilis G1 and S1959 anti‐(O‐polysaccharide) sera also cross‐reacted with LPS of␣P. mirabilis strains from two other serogroups containing␣d‐GalA6(l‐Lys) in the O‐polysaccharide or in the core region.
Regulation of α1,3galactosyltransferase expression in pig endothelial cells
Authors: Mercier Dominique , Charreau Beatrice , Wierinckx Anne , Keijser Remco , Adriaensens Lize , van den Berg Renate , Joziasse David H.
Published: March 2003

The disaccharide galactoseα1,3galactose (the αGal epitope) is the major xenoantigen responsible for the hyperacute vascular rejection occurring in pig‐to‐primates organ transplantation. The synthesis of the αGal epitope is catalyzed by the enzyme α1,3‐galactosyltransferase (α1,3GalT). To be able to control porcine α1,3GalT gene expression specifically, we have analyzed the upstream portion of the α1,3GalT gene, and identified the regulatory sequences.

Porcine α1,3GalT transcripts were detected by 5′ RACE analysis, and the corresponding genomic sequences were isolated from a phage library. The porcine α1,3GalT gene consists of at least 10 different exons, four of which contain 5′ untranslated sequence. Four distinct promoters, termed A–D, drive α1,3GalT gene transcription in porcine cells. A combination of alternative promoter usage and alternative splicing produces a series of transcripts that differ in their 5′ portion, but encode the same protein.

Promoters A–C have been isolated, and functionally characterized using luciferase reporter gene assays in transfected porcine endothelial cells (PEC‐A). Promoter preference in porcine endothelial cells was estimated on the basis of relative transcript levels as determined by real‐time quantitative PCR. More than 90% of the α1,3GalT transcripts in PEC‐A cells originate from promoter B, which has characteristics of a housekeeping gene promoter. While promoter preference remains unchanged, α1,3GalT mRNA levels increase by 50% in 12 h upon tumour necrosis factor α‐activation of PEC‐A cells. However, the magnitude of this change induced by inflammatory conditions could be insufficient to affect cell surface α1,3‐galactosylation.
Functional studies of the Synechocystis phycobilisomes organization by high performance liquid chromatography on line with a mass spectrometer
Authors: Zolla Lello , Bianchetti Maria , Rinalducci Sara
Published: March 2003

This study was designed to yield data on the supramolecular organization of the phycobilisome apparatus from Synechocystis, and the possible effects of environmental stress on this arrangement. Phycobilisomes were dissociated in a low ionic strength solution and a quantitative estimation of the protein components present in each subcomplex was obtained using liquid chromatography coupled on‐line with a mass spectrometer equipped with an electrospray ion source (ESI‐MS). An advantage of this approach is that information can be collected on the initial events, which take place as this organism adapts to environmental changes. Ultracentrifugation of whole phycobilisomes revealed five subcomplexes; the lightest contained four linker proteins plus free phycocyanin, the second the core complex, while the last three bands contained the rod complexes. Four linkers were found in band 1 with higher molecular masses than those expected from the DNA sequence, indicating that they also contain linked chemical groups. UV‐B irradiation specifically destroyed the β‐phycocyanin and one rod linker, which resulted in the disintegration of the rod complexes. The two bilins present in β‐phycocyanin give a greater contribution to the UV absorption than the single bilin of the other bilinproteins and probably react with atmospheric oxygen forming toxic radicals. The protein backbone is, in fact, protected from damage in anaerobic conditions and in the presence of radical scavengers. Cells grown in sulfur‐ and nitrogen‐deficient medium contained significantly reduced levels of β‐phycocyanin and one rod linker.
Mydj2 as a potent partner of hsc70 in mammalian cells
Authors: Bozidis Petros , Lazaridis Ioannis , Pagoulatos Gerassimos N , Angelidis Charalampos E.
Published: March 2003

Dj2 is a member of the DnaJ family of proteins, which regulate the chaperoning function of the hsp70s. We isolated a monkey cDNA dj2 clone corresponding to the large mRNA species encoded by the gene. This mRNA differs from the small mRNA produced by the same gene in that it contains a long 3′ untranslated region. Both messages were found to be equally stable and to produce the same protein, which is susceptible to farnesylation. Studies in mouse tissues and various cell lines revealed that these messages and their products are differentially expressed. Surprisingly, we found that only the nonfarnesylated form of dj2 is capable of translocating to the cell nucleus, especially after heat shock. Finally, based on protein interaction studies, our results indicate that dj2 is a specific partner for hsc70 and not for␣hsp70.