bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of carbonic anhydrase IX in human pancreatic cancer
Authors: Juhász M. , Chen J. , Lendeckel U. , Kellner U. , Kasper H.‐U. , Tulassay Z. , Pastorekova S. , Malfertheiner P. , Ebert M. P. A.
Published: October 2003

Background : Carbonic anhydrase IX has been linked to cancer development and progression.

Aim : To analyse carbonic anhydrase IX expression and anhydrase inhibition in pancreatic cancer and to correlate these findings with p53 expression and microvessel density.

Materials and methods : Seventy‐seven pancreatic cancers were examined (43 males, 34 females; mean age, 64 years). The anti‐carbonic anhydrase IX M75 antibody was used for immunohistochemistry and Western blot analysis. Microvessels were visualized using the anti‐CD34 antibody, and p53 expression in cancer cells was assessed with a specific anti‐p53 antibody. Quantitative polymerase chain reaction was performed in order to assess carbonic anhydrase IX mRNA levels in the pancreas. Furthermore, pancreatic cancer cell lines were treated with acetazolamide, a carbonic anhydrase inhibitor.

Results : In the normal pancreas, carbonic anhydrase IX immunoreactivity was observed at the basolateral membrane of ductal cells in 24 cases (31%). Carbonic anhydrase IX expression was found at the membrane and in the cytoplasm of pancreatic cancer cells in 16 pancreatic cancers (21%). Carbonic anhydrase IX expression was independent of the localization, stage, size, metastases and differentiation of the tumour. p53 expression was significantly more frequent in poorly differentiated cancers (P = 0.0323); however, p53 expression and microvessel density were independent of carbonic anhydrase IX expression. Overall, carbonic anhydrase IX expression was not altered in pancreatic cancers vs. adjacent normal pancreatic tissue as assessed by Western blot and quantitative polymerase chain reaction analysis. However, incubation of pancreatic cancer cell lines with acetazolamide led to a significant inhibition of cell proliferation in AsPC‐1 and PANC‐1 pancreatic cancer cells.

Conclusion : Carbonic anhydrase IX expression is observed in both ductal epithelial and cancer cells of the pancreas. Although the expression of carbonic anhydrase IX in pancreatic cancer is not associated with angiogenesis or advanced disease, it may well be a target for carbo‐anhydrase inhibitors in a subset of pancreatic cancers.
Second‐line treatment for failure to eradicate Helicobacter pylori: a randomized trial comparing four treatment strategies
Authors: Lamouliatte H. , Mégraud F. , Delchier J.‐C. , Bretagne J.‐F. , Courillon‐Mallet A. , De Korwin J.‐D. , Fauchère J.‐L. , Labigne A. , Fléjou J.‐F. , Barthelemy P. ,   FOR A MULTICENTRE STUDY GROUP
Published: October 2003

Aim : To compare the efficacy of different regimens in patients in whom previous Helicobacter pylori eradication therapy has failed.

Methods : In this study named StratHegy patients (n = 287) were randomized to receive one of three empirical triple therapy regimens or a strategy based on antibiotic susceptibility. The empirical regimens were omeprazole, 20 mg b.d., plus amoxicillin, 1000 mg b.d., and clarithromycin, 500 mg b.d., for 7 days (OAC7), clarithromycin, 500 mg b.d., for 14 days (OAC14) or metronidazole, 500 mg b.d., for 14 days (OAM14). In the susceptibility‐based strategy, patients with clarithromycin‐susceptible strains received OAC14, whilst the others received OAM14. The 13C‐urea breath test was performed before randomization and 4–5 weeks after eradication therapy.

Results : In the intention‐to‐treat analysis, the eradication rates for empirical therapies were as follows: OAC7, 47.4% (27/57); OAC14, 34.5% (20/58); OAM14, 63.2% (36/57); it was 74.3% (84/113) for the susceptibility‐based treatment (P < 0.01 when compared with OAC7 and OAC14). In patients receiving clarithromycin, the eradication rates were 80% for clarithromycin‐susceptible strains and 16% for clarithromycin‐resistant strains; in patients receiving OAM14, the eradication rates were 81% for metronidazole‐susceptible strains and 59% for metronidazole‐resistant strains.

Conclusions : Eradication rates of approximately 75% can be achieved with second‐line triple therapy based on antibiotic susceptibility testing. If susceptibility testing is not available, OAM14 is an appropriate alternative.
Cytokine polymorphism frequencies in the Greek Cypriot population
Authors: Costeas P. A. , Koumas L. , Koumouli A. , Kyriakou‐Giantsiou A. , Papaloizou A.
Published: October 2003

There is considerable evidence to suggest that several cytokine genes are polymorphic, resulting in differential transcription and protein expression levels among individuals. It has also been demonstrated that ethnicity can be a determinant for distinctive cytokine polymorphism frequencies. In this study, we evaluated the distribution of cytokine gene polymorphisms in 100 healthy Greek Cypriot subjects, using polymerase chain reaction–sequence‐specific primers (PCR‐SSP) typing analysis. Cytokine gene polymorphisms were determined for transforming growth factor (TGF) β1 codon 10 (TGFβc10; C to T), TGFβ1 codon 25 (TGFβc25; G to C), tumour necrosis factor α (TNFα) promoter −308 (G to A), interleukin (IL)‐6 promoter −174 (G to C), IL‐10 promoter −1082 (G to A), IL‐10 promoter −819 (C to T), IL‐10 promoter −592 (C to A) and interferon γ (IFNγ) intron 1 +874 (A to T). Frequencies for the above cytokine genotypes were calculated for the Greek Cypriot population.
Promoter polymorphisms of the CD14 gene are not associated with bronchial asthma in Caucasian children
Authors: Heinzmann A. , Dietrich H. , Jerkic S.‐P. , Kurz T. , Deichmann K. A.
Published: October 2003

Several studies have investigated the association of a promoter polymorphism in CD14 with atopic phenotypes. We screened this and another polymorphism in 182 asthmatic children and found no association with asthma. Furthermore, there was substantial linkage disequilibrium of the polymorphisms. Thus CD14 does not play a major role in the development of asthma in our population of Caucasian children.
No linkage or association of five polymorphisms in the interleukin‐4 receptor α gene with atopic asthma in Italian families
Authors: Migliaccio C. , Patuzzo C. , Malerba G. , Trabetti E. , Galavotti R. , Pescollderung L. , Boner A. L. , Pignatti P. F.
Published: October 2003

The literature contains conflicting reports on the association of common variants of the interleukin (IL)‐4 receptor alpha (IL4RA) gene with atopic asthma. The purpose of the present study was to investigate the linkage and association of several gene polymorphisms with atopic asthma in a large series of well‐characterized individuals. Analysis of five polymorphisms (I50V, E375A, C406R, S478P and Q551R) of the IL4RA gene was performed in 823 individuals from 182 families with atopic asthmatic children from north‐east Italy. The subjects were tested for clinical asthma, total serum IgE level, skin prick test positivity to common aeroallergens, and bronchial hyperresponsiveness to methacholine. The frequency of the polymorphisms was similar to that reported for other populations. The 375, 406, 478 and 551 polymorphisms were in linkage disequilibrium, as previously reported. No linkage or transmission disequilibrium was observed in the families between any mutation and any of the phenotypes investigated. No multipoint haplotype was associated with any phenotype. In conclusion, the IL4RA gene does not seem to play an important role in genetic predisposition to atopic asthma in the population tested.
Association between an interleukin‐13 promoter polymorphism and atopy
Authors: Hummelshoj T. , Bodtger U. , Datta P. , Malling H. J. , Oturai A. , Poulsen L. K. , Ryder L. P. , Sorensen P. S. , Svejgaard E. , Svejgaard A.
Published: October 2003

Several studies indicate genetic involvement of Th2 cytokines in allergic diseases. Interleukin (IL)‐13 has been mapped to the cytokine cluster on chromosome 5q31–33, which has been associated with atopic conditions. Recently, an association was reported between the T allele in a promoter polymorphism in the IL‐13 gene (C to T exchange) at position −1055 and allergic asthma in a population study in the Netherlands. This observation was apparently confirmed in a case–control study using probands and spouses from a Dutch asthma family study, but the polymorphism in that study was reported to occur at position −1111. In the present study, we established that this polymorphism is located at position −1024 relative to the ATG translation initiation codon, and investigated whether it confers a genetic predisposition to atopic conditions and the Th1 condition multiple sclerosis (MS) in Caucasian subjects. We confirmed the association between the IL‐13 −1024TT genoype and inhalation allergy (P = 2.4E‐02). By combining the data from the three studies, we demonstrated a strong association (P = 1.09E‐05) between the IL‐13 −1024 marker and inhalation allergy. Furthermore, we showed for the first time that this association also exists in atopic dermatitis (P = 2.0E‐02). No association with MS was found.
Primary production and carbon allocation in relation to nutrient supply in a tropical experimental forest
Authors: Giardina Christian P. , Ryan Michael G. , Binkley Dan , Fownes James H.
Published: October 2003

Nutrient supply commonly limits aboveground plant productivity in forests, but the effects of an altered nutrient supply on gross primary production (GPP) and patterns of carbon (C) allocation remain poorly characterized. Increased nutrient supply may lead to a higher aboveground net primary production (ANPP), but a lower total belowground carbon allocation (TBCA), with little change in either aboveground plant respiration (APR) or GPP. Alternatively, increases in nutrient supply may increase GPP, with the quantity of GPP allocated aboveground increasing more steeply than the quantity of GPP allocated belowground. To examine the effects of an elevated nutrient supply on the C allocation patterns in forests, we determined whole‐ecosystem C budgets in unfertilized plots ofEucalyptus salignaand in adjacent plots receiving regular additions of 65 kg N ha−1, 31 kg P ha−1, 46 kg K ha−1, and macro‐ and micronutrients. We measured the absolute flux of C allocated to the components of GPP (ANPP, TBCA and APR), as well as the fraction of GPP allocated to these components.

Fertilization dramatically increased GPP. Averaged over 3 years, GPP in the fertilized plots was 34% higher than that in the unfertilized controls (3.95 vs. 2.95 kg C m−2 yr−1). Fertilization‐related increases in GPP were allocated entirely aboveground – ANPP was 85% higher and APR was 57% higher in the fertilized than in the control plots, while TBCA did not differ significantly between treatments. Carbon use efficiency (NPP/GPP) was slightly higher in the fertilized (0.53) compared with the control plots (0.51). Overall, fertilization increased ANPP and APR, and these increases were related to a greater GPP and an increase in the fraction of GPP allocated aboveground.
Air temperature triggers the recovery of evergreen boreal forest photosynthesis in spring
Authors: Tanja Suni , Berninger Frank , Vesala Timo , Markkanen Tiina , Hari Pertti , Mäkelä Annikki , Ilvesniemi Hannu , Hänninen Heikki , Nikinmaa Eero , Huttula Timo , Laurila Tuomas , Aurela Mika , Grelle Achim , Lindroth Anders , Arneth Almut , Shibistova Olga , Lloyd Jon
Published: October 2003

The timing of the commencement of photosynthesis (P*) in spring is an important determinant of growing‐season length and thus of the productivity of boreal forests. Although controlled experiments have shed light on environmental mechanisms triggering release from photoinhibition after winter, quantitative research for trees growing naturally in the field is scarce. In this study, we investigated the environmental cues initiating the spring recovery of boreal coniferous forest ecosystems under field conditions. We used meteorological data and above‐canopy eddy covariance measurements of the net ecosystem CO2 exchange (NEE) from five field stations located in northern and southern Finland, northern and southern Sweden, and central Siberia. The within‐ and intersite variability for P* was large, 30–60 days. Of the different climate variables examined, air temperature emerged as the best predictor for P* in spring. We also found that ‘soil thaw’, defined as the time when near‐surface soil temperature rapidly increases above 0°C, is not a useful criterion for P*. In one case, photosynthesis commenced 1.5 months before soil temperatures increased significantly above 0°C. At most sites, we were able to determine a threshold for air‐temperature‐related variables, the exceeding of which was required for P*. A 5‐day running‐average temperature (T5) produced the best predictions, but a developmental‐stage model (S) utilizing a modified temperature sum concept also worked well. But for both T5 and S, the threshold values varied from site to site, perhaps reflecting genetic differences among the stands or climate‐induced differences in the physiological state of trees in late winter/early spring. Only at the warmest site, in southern Sweden, could we obtain no threshold values for T5 or S that could predict P* reliably. This suggests that although air temperature appears to be a good predictor for P* at high latitudes, there may be no unifying ecophysiological relationship applicable across the entire boreal zone.
Exposure to an enriched CO2 atmosphere alters carbon assimilation and allocation in a pine forest ecosystem
Authors: Schäfer Karina V. R. , Oren Ram , Ellsworth David S. , Lai Chun‐Ta , Herrick Jeffrey D. , Finzi Adrien C. , Richter Daniel D. , Katul Gabriel G.
Published: October 2003

We linked a leaf‐level CO2 assimilation model with a model that accounts for light attenuation in the canopy and measurements of sap‐flux‐based canopy conductance into a new canopy conductance‐constrained carbon assimilation (4C‐A) model. We estimated canopy CO2 uptake (AnC) at the Duke Forest free‐air CO2 enrichment (FACE) study. Rates of AnC estimated from the 4C‐A model agreed well with leaf gas exchange measurements (Anet) in both CO2 treatments. Under ambient conditions, monthly sums of net CO2 uptake by the canopy (AnC) were 13% higher than estimates based on eddy‐covariance and chamber measurements. Annual estimates of AnC were only 3% higher than carbon (C) accumulations and losses estimated from ground‐based measurements for the entire stand. The C budget for the Pinus taeda component was well constrained (within 1% of ground‐based measurements). Although the closure of the C budget for the broadleaf species was poorer (within 20%), these species are a minor component of the forest. Under elevated CO2, the C used annually for growth, turnover, and respiration balanced only 80% of the AnC. Of the extra 700 g C m−2 a−1 (1999 and 2000 average), 86% is attributable to surface soil CO2 efflux. This suggests that the production and turnover of fine roots was underestimated or that mycorrhizae and rhizodeposition became an increasingly important component of the C balance. Under elevated CO2, net ecosystem production increased by 272 g C m−2 a−1: 44% greater than under ambient CO2. The majority (87%) of this C was sequestered in a moderately long‐term C pool in wood, with the remainder in the forest floor–soil subsystem.
BIOMOD – optimizing predictions of species distributions and projecting potential future shifts under global change
Authors: Thuiller Wilfried
Published: October 2003

A new computation framework (BIOMOD: BIOdiversity MODelling) is presented, which aims to maximize the predictive accuracy of current species distributions and the reliability of future potential distributions using different types of statistical modelling methods. BIOMOD capitalizes on the different techniques used in static modelling to provide spatial predictions. It computes, for each species and in the same package, the four most widely used modelling techniques in species predictions, namely Generalized Linear Models (GLM), Generalized Additive Models (GAM), Classification and Regression Tree analysis (CART) and Artificial Neural Networks (ANN). BIOMOD was applied to 61 species of trees in Europe using climatic quantities as explanatory variables of current distributions. On average, all the different modelling methods yielded very good agreement between observed and predicted distributions. However, the relative performance of different techniques was idiosyncratic across species, suggesting that the most accurate model varies between species. The results of this evaluation also highlight that slight differences between current predictions from different modelling techniques are exacerbated in future projections. Therefore, it is difficult to assess the reliability of alternative projections without validation techniques or expert opinion. It is concluded that rather than using a single modelling technique to predict the distribution of several species, it would be more reliable to use a framework assessing different models for each species and selecting the most accurate one using both evaluation methods and expert knowledge.
Ozone exposure over two growing seasons alters root‐to‐shoot ratio and chemical composition of birch (Betula pendula Roth)
Authors: Yamaji K. , Julkunen‐Tiitto R. , Rousi M. , Freiwald V. , Oksanen E.
Published: October 2003

Physiological and chemical responses of 17 birch (Betula pendula Roth) clones to 1.5–1.7 × ambient ozone were studied in an open‐field experiment over two growing seasons. The saplings were studied for growth, foliar visible injuries, net photosynthesis, stomatal conductance, and chlorophyll, carotenoid, Rubisco, total soluble protein, macronutrient and phenolic concentrations in leaves. Elevated ozone resulted in growth enhancement, changes in shoot‐to‐root (s/r) ratio, visible foliar injuries, reduced stomatal conductance, lower late‐season net photosynthesis, foliar nutrient imbalance, changes in phenolic composition, and reductions in pigment, Rubisco and soluble protein contents indicating accelerated leaf senescence. Majority of clones responded to ozone by changing C allocation towards roots, by stomatal closure (reduced ozone uptake), and by investment in low‐cost foliar antioxidants to avoid and tolerate ozone stress. A third of clones, showing increased s/r ratio, relied on inducible efficient high‐cost antioxidants, and enhanced leaf production to compensate ozone‐caused decline in leaf‐level net photosynthesis. However, the best ozone tolerance was found in two s/r ratio‐unaffected clones showing a high constitutive amount of total phenolics, investment in low‐cost antioxidants and N distribution to leaves, and lower stomatal conductance under ozone stress. The results highlight the importance of phenolic compounds in ozone defence mechanisms in the birch population. Depending on the genotype, ozone detoxification was improved by an increase in either efficient high‐cost or less efficient low‐cost antioxidative phenolics, with close connections to whole‐plant physiology.
Molecular analysis of methanogenic archaeal communities in managed and natural upland pasture soils
Authors: Nicol Graeme W. , Glover L. Anne , Prosser James I.
Published: October 2003

Grassland management influences soil archaeal communities, which appear to be dominated by nonthermophilic crenarchaeotes. To determine whether methanogenic Archaea associated with the Euryarchaeota lineage are also present in grassland soils, anaerobic microcosms containing both managed (improved) and natural (unimproved) grassland rhizosphere soils were incubated for 28 days to encourage the growth of anaerobic Archaea. The contribution of potential methanogenic organisms to the archaeal community was assessed by the molecular analysis of RNA extracted from soil, using primers targeting all Archaea and Euryarchaeota. Archaeal RT‐PCR products were obtained from all anaerobic microcosms. However, euryarchaeal RT‐PCR products (of putative methanogen origin) were obtained only from anaerobic microcosms of improved soil, their presence coinciding with detectable methane production. Sequence analysis of excised denaturing gradient gel electrophoresis (DGGE) bands revealed the presence of euryarchaeal organisms that could not be detected before anaerobic enrichment. These data indicate that nonmethanogenic Crenarchaeota dominate archaeal communities in grassland soil and suggest that management practices encourage euryarchaeal methanogenic activity.
Global terrestrial carbon storage and uncertainties in its temperature sensitivity examined with a simple model
Authors: Lenton Timothy M. , Huntingford Christopher
Published: October 2003

The future of the land carbon sink is a significant uncertainty in global change projections. Here, key controls on global terrestrial carbon storage are examined using a simple model of vegetation and soil. Equilibrium solutions are derived as a function of atmospheric CO2 and global temperature, these environmental variables are then linked in an idealized global change trajectory, and the lag between the dynamic and equilibrium solutions is derived for different linear rates of increase in atmospheric CO2. Terrestrial carbon storage is departing significantly from equilibrium because CO2 and temperature are increasing on a similar timescale to ecosystem change, and the lag is found to be proportional to the rate of forcing. Thus peak sizes of the land carbon sink, and any future land carbon source, are proportional to the rate of increase of CO2. A switch from a land carbon sink to a source occurs at a higher CO2 and temperature under more rapid forcing. The effects of parameter uncertainty in temperature sensitivities of photosynthesis, plant respiration and soil respiration, and structural uncertainty through the effect of fixing the ratio of plant respiration to photosynthesis are explored. In each case, the CO2 fertilization effect on photosynthesis is constrained to reproduce the 1990 atmospheric CO2 concentration within a closed global model. New literature compilations are presented for the temperature sensitivities of plant and soil respiration. A lower limit, Q10=1.29, for soil respiration significantly increases future land carbon storage. An upper limit, Q10=3.63, for soil respiration underpredicts the increase in carbon storage since the Last Glacial Maximum. Fixing the ratio of plant respiration to photosynthesis (R/P) at 0.5 generates the largest and most persistent land carbon sink, followed by the weakest land carbon source.
Dementia – involving patients and their caregivers in a drama programme: the caregivers' experiences
Authors: Lepp Margret , Ringsberg Karin C. , Holm Ann‐Kristin , Sellersjö Gunilla
Published: October 2003

• A cultural drama programme was designed for patients with dementia and was led by teachers trained in drama in education and storytelling. The focus was on dance, rhythm, song, storytelling and conversations.

• The aim of this study was to describe how a drama programme for patients with dementia and their caregivers was experienced by the caregivers.

• Twelve strategically selected patients, 10 women and two men, with moderate and severe dementia, and their seven female caregivers participated in the programme. Sessions were held for one and a half hour, weekly once for 2 months. A focus group interview was held with the caregivers 1 month after the programme had ended. The interview and analysis of data were carried out according to the principles of phenomenography.

• Two categories, ‘interaction’ and ‘professional growth’, and five subcategories emerged in the analysis. In these, the caregivers described how fellowship developed between the participants and how they shared joy and sorrow. The patients communicated with each other and the leaders, and the programme seemed to help the patients to remember and make associations with situations experienced earlier in their lives. The patients also showed knowledge and ability in things about which the caregivers were unaware until the time of the drama programme. In other daily life situations, the patients showed their feelings, both joy and sorrow, more openly, their self‐confidence grew and they showed greater interest in their surroundings. The caregivers furthermore expressed that they felt confirmed in their roles as caregivers. The programme prompted them to reflect upon their roles as caregivers.

• In conclusion, a drama programme with cultural features seems to increase the quality of life in patients with dementia and strengthen the caregivers in their profession.
Burnout among nursing staff in accident and emergency and acute medicine: a comparative study
Authors: Gillespie Mark , Melby Vidar
Published: October 2003

• This study was designed to identify the prevalence of burnout among nurses working in Accident and Emergency (A & E) and acute medicine, to establish factors that contribute to stress and burnout, to determine the experiences of nurses affected by it and highlight its effects on patient care and to determine if stress and burnout have any effects on individuals outside the clinical setting.

• A triangulated research design was used incorporating quantitative and qualitative methods.

• Maslach Burnout Inventory was used.

• Nurses working in acute medicine experienced higher levels of emotional exhaustion than their A & E counterparts. The overall level of depersonalization was low. High levels of personal accomplishment were experienced less by junior members of staff.

• Stress and burnout have far reaching effects both for nurses in their clinical practice and personal lives. If nurses continue to work in their current environment without issues being tackled, then burnout will result. The science of nursing does not have to be painful, but by recognition of the existence of stress and burnout we can take the first steps towards their prevention.
Health promotion and health education viewed as symbiotic paradigms: bridging the theory and practice gap between them
Authors: Whitehead Dean
Published: October 2003

• A recognized ‘paradigm war’ exists between the two distinct approaches of health education and health promotion practice. This tension is both unhealthy and unhelpful and is known to have a profound effect on nursing activity.

• Leading health promotionalists have begun to acknowledge the futility of the stated paradigm tension, realizing that health education and health promotion interventions are not that dissimilar in their origins and intentions. Progressive health education and health promotion programmes acknowledge the interrelatedness of both approaches and seek to incorporate favourable aspects of the two.

• The aim of this article is to present arguments and stances that help to diffuse/avoid the stated paradigm conflict, as a basis for health education and health promotion reform in nursing. It also seeks to clarify the nature of both health education and health promotion practice so as to avoid contextual confusion. In doing so, this article draws significantly from the author's previous work.

• This article concludes that the constructive review of any intended health education/health promotion programme lies in the consideration of each approach according to its own relative merits, what is required of the programme, and the nature of the setting in which the intervention takes place.
Paediatric day surgery: impact on Hong Kong Chinese children and their parents
Authors: Li Ho Cheung William , Lam Ho Yan Angie
Published: October 2003

• Paediatric day surgery is a potentially stressful and threatening experience for children and parents.

• The purposes of this study were to investigate the effects of paediatric day surgery on anxiety level of Hong Kong Chinese children and their parents, and to examine the relationship between children's preoperative anxiety and their level of cooperation during induction and postoperative periods.

• A total of 112 children admitted for circumcision with their parents in a day surgery unit were recruited. The state anxiety level for both children and parents was assessed at the time of admission and again at 4 hours after operation. Children's level of cooperation during the induction and the postoperative periods were also assessed.

• The results showed that the preoperative anxiety level for both children and their parents was relatively high. Children with high preoperative anxiety levels were associated with lower levels of cooperation during induction and postoperative periods. The results also indicated that parents’ high state anxiety was associated with their children's high state anxiety.

• This study designated that preoperative intervention to minimize children and parents’ anxiety is crucial and that there is still room for improvement.
Hospital in the home: constructions of the nursing role – a literature review
Authors: Duke Maxine , Street Annette
Published: October 2003

• Acute medical and nursing treatment in the home is increasingly seen as an alternative to hospitalization. Models such as hospital in the home (HITH) or acute home care are said to provide a safe, comfortable environment for patients that is conducive to healing.

• A review of the literature reveals the embryonic nature of the research and discussion related to this alternative care delivery model. In general, the benefits of hospital in the home programmes are presented in an uncritical manner.

• Medical practitioners have embraced the move to home care as a means of expanding the use of advanced technologies and improved drug regimes beyond the hospital walls.

• The nursing response has been mechanistic and recipe‐like while advancing the HITH nursing role as an opportunity for speciality practice by virtue of the increased autonomy and independence required.

• This review demonstrates the influence of a professional mandate for specialization, and the ideological and scientific interests that have influenced the role of the nurse.
Dementia and aggressiveness: video recorded morning care from different care units
Authors: Skovdahl Kirsti , Kihlgren Annica Larsson , Kihlgren Mona
Published: October 2003

• The aim of the study was to illuminate, from video recorded sequences, interactions between individuals with dementia and aggressive behaviour and caregivers who reported problems dealing with such behaviour and caregivers who did not. Nine caregivers and two residents participated.

• The video recordings were later transcribed into text and analysed by using a phenomenological hermeneutic approach, inspired by Ricoeur's philosophy.

• The main themes that emerged from the analysis were ‘Being involved and developing a positive interaction’ and ‘Being confined to routines and remaining in negative interaction’.

• The findings indicated the interactions either to be in a positive or negative spiral. Caregivers who had reported problems dealing with behavioural and psychiatric symptoms in dementia focused on accomplishing the task, where the main focus was on ‘the goal itself’. In other sequences with caregivers who had been satisfied with their capability the focus was placed on ‘how’ the caregivers could reach their goal.

• Power was central in the material, in different ways, either as a possible way to handle the situation or as a possible way of defending oneself. Parts of Kitwood's framework and Fromm's theory about power ‘over’ and power ‘to’, has been used in the comprehensive understanding.

• Our conclusion is that caregivers should use power ‘to’ when they have to help persons with dementia and aggressive behaviour, as a part of behavioural and psychiatric symptoms of dementia, for being able to give help in the best possible way. They should also act in a sensitive and reflective manner, with the individual in focus.
Information provided to patients undergoing gastroscopy procedures
Authors: Thompson Kate , Melby Vidar , Parahoo Kader , Ridley Tanya , Humphreys William G.
Published: October 2003

• This study aimed to investigate the information provided to patients undergoing gastroscopy procedures in Northern Ireland.

• Questionnaires were developed by the authors and were completed by 402 patients (RR = 43.8%) and 62 nurses (RR = 75.6%).

• Patients received most of the procedural information from nurses, and they recognized the importance of providing sensory information. Patients were generally satisfied with the information provided.

• There is clear evidence of fragmented care, and major changes are required to ensure that patients receive holistic information that includes procedural and sensory aspects.

• Nurses and doctors must realize that their role in information giving is to ensure that comprehensive information is provided by the appropriate professional at the appropriate time.
Patient anxiety and modern elective surgery: a literature review
Authors: Mark Mitchell
Published: October 2003

• Medical advances have led to a considerable rise in the level of elective surgery undertaken as day‐case surgery and with minimal hospital stay. However, amid such advances, preoperative psychological care has remained relatively static.

• A considerable number of patients are very anxious prior to elective surgery and little formal care is undertaken to address this major issue. A review of the literature from 1990 to 2002 was therefore undertaken in order to assess the present level of knowledge and interventions concerning patient anxiety when undergoing modern, intermediate surgical intervention.

• Thirty‐four studies embracing data from 3754 patients undergoing both inpatient and day‐case procedures were reviewed. Three main themes emerged – causes of anxiety, clinical concerns and measurement, and anxiety management.

• Each theme is discussed alongside details extracted from the relevant studies. Finally, the main issues arising are summarized and future research challenges identified.
Clinical supervision – factors defined by nurses as influential upon the development of competence and skills in supervision
Authors: Landmark Bjørg Th. , Hansen Grethe Storm , Bjones IngebjØrg , BØhler Ann
Published: October 2003

• The aim of this study was to describe factors defined by nurses as influential upon the development of competence and skills in supervision.

• Although clinical supervision has been widely studied and described during the last decade, influential factors regarding the development of supervisory competence, as defined by clinical supervisors themselves, is little documented.

• Focus group interviews were analysed using methods of qualitative content analysis as described by Kvale.

• Factors related to three areas of importance for the development of competence and skills in student supervision are defined by nurses in this study. They are didactics, role functions and organizational framework. Didactic factors described included: integration of theory and practice; reflection on clinical situations; clarification of supervision aims and student evaluation. Role function factors were described as: feelings of security and awareness in supervision, differentiation between student and supervisor roles and the meaning attached to being a role model. Framework factors included nursing faculty and clinical field expectations.

• An understanding of how nurses describe what they need to support their development as clinical supervisors gives a basis for the development of postgraduate education in clinical supervision. Competent clinical supervisors can be better able to support students as they build bridges between theory and practice.
Corticosteroid use and risk of hip fracture: a population‐based case–control study in Denmark
Authors: Vestergaard P. , Olsen M. L. , Paaske Johnsen S. , Rejnmark L. , Toft Sørensen H. , Mosekilde L.
Published: October 2003

Vestergaard P, Olsen ML, Paaske Johnsen S, Rejnmark L, Toft Sørensen H, Mosekilde L (Aarhus University Hospital, Denmark; and Aarhus and Aalborg University Hospitals; Aarhus, Denmark). Corticosteroid use and risk of hip fracture: a population‐based case–control study in Denmark. J Intern Med 2003; 254: 486–493.

Background. Corticosteroids (CS) are used in a wide range of conditions but have several possible adverse effects including an increased risk of osteoporotic fractures.

Objective. To examine the association between cumulative CS dose and risk of hip fracture.

Design. Population‐based case–control design.

Subjects and methods. A total of 6660 subjects with hip fracture and 33 272 age‐matched population controls were identified using the County Hospital Discharge Registry in North Jutland County, Denmark and the Danish Central Personal Registry, respectively. Data on redeemed prescriptions for CS within the last 5 years before the index date were retrieved from a population‐based prescription database, and recalculated to prednisolone equivalents. Cases and controls were categorized according to cumulative CS dose: (i) no use; (ii) <130 mg (e.g. equivalent to 30 mg of prednisolone for 4 days given for an acute exacerbation of asthma); (iii) 130–499 mg (e.g. equivalent to a short course of prednisolone of 450 mg for acute asthma); (iv) 500–1499 mg (e.g. equivalent to 7.5 mg prednisolone daily for 6 months or 800 μg day−1 of inhaled budesonide for 1 year); and (v) ≥1500 mg (e.g. equivalent to >4.1 mg day−1 for 1 year, a long‐term high dose). Data were analysed using conditional logistic regression adjusted for potential confounders including gender, redeemed prescriptions for hormone replacement therapy, antiosteoporotic, anxiolytic, antipsychotic and antidepressant drugs.

Results. Compared with never users, an increased risk of hip fracture was found for CS users, with increasing cumulative doses of any type of CS use during the preceding 5 years [adjusted odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.89–1.04] for <130 mg prednisolone; OR = 1.17 (CI = 1.01–1.35) for 130–499 mg; OR = 1.36 (CI = 1.19–1.56) for 500–1499 mg; and OR = 1.65 (CI = 1.43–1.92) for ≥1500 mg. An increased risk was also found when the study population was stratified according to gender, age and type of CS (systemic or topical).

Conclusions. Even a limited daily dose of CS (more than an average dose of approximately 71 μg prednisolone per day) was associated with an increased risk of hip fracture.
Homocysteine and its relation to B‐vitamins in Graves’ disease before and after treatment: effect modification by smoking
Authors: Nedrebø B. G. , Hustad S. , Schneede J. , Ueland P. M. , Vollset S. E. , Holm P. I. , Aanderud S. , Lien E. A.
Published: October 2003

Abstract. Nedrebø BG, Hustad S, Schneede J, Ueland PM, Vollset SE, Holm PI, Aanderud S, Lien EA (University of Bergen; Haukeland University Hospital, Bergen; and Haugesund Hospital, Haugesund; Norway). Homocysteine and its relation to B‐vitamins in Graves’ disease before and after treatment: effect modification by smoking. J Intern Med 2003; 254: 504–512.

Objectives. To investigate plasma total homocysteine levels and its relation to B‐vitamins and smoking in Graves’ disease before and after antithyroid therapy.

Design. A longitudinal study taking place at four hospitals in Norway.

Methods and subjects. Plasma total homocysteine, serum folate, serum cobalamin and riboflavin, flavin mononucleotide and flavin adenine dinucleotide in plasma were investigated in 182 patients with hyperthyroidism before treatment. The same parameters were reinvestigated in 112 of these patients after attaining euthyroid state.

Results. In hyperthyroidism, plasma total homocysteine was low, and inversely related to folate, cobalamin and riboflavin, and positively related to serum creatinine and age. Following antithyroid therapy, total homocysteine increased and the concentration of folate, cobalamin, riboflavin, flavin mononucleotide and flavin adenine dinucleotide decreased significantly. The most pronounced reduction (35%) was observed for flavin mononucleotide. In the hyperthyroid state, smokers had lower levels of folate and flavin mononucleotide than non‐smokers. After restoration of euthyroidism, both folate and riboflavin were significantly lower in smokers than non‐smokers. Plasma total homocysteine increased according to decreasing quartiles of B‐vitamins. For riboflavin, this relation was confined to smokers.

Conclusion. Plasma total homocysteine changes according to thyroid status. These changes may be partly attributable to altered folate, cobalamin but also riboflavin status, particulary in smokers.
Issues facing clinical trials of the future
Authors: Califf R. M.
Published: October 2003

Abstract. Califf RM (Duke University Medical Center, Durham, NC, USA). Issues facing clinical trials of the future (Clinical Trials). J Intern Med 2003; 254: 426–433.

Diagnostic and therapeutic technology continues to advance rapidly, as does our knowledge of therapeutics and of clinical research methods. Unfortunately, these advances have been only poorly coupled with our knowledge of therapeutic principles, leading to increasing uncertainty about which technologies are truly effective and, amongst those that are effective, which are most effective for the cost. This article presents general principles derived from several investigators’ experiences with clinical trials, and uses them to suggest how future clinical trials may differ from current approaches. A proposed organization for future trials also is elucidated.
Mass spectrometric approach for identifying putative plasma membrane proteins of Arabidopsis leaves associated with cold acclimation
Authors: Kawamura Yukio , Uemura Matsuo
Published: October 2003

Although enhancement of freezing tolerance in plants during cold acclimation is closely associated with an increase in the cryostability of plasma membrane, the molecular mechanism for the increased cryostability of plasma membrane is still to be elucidated. In Arabidopsis, enhanced freezing tolerance was detectable after cold acclimation at 2°C for as short as 1 day, and maximum freezing tolerance was attained after 1 week. To identify the plasma membrane proteins that change in quantity in response to cold acclimation, a highly purified plasma membrane fraction was isolated from leaves before and during cold acclimation, and the proteins in the fraction were separated with gel electrophoresis. We found that there were substantial changes in the protein profiles after as short as 1 day of cold acclimation. Subsequently, using matrix‐assisted laser desorption–ionization time‐of‐flight mass spectrometry (MALDI‐TOF MS), we identified 38 proteins that changed in quantity during cold acclimation. The proteins that changed in quantity during the first day of cold acclimation include those that are associated with membrane repair by membrane fusion, protection of the membrane against osmotic stress, enhancement of CO2 fixation, and proteolysis.
Formation of plant cuticle: evidence for the occurrence of the peroxygenase pathway
Authors: Lequeu José , Fauconnier Marie‐Laure , Chammaï Antoine , Bronner Roberte , Blée Elizabeth
Published: October 2003

Cuticle plays a major role as a protective barrier in plants. Despite its physiological importance, the mode of formation of this complex structure remains poorly understood. In particular, none of the putative enzymes involved in the biosynthesis of the cutin, the matrix of cuticle, have been cloned. We have shown previously that peroxygenase is able to catalyze in vitro the epoxidation step required for the biosynthesis of C18 cutin monomers. In the present work, we have confirmed in planta that this oxidase is indeed a key enzyme involved in the formation of cutin. Thus, in maize leaves, the specific inactivation of peroxygenase by organophosphorothioates resulted in a dramatic decrease of cuticular epoxide content, as visualized by a specific histochemical technique that was accompanied by a reduced thickness of the cuticle. A strict correlation could also be established between the extent of inhibition of the peroxygenase and the modification of the cuticle triggered by a family of structurally related inhibitors. Importantly, these effects were restricted to plants that contain a cutin originating from C18 monomers. The altered cuticle of maize, treated with the peroxygenase inhibitor, was characterized by an increased permeability to pesticides. In addition, such plants became largely susceptible to infection by fungi, implying that the cuticle represents a crucial target for the modulation of the response in plant–pathogen interactions.
Roles of OsCKI1, a rice casein kinase I, in root development and plant hormone sensitivity
Authors: Liu Wei , Xu Zhi‐Hong , Luo Da , Xue Hong‐Wei
Published: October 2003

Casein kinases are critical in cell division and differentiation across species. A rice cDNA fragment encoding a putative casein kinase I (CKI) was identified via cDNA macroarray under brassinosteroid (BR) treatment, and a 1939‐bp full‐length cDNA, OsCKI1, was isolated and found to encode a putative 463‐aa protein. RT‐PCR and Northern blot analysis indicated that OsCKI1 was constitutively expressed in various rice tissues and upregulated by treatments with BR and abscisic acid (ABA). Enzymatic assay of recombinant OsCKI1 proteins expressed in Escherichia coli showed that the protein was capable of phosphorylating casein. The physiological roles of OsCKI1 were studied through antisense transgenic approaches, and homozygous transgenic plants showed abnormal root development, including fewer lateral and adventitious roots, and shortened primary roots as a result of reduced cell elongation. Treatment of wild‐type plants with CKI‐7, a specific inhibitor of CKI, also confirmed these functions of OsCKI1. Interestingly, in transgenic and CKI‐7‐treated plants, exogenously supplied IAA could restore normal root development, and measurement of free IAA content in CKI‐deficient primary and adventitious roots revealed altered auxin content, indicating that OsCKI1 is involved in auxin metabolism or that it may affect auxin levels. Transgenic plants were less sensitive than control plants to ABA or BR treatment during germination, suggesting that OsCKI1 may be involved in various hormone‐signaling pathways. OsCKI1‐GFP fusion studies revealed the localization of OsCKI1 to the nucleus, suggesting a possible involvement in regulation of gene expression. In OsCKI1‐deficient plants, differential gene expression was investigated using cDNA chip technology, and results indicated that genes related to signal transduction and hormone metabolism were indeed with altered expression.
Transcriptome analysis of Arabidopsis colonized by a plant‐growth promoting rhizobacterium reveals a general effect on disease resistance
Authors: Cartieaux Fabienne , Thibaud Marie‐Christine , Zimmerli Laurent , Lessard Philippe , Sarrobert Catherine , David Pascale , Gerbaud Alain , Robaglia Christophe , Somerville Shauna , Nussaume Laurent
Published: October 2003

RNA transcript levels of Arabidopsis plants, infected by the rhizobacterium Pseudomonas thivervalensis (strain MLG45), and axenic control plants were compared using cDNA microarrays representing approximately 14 300 genes. The analysis revealed an increase of defence‐related transcripts in the shoots of bacterized plants relative to control (axenic) plants. These modifications of transcript levels were confirmed by physiological experiments. Plants infected with P. thivervalensis were more resistant to subsequent infections by the virulent pathogen P. syringae pv. tomato (strain DC3000) than control plants. In addition, photosynthesis rates were repressed consistently with the reduced growth of plants colonized by P. thivervalensis. These results highlight the value of molecular phenotyping to predict physiological changes.