bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantification of menstrual flow by weighing protective pads in women with normal, decreased or increased menstruation
Authors: GUDMUNDSDOTTIR BRYNJA R. , HJALTALIN ELIN F. , BRAGADOTTIR GUDRUN , HAUKSSON ARNAR , GEIRSSON REYNIR T. , ONUNDARSON PALL T.
Published: January 2009

Objective. To investigate the association between menstrual flow weight measured from modern sanitary pads (converting liquid to non‐evaporating gel) and clinically assessed normal, increased or decreased menstrual flow. Design. Objective method development study. Setting. Outpatient clinic, University Hospital, Reykjavik. Population. One hundred and thirteen volunteers included 26 normally menstruating adult women and 52 normally menstruating teenagers not using oral or intrauterine contraception, seven normally menstruating women using oral contraception, 17 women with clinically diagnosed menorrhagia, five women using oral contraception for clinical menorrhagia, and six teenage girls claiming heavy menstrual flow. Methods. Menstruation length, menstrual flow weight and history of iron deficiency were assessed. During the menstruation following recruitment, all women collected their used protective pads in a hygienic manner and returned them to the laboratory for accurate weighing. Main outcome measures. Menstrual flow total weight measured in grams. Results. Mean menstrual flow total weight in the 78 asymptomatic women was 51 g (median 44, range 5–144). The mean flow in 17 women clinically diagnosed with menorrhagia was 217 g (median 207, range 63 – 402) (p<0.0001 compared to healthy women). The seven healthy women using oral contraceptives discharged 13 g (13–19) (p = 0.0004 compared with normals). Menstruation lasted<eight days in 77/78 healthy women and in 12 of 17 clinically diagnosed menorrhagic women. Conclusions. Measurement of menstrual flow total weight accurately reflects clinically assessed normal, increased and decreased flow. The method is an easy and accurate way of objectively estimating menstrual flow.
New Challenges in Biorobotics: Incorporating Soft Tissue into Control Systems
Authors: Trimmer Barry A.
Published: January 2009

The development of truly biomimetic robots requires that soft materials be incorporated into the mechanical design and also used as an integral part of the motor control system. One approach to this challenge is to identify how soft animals control their movements and then apply the found principles in robotic applications. Here I show an example of how a combination of animal kinematics, neural patterning and constitutive modelling of tissues can be used to explore motor control in the caterpillar, Manduca sexta. Although still in the early stages, these findings are being used to design and fabricate a new type of robot that does not have a rigid skeleton and is structured entirely from soft or compliant materials. It is hoped that this new robotic platform will promote the development of actuators, sensors and electronics that are compatible with soft materials.
Jungle Honey Enhances Immune Function and Antitumor Activity
Authors: Fukuda Miki , Kobayashi Kengo , Hirono Yuriko , Miyagawa Mayuko , Ishida Takahiro , Ejiogu Emenike C. , Sawai Masaharu , Pinkerton Kent E. , Takeuchi Minoru
Published: January 2009

Jungle honey (JH) is collected from timber and blossom by wild honey bees that live in the tropical forest of Nigeria. JH is used as a traditional medicine for colds, skin inflammation and burn wounds as well as general health care. However, the effects of JH on immune functions are not clearly known. Therefore, we investigated the effects of JH on immune functions and antitumor activity in mice. Female C57BL/6 mice were injected with JH (1 mg/mouse/day, seven times intra‐peritoneal). After seven injections, peritoneal cells (PC) were obtained. Antitumor activity was assessed by growth of Lewis Lung Carcinoma/2 (LL/2) cells. PC numbers were increased in JH‐injected mice compared to control mice. In Dot Plot analysis by FACS, a new cell population appeared in JH‐injected mice. The percent of Gr‐1 surface antigen and the intensity of Gr‐1 antigen expression of PC were increased in JH‐injected mice. The new cell population was neutrophils. JH possessed chemotactic activity for neutrophils. Tumor incidence and weight were decreased in JH‐injected mice. The ratio of reactive oxygen species (ROS) producing cells was increased in JH‐injected mice. The effective component in JH was fractionized by gel filtration using HPLC and had an approximate molecular weight (MW) of 261. These results suggest that neutrophils induced by JH possess potent antitumor activity mediated by ROS and the effective immune component of JH is substrate of MW 261.
Forgotten Features of Head Zones and Their Relation to Diagnostically Relevant Acupuncture Points
Authors: Beissner Florian , Henke Christian , Unschuld Paul U.
Published: January 2009

In the 1890s Sir Henry Head discovered certain areas of the skin that develop tenderness (allodynia) in the course of visceral disease. These areas were later termed “Head zones”. In addition, he also emphasized the existence of specific points within these zones, that he called “maximum points”, a finding that seems to be almost forgotten today. We hypothesized that two important groups of acupuncture points, the diagnostically relevant Mu and Shu points, spatially and functionally coincide with these maximum points to a large extent. A comparison of Head′s papers with the Huang Di Neijing (Yellow Thearch′s Inner Classic) and the Zhen Jiu Jia Yi Jing (Systematic Classic of Acupuncture and Moxibustion), two of the oldest still extant Chinese sources on acupuncture, revealed astonishing parallels between the two concepts regarding both point locations and functional aspects. These findings suggest that the Chinese discovery of viscerocutaneous reflexes preceded the discovery in the West by more than 2000 years. Furthermore, the fact that Chinese medicine uses Mu and Shu points not only diagnostically but also therapeutically may give us new insights into the underlying mechanisms of acupuncture.
Genomic copy number determination in cancer cells from single nucleotide polymorphism microarrays based on quantitative genotyping corrected for aneuploidy
Authors: Attiyeh Edward F. , Diskin Sharon J. , Attiyeh Marc A. , Mossé Yaël P. , Hou Cuiping , Jackson Eric M. , Kim Cecilia , Glessner Joseph , Hakonarson Hakon , Biegel Jaclyn A. , Maris John M.
Published: January 2009

Microarrays are frequently used to profile genome-wide copy number (CN) aberrations. While generally robust for detecting CN variants in germline DNA, the methods used to derive CN from signal intensity values have been suboptimal when applied to cancer genomes. The complexity of genomic aberrations in cancer makes it more difficult to discriminate between signal and noise, and measuring CN as a discrete variable does not account for tumor heterogeneity. Furthermore, standard normalization approaches detect CN changes relative to the overall DNA content, which is often not diploid in cancer. We propose an algorithm that uses the degree of allelic imbalance as well as probe intensity, with a correction for aneuploidy, for a quantitative CN assessment and scoring of allelic ratios. This algorithm results in a more precise definition of CN and allelic aberration in the cancer genome, which is essential for translational efforts focused on using these tools for molecular diagnostics and for the discovery of therapeutic targets.
Human gamma-satellite DNA maintains open chromatin structure and protects a transgene from epigenetic silencing
Authors: Kim Jung-Hyun , Ebersole Thomas , Kouprina Natalay , Noskov Vladimir N. , Ohzeki Jun-Ichirou , Masumoto Hiroshi , Mravinac Brankica , Sullivan Beth A. , Pavlicek Adam , Dovat Sinisa , Pack Svetlana D. , Kwon Yoo-Wook , Flanagan Patrick T. , Loukinov Dmitri , Lobanenkov Victor , Larionov Vladimir
Published: January 2009

The role of repetitive DNA sequences in pericentromeric regions with respect to kinetochore/heterochromatin structure and function is poorly understood. Here, we use a mouse erythroleukemia cell (MEL) system for studying how repetitive DNA assumes or is assembled into different chromatin structures. We show that human gamma-satellite DNA arrays allow a transcriptionally permissive chromatin conformation in an adjacent transgene and efficiently protect it from epigenetic silencing. These arrays contain CTCF and Ikaros binding sites. In MEL cells, this gamma-satellite DNA activity depends on binding of Ikaros proteins involved in differentiation along the hematopoietic pathway. Given our discovery of gamma-satellite DNA in pericentromeric regions of most human chromosomes and a dynamic chromatin state of gamma-satellite arrays in their natural location, we suggest that gamma-satellite DNA represents a unique region of the functional centromere with a possible role in preventing heterochromatin spreading beyond the pericentromeric region.
Early extinction after fear conditioning yields a context-independent and short-term suppression of conditional freezing in rats
Authors: Chang Chun-hui , Maren Stephen
Published: January 2009

Extinction of Pavlovian fear conditioning in rats is a useful model for therapeutic interventions in humans with anxiety disorders. Recently, we found that delivering extinction trials soon (15 min) after fear conditioning yields a short-term suppression of fear, but little long-term extinction. Here, we explored the possible mechanisms underlying this deficit by assessing the suppression of fear to a CS immediately after extinction training (Experiment 1) and the context specificity of fear after both immediate and delayed extinction training (Experiment 2). We also examined the time course of the immediate extinction deficit (Experiment 3). Our results indicate that immediate extinction produces a short-lived and context-independent suppression of conditional freezing. Deficits in long-term extinction were apparent even when the extinction trials were given up to 6 h after conditioning. Moreover, this deficit was not due to different retention intervals that might have influenced the degree of spontaneous recovery after immediate and delayed extinction (Experiment 4). These results suggest that fear suppression under immediate extinction may be due to a short-term, context-independent habituation process, rather than extinction per se. Long-term extinction memory only develops when extinction training occurs at least six hours after conditioning.
Infusion of the NMDA receptor antagonist, DL-APV, into the basolateral amygdala disrupts learning to fear a novel and a familiar context as well as relearning to fear an extinguished context
Authors: Laurent Vincent , Westbrook R. Frederick
Published: January 2009

Ample evidence suggests that activation of NMDA receptors (NMDAr) in the basolateral complex of the amygdala (BLA) is necessary for context fear conditioning. The present series of experiments examined whether this activation was still required when the to-be-shocked context had a history. We found that BLA infusion of the selective NMDAr antagonist DL-APV impaired the acquisition of fear responses to a novel context, a moderately familiar context, or a highly familiar context. The same treatment also impaired the reacquisition of fear responses to a dangerous context, a context extinguished to criterion, or a context massively extinguished. Importantly, DL-APV persistently suppressed fear responses, suggesting that the NMDAr antagonist disrupted basal synaptic transmission in the BLA. Therefore, we conclude that neuronal activity in the BLA is critical for learning and relearning context-conditioned fear. This finding is consistent with current neural models that attribute context fear conditioning to interactions among several brain regions, most notably the hippocampus and the BLA.
SHORT HYPOCOTYL UNDER BLUE1 Associates withMINISEED3andHAIKU2Promoters in Vivo to RegulateArabidopsisSeed Development
Authors: Zhou Yun , Zhang Xiaojuan , Kang Xiaojun , Zhao Xiangyu , Zhang Xiansheng , Ni Min
Published: January 2009

Seed development in Arabidopsis thaliana undergoes an initial phase of endosperm proliferation followed by a second phase in which the embryo grows at the expense of the endosperm. As mature seed size is largely attained during the initial phase, seed size is coordinately determined by the growth of the maternal ovule, endosperm, and embryo. Here, we identify SHORT HYPOCOTYL UNDER BLUE1 (SHB1) as a positive regulator of Arabidopsis seed development that affects both cell size and cell number. shb1-D, a gain-of-function overexpression allele, increases seed size, and shb1, a loss-of-function allele, reduces seed size. SHB1 is transmitted zygotically. The increase in shb1-D seed size is associated with endosperm cellurization, chalazal endosperm enlargement, and embryo development. SHB1 is required for the proper expression of two other genes that affect endosperm development, MINISEED3 (MINI3) and HAIKU2 (IKU2), a WRKY transcription factor gene and a leucine-rich repeat receptor kinase gene. SHB1 associates with both MINI3 and IKU2 promoters in vivo. SHB1 may act with other proteins that bind to MINI3 and IKU2 promoters to promote a large seed cavity and endosperm growth in the early phase of seed development. In the second phase, SHB1 enhances embryo cell proliferation and expansion through a yet unknown IKU2-independent pathway.
Cytokine profiles in chickens infected with virulent and avirulent Marek's disease viruses: Interferon‐gamma is a key factor in the protection of Marek's disease by vaccination
Authors: Kano Rika , Konnai Satoru , Onuma Misao , Ohashi Kazuhiko
Published: January 2009

Marek's disease has been controlled by vaccination with avirulent strains of MDV. However, the protection mechanism following vaccination is not fully understood. In this study immune responses of PBMC and splenocytes derived from vaccinated chickens challenged with virulent MDV were examined using real‐time PCR and ELISA. Higher levels of IFN‐γ induction were observed in chickens vaccinated during the latent phase of infection with virulent MDV than in similarly challenged, unvaccinated chickens. Furthermore, the mean expression of IFNGR2 and IFN regulatory factor‐3 mRNAs was significantly higher in vaccinated than in unvaccinated chickens. These results show that IFN‐γ could be one of the important factors in prevention of MD by vaccination and is effective during the latent phase of the infection.
Effects of the administration of cholera toxin as a mucosal adjuvant on the immune and protective response induced by Proteus mirabilis MrpA fimbrial protein in the urinary tract
Authors: Scavone Paola , Rial Analía , Umpierrez Ana , Chabalgoity Alejandro , Zunino Pablo
Published: January 2009

Proteus mirabilis is commonly associated with complicated UTI and expresses several virulence factors, including MR/P fimbriae. In the present study mice were immunised nasally with MrpA, the structural subunit of MR/P, with or without CT as a mucosal adjuvant. The animals were then challenged with P. mirabilis and induction of specific serum and urine IgG and IgA, IFN‐γ production and bacterial kidney and bladder colonization were assessed. MrpA‐immunised mice exhibited significant induction of serum IgA and urine IgA and IgG. MrpA/CT‐immunised mice showed both significant serum and urine IgA and IgG production. Only this group showed significant IFN‐γ production. Both groups of animals had significant decrease in bacterial colonization of kidneys but not of bladders. No correlation between specific antibody induction in serum and CFU decrease was observed in any group of animals. Our results suggest that a mucosal adjuvant (CT) in the urinary tract enhanced humoral and cytokine response although it did not influence the degree of protection against UTI provided by MrpA. Further studies are necessary to understand immune modulation in the urinary tract.
Inhibition of heat shock protein 90 sensitizes melanoma cells to thermosensitive ferromagnetic particle‐mediated hyperthermia with low Curie temperature
Authors: Ito Aki , Saito Hajime , Mitobe Kazutaka , Minamiya Yoshihiro , Takahashi Naoko , Maruyama Kiyotomi , Motoyama Satoru , Katayose Yoshihisa , Ogawa Jun‐ichi
Published: January 2009

Heat shock protein (Hsp) 90 is a key regulator of a variety of oncogene products and cell‐signaling molecules, and the therapeutic benefit of its inhibition in combination with radiation or chemotherapy has been investigated. In addition, hyperthermia has been used for many years to treat various malignant tumors. We previously described a system in which hyperthermia was induced using thermosensitive ferromagnetic particles (FMP) with a Curie temperature (Tc = 43˚C) low enough to mediate automatic temperature control, and demonstrated its antitumor effect in a mouse melanoma model. In the present study, we examined the antitumor effects of combining a Hsp90 inhibitor (geldanamycin; GA) with FMP‐mediated hyperthermia. In cultured B16 melanoma cells, GA exerted an antitumor effect by increasing the cells’ susceptibility to hyperthermia and reducing expression of Akt. In an in vivo study, melanoma cells were subcutaneously injected into the backs of C57BL/6 mice. FMP were then injected into the resultant tumors, and the mice were divided into four groups: group I, no treatment (control); group II, one hyperthermia treatment; group III, GA alone; and group IV, GA with hyperthermia. When exposed to a magnetic field, the temperature of tissues containing FMP increased and stabilized at the Tc. In group IV, complete regression of tumors was observed in five of nine mice (56%), whereas no tumor regression was seen in groups I–III. Our findings suggest that inhibition of Hsp90 with hyperthermia increases its antitumor effect. Thus, the combination of FMP‐mediated, self‐regulating hyperthermia with Hsp90 inhibition has important implications for the treatment of cancer. (Cancer Sci 2009; 100: 558–564)
Overexpression of protease inhibitor‐dead secretory leukocyte protease inhibitor causes more aggressive ovarian cancer in vitro and in vivo
Authors: Devoogdt Nick , Rasool Nabila , Hoskins Ebony , Simpkins Fiona , Tchabo Nana , Kohn Elise C.
Published: January 2009

The alarm anti‐protease secretory leukocyte protease inhibitor (SLPI) is frequently overexpressed in ovarian cancer cells and has been proposed for inclusion in biomarker panels but function remains unclear. We hypothesized that SLPI overexpression promotes ovarian cancer growth and survival. Low SLPI‐expressing Hey‐A8 ovarian cancer cells were engineered to produce functional (WT) or protease inhibitor‐null (PI‐) mutant SLPI; lack of PI activity was confirmed by enzymatic assay. WT/SLPI and PI‐ mutants stimulated significant proliferation and survival of Hey‐A8 ovarian cancer cells under basal culture conditions (P ≤ 0.02), in soft agar colony number and size (P ≤ 0.05), and in anoikis resistance (P ≤ 0.005). SLPI protected the ovarian cancer survival factor, progranulin (PRGN), and HEY‐A8 cells from degradation and apoptosis due to neutrophil elastase. PI‐/SLPI cells had greater protective activity than WT/SLPI cells. HEY‐A8 murine xenografts revealed enhanced solid tumor formation, dissemination, and invasion in WT/SLPI and PI‐/SLPI mutants. Increased proliferation was demonstrated by Ki‐67 staining (P ≤ 0.02). Increased secreted PRGN was seen in culture and was also observed by immunohistochemistry in the SLPI transfectant xenografts. This study describes a PI‐independent function for SLPI in ovarian cancer growth and dissemination. (Cancer Sci 2009; 100: 434–440).
Attitudes of Flemish secondary school students towards euthanasia and other end‐of‐life decisions in minors
Authors: Pousset G. , Bilsen J. , De Wilde J. , Deliens L. , Mortier F.
Published: January 2009

Background  The aim of the study was to investigate attitudes of secondary school students towards acceptability of requests by minors for end‐of‐life decisions (ELDs) with a possible life‐shortening effect: non‐treatment decisions, potentially life‐shortening alleviation of pain and symptoms (APS) and euthanasia.

Methods  A cross‐sectional survey was conducted among second and fourth grades students in 20 secondary schools in Flanders, Belgium. An anonymous structured questionnaire was administered to measure attitudes towards acceptability of requests for euthanasia and other ELDs, towards the right to be informed about terminal prognosis and their own desire to be informed.

Results  In total, 1769 students participated. In case of a terminal patient, 61% found a request for euthanasia acceptable, 60% a request for APS and 69% a request for non‐treatment decision, compared with 18% (euthanasia) and 50% (APS) in case of a non‐terminal patient. Acceptance was highest among: boys, participants older than 14 years and participants from general as opposed to technical and vocational education. Sixty‐six per cent said the parents' opinion not being asked was a circumstance that should hold back a physician from administering a lethal drug. Ninety per cent of participants thought a minor has the right to be informed about terminal prognosis of a disease while 78% would like to be informed themselves.

Conclusions  Attitudes towards ELD requests varied with case and participant characteristics and type of ELD. The studied adolescents have a clear wish to be informed about terminal prognosis. Physicians and caregivers should adequately involve adolescents in decision making and tailor prognosis‐related information to their needs and level of competency.
Optimism and health‐related quality of life in adolescents with cancer
Authors: Mannix M. M. , Feldman Jonathan M. , Moody Karen
Published: January 2009

Objective  To delineate the relationship between optimism and health‐related quality of life (HRQOL) and quality of life (QOL) in adolescents with cancer living in the Bronx, New York.

Methods  Optimism was assessed using the Life Orientation Test, Revised (LOT‐R). HRQOL and QOL were measured using the Pediatric Quality of Life Inventory, Cancer Module, Acute Version and The Pediatric Quality of Life Inventory, Generic Core Scale, respectively. Associations between optimism and HRQOL and QOL were assessed using Pearson's product‐moment correlations.

Results  Twenty‐three adolescents participated in this study; the mean age was 16 and the majority was male. This sample was highly optimistic and reported high HRQOL and QOL. Optimism was correlated with less reported pain and hurt, better communication with doctors, higher reported psychological functioning and higher overall QOL.

Conclusion  Optimism is associated with higher QOL in inner city adolescents with cancer. Further research should assess whether interventions that increase optimism lead to greater QOL in this population.
Effect of eutrophication on air–sea CO2 fluxes in the coastal Southern North Sea: a model study of the past 50 years
Authors: GYPENS N. , BORGES A. V. , LANCELOT C.
Published: January 2009

The RIVERSTRAHLER model, an idealized biogeochemical model of the river system, has been coupled to MIRO‐CO2, a complex biogeochemical model describing diatom and Phaeocystis blooms and carbon and nutrient cycles in the marine domain, to assess the dual role of changing nutrient loads and increasing atmospheric CO2 as drivers of air–sea CO2 exchanges in the Southern North Sea with a focus on the Belgian coastal zone (BCZ). The whole area, submitted to the influence of two main rivers (Seine and Scheldt), is characterized by variable diatom and Phaeocystis colonies blooms which impact on the trophic status and air–sea CO2 fluxes of the coastal ecosystem. For this application, the MIRO‐CO2 model is implemented in a 0D multibox frame covering the eutrophied Eastern English Channel and Southern North Sea and receiving loads from the rivers Seine and Scheldt. Model simulations are performed for the period between 1951 and 1998 using real forcing fields for sea surface temperature, wind speed and atmospheric CO2 and RIVERSTRAHLER simulations for river carbon and nutrient loads. Model results suggest that the BCZ shifted from a source of CO2 before 1970 (low eutrophication) towards a sink during the 1970–1990 period when anthropogenic DIN and P loads increased, stimulating C fixation by autotrophs. In agreement, a shift from net annual heterotrophy towards autotrophy in BCZ is simulated from 1980. The period after 1990 is characterized by a progressive decrease of P loads concomitant with a decrease of primary production and of the CO2 sink in the BCZ. At the end of the simulation period, the BCZ ecosystem is again net heterotroph and acts as a source of CO2 to the atmosphere. R‐MIRO‐CO2 scenarios testing the relative impact of temperature, wind speed, atmospheric CO2 and river loads variability on the simulated air–sea CO2 fluxes suggest that the trend in air–sea CO2 fluxes simulated between 1951 and 1998 in the BCZ was mainly controlled by the magnitude and the ratio of inorganic nutrient river loads. Quantitative nutrient changes control the level of primary production while qualitative changes modulate the relative contribution of diatoms and Phaeocystis to this flux and hence the sequestration of atmospheric CO2.
An evaluation of the hand and nasal flora of Turkish nursing students after clinical practice
Authors: Akpınar Reva Balcı , Celebıoglu Ayda , Uslu Hakan , Hamidullah Uyanık Muhammet
Published: January 2009

Aim.  The purpose of this study was to evaluate and compare the hand and nasal flora of nursing students before and after the clinical practice.

Background.  Hospitals are places where infective agents abound. Healthcare workers, relatives of patients and students practising in the hospital medium are often exposed to these infective agents. Although the role of the hand and nasal flora of healthcare workers in the development of nosocomial infections has been emphasised by earlier studies, there are a limited number of studies which investigate the hand and nasal flora of nursing students.

Design.  Descriptive.

Methods.  This descriptive study involved 66 volunteer nursing students. Two samples of flora from both hands and nose of each student were obtained. The inoculated samples were then evaluated through routine bacteriological study methods. Chi‐square and percentage calculations were used in comparisons.

Results.  None of the students had methicillin‐resistant Staphylococcus aureus or methicillin‐resistant coagulase‐negative Staphylococcus colonisation in the hand samples before clinical practice, 6·1% of the students had methicillin‐resistant Staphylococcus aureus and 4·5% had methicillin‐resistant coagulase‐negative Staphylococcus colonisation after the practice. Although the differences between the rates of contamination with pathogen micro‐organisms in the hand and nasal flora of the student nurses before and after clinical practice were not significant, the rate of colonisation after clinical practice was higher.

Conclusions.  In this study, the rate of colonisation after clinical practice was higher. These findings indicate that students might have been contaminated with bacteria during clinical practice.

Relevance to clinical practice.  The results of this study have practical importance in clinical practice. The role of the hand and nasal flora of nursing students in the development of nosocomial infections is significant. For this reason, some precautions, such as using gloves and handwashing with special solutions when needed, should be taken to prevent nosocomial infections and protect students against associated risks.
Visual impairment and falls: a register study
Authors: Källstrand‐Ericson Jeanette , Hildingh Cathrine
Published: January 2009

Aim.  The aim of this register study was to investigate falls and fall injuries of inpatients 65 years and over to determine whether a causal factor of visual impairment was documented.

Background.  All Organisation for Economic Cooperation and Development (OECD) countries have an increasing older population with falls and fall injuries becoming a major problem. A visual impairment can be an independent risk factor for falls but can also occur in combination with other intrinsic and extrinsic risk factors.

Design.  A retrospective non‐randomised register study.

Methods.  In 2004, all documented falls of inpatients aged 65 years and over were examined. Medical records and eye clinic records were scrutinised to identify whether any visual impairment have been documented.

Conclusion.  The majority of falls occurred between the hours of 24:00–06:00 and the inpatients most often affected were those with a visual impairment. The falls occurred in connection with movement when the inpatient was unaccompanied. Documentation in records at the medical clinic was defective and subjectively perceived visual impairment was not documented at all. Both subjective and objective visual impairment occurred in all eye clinic records.

Relevance to clinical practice.  Visual impairment along with the ageing process are features affecting falls and the hospital environment needs to be adapted by improving the use of strong, contrasting colours and providing good lighting for older inpatients with visual impairment during the night time period. Hospital safety for older people with visual impairment is a concern if falls are to be reduced. Healthcare professionals need to undertake individual risk assessments to establish the degree of visual impairment of the older person so that appropriate interventions can be implemented to reduce the incidence of falls and fall injuries.
The dramatic encounter: experiences of taking part in a health conversation
Authors: Persson Marianne , Friberg Febe
Published: January 2009

Aim.  The purpose of this study was to describe lived experiences of a health conversation from the perspective of participants who, in the course of a health check, had been informed that they were at increased risk of cardiovascular heart disease.

Background.  The modern lifestyle has created an increased occurrence of cardiovascular heart disease. Counselling about lifestyle changes to prevent disease is an important duty of nurses in primary healthcare when encountering patients with risk factors such as diabetes, hypertension and hypercholesterolemia. It is well known that accomplishing lifestyle changes is complicated. Research has shown the importance of assuming the patient perspective in pedagogical encounters and that nurses involved in patient teaching need more knowledge about the learning person.

Design.  Written narratives about the health conversation followed by interviews with open‐ended questions. Nine informants from the Skaraborg Project participated.

Methods.  A phenomenological analysis was chosen to describe the participants’ experiences and to visualise the meaning of the new knowledge obtained in the encounter.

Results.  Three themes were identified; ‘The unavoidable message’, ‘Reflection on the content of the conversation’ and ‘The pedagogical encounter’. Sub‐themes show the variations of meaning owing to the participants’ previous life experiences.

Conclusions.  The nurse must be aware of differences in perceptions concerning the health conversation and possible consequences for the life situation. The health conversation encounter requires preparedness and a pedagogical awareness as well as an ability to recognise the person’s need for understanding and level of motivation to make lifestyle changes.

Relevance to clinical practice.  Time and space must be created for health conversations and follow‐up of cardiovascular heart disease to achieve a preventive pedagogical encounter in primary healthcare.
'Caring Across Thorns' – Different care outcomes for borderline personality disorder patients in Taiwan
Authors: Ma Wei‐Fen , Shih Fu‐Jin , Hsiao Szu‐Mei , Shih Shaw‐Nin , Hayter Mark
Published: January 2009

Aim.  To explore the contributing factors and effects of Taiwan’s mental health nurses’ decision‐making patterns on care outcomes for patients with borderline personality disorder.

Background.  Patients with borderline personality disorder have been identified as difficult to care for. Taiwan’s mental health nurses have complained about the lack of successful outcomes with existing care regimes, and few studies have explored these nurses’ perceptions of how their decision‐making process impacts quality of care for their clients.

Design.  Descriptive qualitative research.

Methods.  Data collected through semi‐structured, face‐to‐face, in‐depth interviews were analysed by qualitative content analysis. Fifteen mental health nurses were purposively recruited from a psychiatric centre in northern Taiwan.

Results.  The informants’ caring outcomes for borderline personality disorder patients were involved with interactions of the following five themes: (a) shifting from the honeymoon to chaos stage, (b) nurses’ expectations for positive vs. negative outcomes, (c) practicing routine vs. individualised nursing care, (d) adequate or inadequate support from healthcare team members and (e) differences in care outcomes (satisfactory experiences, unsatisfactory experiences and superficial relationships). A conceptual framework of a ‘two‐stage care process’ was developed to depict the relationships among these five themes with different care outcomes.

Conclusions.  Although Taiwan’s mental health nurses reported more unsatisfactory than satisfactory care outcomes, more satisfactory patient outcomes might be obtained by nurses’ positive attitudes, unrelenting efforts towards promoting the health of these patients and receiving timely and constant support from healthcare team members.

Relevance to clinical practice.  Mental health nurses should not give up too readily on borderline personality disorder clients, but adopt a positive attitude and coach them in learning to relax and work with others. Nurses are encouraged to establish supportive team relationships to motivate each other to work for positive care outcomes, to better understand their clients’ needs and to develop individualised in addition to routine care strategies.
Accuracy of patient recall of preoperative symptom severity (angina and breathlessness) at one year following aorta‐coronary artery bypass grafting
Authors: Lindsay Grace M , Niven Kate A , Brodie Eric E , Gaw Allan , Belcher Philip R
Published: January 2009

Aim and objective.  The accuracy with which patients recall their cardiac symptoms prior to aorta‐coronary artery bypass grafting is assessed approximately one year after surgery together with patient‐related factors potentially influencing accuracy of recall.

Background.  This is a novel investigation of patient’s rating of preoperative symptom severity before and approximately one year following aorta‐coronary artery bypass grafting.

Design.  Patients undergoing aorta‐coronary artery bypass grafting (n = 208) were recruited preoperatively and 177 of these were successfully followed up at 16·4 (SD 2·1) months after surgery and asked to describe current and recalled preoperative symptoms using a 15‐point numerical scale.

Method.  Accuracy of recall was measured and correlated (Pearson’s correlation) with current and past symptoms, health‐related quality of life and coronary artery disease risk factors. Hypothesis tests used Student’s t‐test and the chi‐squared test.

Results.  Respective angina and breathlessness scores were recalled accurately by 16·9% and 14·1% while 59% and 58% were inaccurate by more than one point. Although the mean preoperative and recalled scores for severity of both angina and breathlessness and were not statistically different, patients who recalled most accurately their preoperative scores had, on average, significantly higher preoperative scores than those with less accurate recall. Patients whose angina and breathlessness symptoms were relieved by operation had significantly better accuracy of recall than patients with greater levels of symptoms postoperatively.

Conclusion.  Patient’s rating of preoperative symptom severity before and one year following aorta‐coronary artery bypass grafting was completely accurate in approximately one sixth of patients with similar proportions of the remaining patients overestimating and underestimating symptoms. The extent to which angina and breathlessness was relieved by operation was a significant factor in improving accuracy of recall.

Relevance to clinical practice.  Factors associated with accuracy of recall of symptoms provide useful insights for clinicians when interpreting patients’ views of the effectiveness of aorta‐coronary artery bypass grafting for the relief of symptoms associated with coronary heart disease.
Reliability of infrared ear thermometry in the prediction of rectal temperature in older inpatients
Authors: Smitz Simon , Van de Winckel Ann , Smitz Marc‐François
Published: January 2009

Aims and objectives.  To assess the capability of infrared ear thermometry accurately to predict rectal temperature in older patients.

Background.  Infrared ear thermometry is now commonly used for predicting body temperature in older patients. However, ear thermometry has been insufficiently evaluated in geriatric patients.

Design.  Prospective, convenience sample, unblinded study.

Methods.  All patients (or their guardians) gave informed consent. Patients hospitalised in a geriatric unit underwent sequential ear and rectal temperatures measurements using two different models of infrared ear thermometers (ThermoScan and Genius) and a rectal probe, respectively. After a brief otoscopic examination, ear temperatures were measured twice at both ears with each thermometer, the highest of four measurements being retained for analysis. The rectal temperature was the reference standard.

Results.  Hundred patients (31 males), aged 81 (SD 7) years completed the study. The mean rectal temperature was 37·3 °C (SD 0·7) °C (range 36·3–40·7 °C). Eighteen patients were febrile (rectal temperature ≥ 37·8 °C). The mean bias between rectal and ear temperatures as measured with the ThermoScan was –0·20 °C (SD 0·32) °C and the 95% limits of agreement were –0·83 °C and 0·42 °C (95% CI, –0·88–0·48 °C). Using the Genius, the corresponding figures were –0·56 °C (SD 0·39) °C, –1·32 °C and 0·20 °C (95% CI, –1·39–0·27 °C). After correction for bias, the ThermoScan predicted the level of fever with a maximum error of 0·7 °C (mean error 0·3 °C). Using the Genius, the maximum error and the mean error were 1·6 °C and 0·4 °C, respectively.

Conclusions.  Infrared ear thermometry can predict rectal temperature in normothermic and in febrile inpatients with an acceptable level of accuracy. However, the predictive accuracy depends on both operator technique and quality of instrumentation.

Relevance to clinical practice.  Proper technique (measuring in both ears) and optimal instrumentation (model of ear thermometer) are essential for accuracy.
A systematic review of interrater reliability of pressure ulcer classification systems
Authors: Kottner Jan , Raeder Kathrin , Halfens Ruud , Dassen Theo
Published: January 2009

Aims. To review systematically the interrater reliability of pressure ulcer classification systems to find out which classification should be used in daily practice.

Background. Pressure ulcer classification systems are important tools in research and practice. They aim at providing accurate and precise communication, documentation and treatment decisions. Pressure ulcer classifications are criticised for their low degree of interrater reliability.

Design. Systematic review.

Methods. The data bases MEDLINE, EMBASE, CINAHL and the World Wide Web were searched. Original research studies estimating interrater reliability of pressure ulcer classification systems were included. Study selection, data extraction and quality assessment was conducted independently by two reviewers.

Results. Twenty‐four out of 339 potentially relevant studies were included in the final data synthesis. Due to the heterogeneity of the studies a meaningful comparison was impossible.

Conclusions. There is at present not enough evidence to recommend a specific pressure ulcer classification system for use in daily practice. Interrater reliability studies are required, in which comparable raters apply different pressure ulcer classification systems to comparable samples.

Relevance to clinical practice. It is necessary to determine the interrater reliability of pressure ulcer classifications among all users in clinical practice. If interrater reliability is low the use of those systems is questionable. On the basis of this review there are no recommendations as to which system is to be given preference.
Acute effect of nut consumption on plasma total polyphenols, antioxidant capacity and lipid peroxidation
Authors: Torabian S. , Haddad E. , Rajaram S. , Banta J. , Sabaté J.
Published: January 2009

Background:  Nuts have been shown to have beneficial effects on human health due to the healthy fat content; however, the effect of antioxidants (i.e. polyphenols) in nuts have not been fully investigated. The present study aimed to assess the immediate effect of a polyphenol‐rich meal (75% of energy from nuts: walnuts or almonds) and a polyphenol‐free meal on plasma polyphenol content, antioxidant capacity and lipid peroxidation in healthy volunteers.

Methods:  Thirteen subjects participated in a randomized, crossover, intervention study. After an overnight fast, walnuts, almonds or a control meal in the form of smoothies were consumed by study subjects. Each subject participated on three occasions, 1 week apart, consuming one of the smoothies each time. Blood samples were obtained at fasting and then at intervals up to 3.5 h after consumption of the smoothies.

Results:  There was a significant increase in plasma polyphenol concentration following both nut meals, with peak concentrations being achieved at 90 min, and with a walnut meal having a more sustained higher concentration than an almond meal. The plasma total antioxidant capacity reached its highest point at 150 min postconsumption of the nut meals, and was higher after the almond compared to walnut meal. A gradual significant (P < 0.05) reduction in the susceptibility of plasma to lipid peroxidation was observed 90 min after ingestion of the nut meals. No changes were observed following consumption of control meal.

Conclusions:  Consumption of both nuts increased plasma polyphenol concentrations, increased the total antioxidant capacity and reduced plasma lipid peroxidation.
Low‐glycaemic index sweetener‐based beverages reduce 24‐h glucose profiles in healthy adults
Authors: Henry C. J. K. , Newens K. J. , Lightowler H. J.
Published: January 2009

Background:  Previous research has shown that substitution of high‐glycaemic index (GI) bread for low‐GI bread can favourably alter the 24‐h glucose profile. Given the high beverage consumption in the UK, the present study aimed to evaluate the impact of consuming a beverage containing a low‐GI, natural sweetener at mealtimes compared to a sucrose‐based beverage, on the 24‐h glucose profile.

Methods:  In a randomized crossover design, six subjects (aged 41 ± 16 years; body mass index = 25.8 ± 4.1 kg m−2) were provided with a diet including low‐GI or control (sucrose) beverages on two nonconsecutive days. On each study day, subjects consumed the low‐GI or control beverage at breakfast, lunch and dinner. Interstitial glucose concentrations were measured over 24 h using a continuous glucose monitoring system.

Results:  Compared to the control beverage, the low‐GI beverage significantly reduced mean glucose concentration over 24 h (P < 0.05). Similarly, 24‐h and daytime incremental area under the curves for glucose were significantly lower (P = 0.001).

Conclusions:  The substitution of a sucrose‐based beverage for a beverage containing a low‐GI, natural sweetener at mealtimes is a simple dietary change that can significantly reduce 24‐h glucose levels and may be beneficial for many individuals.
Pharmacokinetics and milk distribution characteristics of orbifloxacin following intravenous and intramuscular injection in lactating ewes
Authors: GOUDAH A. , CHO H.‐J. , SHIN H.‐C. , SHIM J.‐H. , REGMI N. L. , SHIMODA M. , ABD EL‐ATY A. M.
Published: January 2009

The purpose of the current investigation is to elucidate the pharmacokinetic profiles of orbifloxacin (OBFX) in lactating ewes (n = 6) following intravenous (i.v.) and intramuscular (i.m.) administrations of 2.5 mg/kg W. In a crossover study, frequent blood, milk, and urine samples were drawn for up to 48 h after the end of administration, and were then assayed to determine their respective drug concentrations through microbiological assay using Klebsiella pneumoniae as the test micro‐organism. Plasma pharmacokinetic parameters were derived from plasma concentration–time data using a compartmental and noncompartmental analysis, and validated a relatively rapid elimination from the blood compartment, with a slope of the terminal phase of 0.21 ± 0.02 and 0.19 ± 0.06 per hour and a half‐life of 3.16 ± 0.43 and 3.84 ± 0.59 h, for i.v. and i.m. dosing, respectively. OBFX was widely distributed with a volume of distribution V(d(ss)) of 1.31 ± 0.12 L/kg, as suggested by the low percentage of protein binding (22.5%). The systemic body clearance (ClB) was 0.32 ± 0.12 L/h·kg. Following i.m. administration, the maximum plasma concentration (Cmax) of 1.53 ± 0.34 μg/mL was reached at tmax 1.25 ± 0.21 h. The drug was completely absorbed after i.m. administration, with a bioavailability of 114.63 ± 11.39%. The kinetic milk AUCmilk/AUCplasma ratio indicated a wide penetration of orbifloxacin from the bloodstream to the mammary gland. OBFX urine concentrations were higher than the concurrent plasma concentrations, and were detected up to 30 h postinjection by both routes. Taken together, these findings indicate that systemic administration of orbifloxacin could be efficacious against susceptible mammary and urinary pathogens in lactating ewes.
Effect of milk fraction on concentrations of cephapirin and desacetylcephapirin in bovine milk after intramammary infusion of cephapirin sodium
Authors: STOCKLER R. M. , MORIN D. E. , LANTZ R. K. , HURLEY W. L. , CONSTABLE P. D.
Published: January 2009

Clinical mastitis in dairy cows is commonly treated with intramammary (IMM) antimicrobial agents. Pharmacokinetic data are used to design treatment regimens and determine withholding times. In some pharmacokinetic studies, investigators measure antimicrobial concentrations in foremilk, whereas in others, they use bucket milk or do not specify the milk fraction sampled. Our objective was to compare antimicrobial concentrations in foremilk, bucket milk, and strippings after IMM treatment of six healthy Holsteins. One mammary gland/cow was infused with 200 mg of cephapirin (CEPH) after each of the two milkings, using different milking frequencies and treatment intervals in a randomized crossover design. Treated glands were sampled at the first milking following each infusion. Antimicrobial concentrations in milk were measured using HPLC/MS/MS. CEPH concentration was higher in foremilk (geometric mean 44.2 μg/mL) than in bucket milk (15.7 μg/mL) or strippings (18.5 μg/mL), as it was true for desacetylcephapirin (DAC) (59.5, 23.0, and 30.2 μg/mL, respectively). This finding, which was based on milk samples collected at the first milking after IMM infusion, suggests that pharmacokinetic data based on drug concentrations in foremilk may be misleading. Strippings were more representative of bucket milk than foremilk. The relationship between milk fraction and antimicrobial concentration should be investigated for other IMM antimicrobial agents. Meanwhile, it is essential that pharmacokinetic and residue studies report the fraction of milk that was analyzed.