bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of latitude, water depth, dayv.night and wetv.dry periods on the species composition of reef fish communities in tropical Western Australia
Authors: Travers M. J. , Newman S. J. , Potter I. C.
Published: September 2006

Trap sampling over reefs in deep (mean = 20 m) and shallow (mean = 10 m) waters alongc. 1500 km of coastline in tropical north‐western Australia during both day and night and in wet and dry periods yielded 23 377 fishes, representing 32 families, 58 genera and 119 species. Individuals of the Serranidae, Lutjanidae, Lethrinidae and Carangidae contributed 88·9% to the total catch. The ichthyofaunal compositions of the Kimberley, Canning and Pilbara bioregions were relatively discrete. Species composition was influenced far more by location (latitude) than by water depth, period and time of day, and underwent a gradational change southwards. The latter change reflected differences in the trends exhibited by the relative abundances of certain species with increasing latitude and the confinement of other species largely to particular regions. The three most abundant species,i.e.Lethrinussp. 3,Lutjanus carponotatusandLethrinus laticaudiscontributed 34·8, 20·8 and 11·6% to the total catch, respectively. The first species was rarely recorded in the two most northern locations and was abundant in the four most southern locations, whereas the last two species were relatively more abundant in northern than in southern locations.Lutjanus bitaeniatusandLutjanus johniiwere found exclusively at the two locations in the Kimberley region, whereasAbalistes stellatus,Pentapodus emeryiiandLethrinus nebulosuswere not caught in this region but were found in both locations of the Canning and Pilbara regions. The species composition in deep and shallow waters at each location almost invariably differed significantly between day and night and between dry and wet periods, with species such asL. bitaeniatus,L. johnii,Lutjanus sebaeandA. stellatusbeing more abundant over deep reefs, whereasL. carponotatus,L. laticaudis,Siganus fuscescensandLethrinus lentjanwere more numerous over shallow reefs. Species such asL. johniiandLethrinus atkinsoniwere relatively more important in night‐time than daytime catches, whereas the reverse applied toLethrinus lentjan,L. laticaudisandChoerodon cyanodus.Lethrinussp. 3 andL. laticaudiswere relatively more important in catches during the dry than wet period.
First record of Apogon queketti Gilchrist (Osteichthyes: Apogonidae) in the Mediterranean Sea
Authors: Eryilmaz L. , Dalyan C.
Published: September 2006

The spotfin cardinalfish Apogon queketti is recorded for the first time in the north‐eastern Mediterranean Sea (Iskenderun Bay, Turkey). Two specimens of this species, 111 and 102 mm total length were caught by a commercial trawler at depths of 55 and 60 m on 14 October 2004 and 23 April 2005, respectively. The occurrence of this species in the Mediterranean Sea is the result of migration from the Red Sea via the Suez Canal.
Dietary habits of the deep‐sea flatfish Lepidorhombus boscii in north‐eastern Mediterranean waters
Authors: Vassilopoulou V.
Published: September 2006

Stomach content analysis of four‐spotted megrim Lepidorhombus boscii in the oligotrophic Aegean Sea revealed that specimens with fully filled stomachs were rarely encountered. The overall dietary breadth of the species appeared to increase in winter and spring, when stomachs fullness was reduced. The species exhibited a relatively high trophic diversity and could be considered a euryphagous carnivore preying mainly upon crustaceans. Decapod natants, namely Processa canaliculata and Alpheus glaber, dominated in terms of per cent mass, while mysids, represented mainly by Lophogaster typicus, were the most important dietary component in terms of per cent number. Isopods, amphipods and decapod brachyurans were also frequently encountered among stomach contents. Fishes were only ingested by larger specimens (>180 mm total length, LT); mouth gape dimensions increasing in larger specimens, enabled them to consume larger organisms. Discriminant function analysis showed that size and then sex of predators had the highest weight in discriminating the dietary groups produced by cluster analysis. Resource partitioning along the trophic dimension seemed to exist among smaller males and females (<110 mm LT), which also presented significant differences in their mouth gape dimensions. The study of the diel feeding pattern of the species demonstrated that foraging activity took place day and night, while observed qualitative differences might partly reflect variations in prey availability on a 24 h basis.
Spaces of Participation in Pre‐School: Arenas for Establishing Power Orders?
Authors: Löfdahl Annica , Hägglund Solveig
Published: September 2006

This article reports an ethnographic study of pre‐school children's social knowledge domains. Results show how the children's shared knowledge concerning social status and social differentiation in the group was strengthened and confirmed during a traditional teacher‐led ring game, where they were supposed to choose a friend. We suggest that from the perspective of the children, the game situation may be understood as, at the same time, a space of participation and an arena for establishing the power order. From the perspective of the teacher, pedagogical intentions may be challenged as they encounter and are mediated and interpreted by children's peer‐cultures.
Pharmacogenetic impact of polymorphisms in the coding region of the UGT1A1 gene on SN‐38 glucuronidation in Japanese patients with cancer
Authors: Araki Kazuhiro , Fujita Ken‐ichi , Ando Yuichi , Nagashima Fumio , Yamamoto Wataru , Endo Hisashi , Miya Toshimichi , Kodama Keiji , Narabayashi Masaru , Sasaki Yasutsuna
Published: September 2006

Pharmacogenetic testing for UDP‐glucuronosyltransferase (UGT) 1A1*28, a promoter variant of the UGT1A1 gene, is now carried out clinically to estimate the risk of irinotecan‐associated toxicity. We studied the clinical significance of UGT1A1*6 and UGT1A1*27, two variants in exon 1 of the UGT1A1 gene that are found mainly in Asians. The study group comprised 46 Japanese patients who received various regimens of chemotherapy including irinotecan at doses from 50 to 180 mg/m2. Pharmacogenetic relationships were explored between the UGT1A1 genotype and the ratio of the area under the plasma concentration–time curve (AUC) of the active metabolite of irinotecan (SN‐38) to that of SN‐38 glucuronide (SN‐38G), used as a surrogate for UGT1A1 activity (AUCSN‐38/AUCSN‐38G). No patient was homozygous for UGT1A1*28, and none had UGT1A1*27. Two were heterozygous for UGT1A1*28. Two were homozygous and 15 heterozygous for UGT1A1*6, all of whom were wild type with respect to UGT1A1*28. Two patients were simultaneously heterozygous for UGT1A1*28 and UGT1A1*6, present on different chromosomes. The other 25 patients had none of the variants studied. The two patients simultaneously heterozygous for UGT1A1*28 and UGT1A1*6 and the two patients homozygous for UGT1A1*6 had significantly higher AUCSN‐38/AUCSN‐38G ratios than the others (P = 0.0039). Concurrence of UGT1A1*28 and UGT1A1*6, even when heterozygous, altered the disposition of irinotecan remarkably, potentially increasing susceptibility to toxicity. Patients homozygous for UGT1A1*6 should also be carefully monitored. UGT1A1 polymorphisms in the coding region of the UGT1A1 gene should be genotyped in addition to testing for UGT1A1*28 to more accurately predict irinotecan‐related toxicity, at least in Asian patients. (Cancer Sci 2006; 97: 1255–1259)
Participation in a clinical trial influences the future management of patients with gastro‐oesophageal reflux disease in general practice
Authors: MEINECHE‐SCHMIDT V. , HVENEGAARD A. , JUHL H. H.
Published: September 2006

Background  The long‐term effects of participation in trials has not been reported. A randomized‐controlled trial (the ONE study) reported on the management of gastro‐oesophageal reflux disease with esomeprazole in primary care, testing on‐demand treatment vs. treatment courses.

Aim  To evaluate the impact of participation in a trial on General Practitioners management and patient behaviour.

Methods  Management of gastro‐oesophageal reflux disease was compared between General Practitioners who participated in ONE (ONE‐GPs) and a random sample of General Practitioners who did not participate in ONE (Other‐GPs). Symptom presentation and satisfaction with treatment was compared between patients who had participated in ONE (ONE‐patients) and patients who had not (Other‐patients).

Results  ONE‐GPs prescribed on‐demand treatment with proton‐pump inhibitors to 47% of the patients, Other‐GPs to 27%. ONE‐patients consulted for significantly less symptoms compared with Other‐patients. ONE‐patients reported significantly higher patient satisfaction compared with Other‐patients. ONE‐patients used 98 doses during 6 months whereas Other‐patients used 76 doses.

Conclusions  Participation in a clinical trial influenced both doctors and patients. Treatment modalities introduced by the trial were used in daily practice by the General Practitioners. Patients who had participated in the trial consulted for less symptoms and used more medication, compared with patients who did not participate.
Systematic review: lamivudine prophylaxis for chemotherapy‐induced reactivation of chronic hepatitis B virus infection
Authors: KOHRT H. E. , OUYANG D. L. , KEEFFE E. B.
Published: September 2006

Background  Reactivation of hepatitis B virus infection in asymptomatic hepatitis B surface antigen carriers undergoing chemotherapy or immunosuppressive therapy is a well‐documented and potentially fatal complication. Data supporting the use of lamivudine for primary prophylaxis have emerged, but its use remains controversial and is not standardized.

Aim  To review current randomized‐controlled trials, randomized trials and prospective case series to provide a clinically applicable, evidence‐based recommendation.

Methods  The published literature was identified using a MEDLINE/PubMed search with secondary review of cited publications, and inclusion of all prospective studies.

Results  In nine prospective trials and one randomized‐controlled trial, the rate of hepatitis among subjects receiving lamivudine prophylaxis ranged from 0% to 20% (16 of 173, 9.2%), compared with 33–67% among controls. Of patients receiving prophylaxis, 0–24% (15 of 173, 8.7%) developed hepatitis B virus reactivation, compared with 29–56% of controls. Three reactivation‐related mortalities were reported (one receiving prophylaxis, two controls). No patients withdrew secondary to toxicity or development of lamivudine‐resistant mutations.

Conclusions  The available data show a four‐ to sevenfold decrease in the rate of hepatitis and hepatitis B virus reactivation in patients who receive lamivudine prophylaxis. It is thus recommended that all hepatitis B surface antigen carriers receive lamivudine, or a comparable anti‐viral agent, as prophylaxis from the initiation of chemotherapy until at least 1 year following its completion.
The effects of tegaserod on oesophageal function and bolus transport in healthy volunteers: studies using concurrent high‐resolution manometry and videofluoroscopy
Authors: FOX M. , MENNE D. , STUTZ B. , FRIED M. , SCHWIZER W.
Published: September 2006

Background  Tegaserod is a partial 5‐hydroxytryptamine 4 receptor agonist with prokinetic effects on the gastrointestinal tract, its effects on oesophageal function are unknown.

Aim  A randomized, placebo controlled, double‐blind trial assessed the effect of tegaserod on the oesophagus in healthy, asymptomatic subjects.

Method  A 7‐day course of tegaserod 6 mg b.d. vs. placebo was prescribed (n = 17/21 completed both phases of study). High‐resolution manometry and pH measurements were performed before and after a test meal. Bolus transport of liquids and solids was studied by high‐resolution manometry and videofluoroscopy.

Results  Tegaserod had no effect on lower oesophageal sphincter pressure compared with placebo, peristaltic velocity increased (P < 0.001) and distal contractile pressure decreased slightly (P < 0.05). Transient lower oesophageal sphincter relaxations and reflux were infrequent regardless of treatment. During the studies of bolus transport, high‐resolution manometry revealed that tegaserod promoted mid‐oesophageal contractility (P < 0.02) and shortened the ‘proximal transition zone’ (P < 0.05), the level where bolus escape occurred most frequently. These effects had no effect on liquid bolus transport; however a non‐significant trend to improved solid bolus transport was observed (66% vs. 31%;P = 0.07).

Conclusion  Tegaserod did not alter lower oesophageal sphincter pressure, but had significant effects on peristaltic function. High‐resolution manometry promoted mid‐oesophageal contractility during bolus transport. This effect was associated with a non‐significant trend to improved solid bolus transit.
The effect of sildenafil on segmental oesophageal motility and gastro‐oesophageal reflux
Authors: KIM H. S. , CONKLIN J. L. , PARK H.
Published: September 2006

Background  Sildenafil is an inhibitor of type 5 phosphodiesterase. It relaxes or inhibits contraction of smooth muscle by increasing cellular concentrations of cyclic guanosine monophosphate. Multichannel intraluminal impedance manometry/pH allow the precise evaluation of oesophageal bolus transit and acid/non‐acid reflux.

Aim  To investigate the effect of sildenafil on segmental oesophageal motor function and gastro‐oesophageal reflux.

Methods  Eight healthy volunteers underwent multichannel intraluminal impedance manometry baseline, and 15, 30 and 45 min before and after a 50‐mg dose of sildenafil successively. The subjects underwent 2‐h multichannel intraluminal impedance/pH studies on two separate days after either water or sildenafil ingestion.

Results  Sildenafil decreased the resting lower oesophageal sphincter pressure and prolonged the duration of lower oesophageal sphincter relaxation for the 45 min following its ingestion. At 15 min, distal onset velocity, total bolus transit time, bolus presence time and segmental transit time were delayed in the mid to distal oesophagus. At 30 min, distal onset velocity was restored but bolus presence time and bolus presence time were still delayed in distal smooth muscle segment. At 45 min, total bolus transit time and distal onset velocity were restored but bolus presence time and segmental transit time were delayed more in the transition zone. Sildenafil did not alter the reflux.

Conclusion  Sildenafil alters lower oesophageal sphincter function and oesophageal bolus transit, but not induce gastro‐oesophageal reflux.
Adherence rates with infliximab therapy in Crohn's disease
Authors: KANE S. , DIXON L.
Published: September 2006

Background  Inflammatory bowel disease is associated with non‐adherence to treatment with oral medications.

Aim  To assess the intravenous infliximab adherence rate and identify risk factors for non‐adherence to treatment.

Methods  Infliximab infusion dates for 1 June 2002–30 October 2003 were obtained. Additional information was obtained from two other administrative and patient‐based databases. Non‐adherence was defined as a ‘No Show’ designation for a scheduled appointment. Non‐adherence rate, odds ratios for associations to ‘No Show’ appointments and analysis were performed to identify patient characteristics associated with non‐adherent behaviour.

Results  One thousand hundred and eighty‐five infliximab infusions were scheduled for 274 patients. Forty‐eight (4%) of appointments were classified as ‘No Show’. Six patients accounted for 13/48 (27%) of failed appointments; another 35 patients missed one appointment. ‘No Show’ appointments were more likely to be for female patients, those on concomitant immunomodulators and those >18 weeks from initial infusion. Patients who missed >1 appointment were more likely to be female and have Medicaid vs. those with only one missed appointment (P < 0.05). Indication, patient area code and race were not significantly associated with single or repeated No Show behaviour.

Conclusions  Overall, the non‐adherence rate for infliximab is low. Risk factors that may contribute to non‐adherence to treatment include female gender and maintenance dosing.
Influence of delaying gastric emptying on meal‐related symptoms in healthy subjects
Authors: TACK J. , COULIE B. , VERBEKE K. , JANSSENS J.
Published: September 2006

Background  Although delayed gastric emptying is often found in functional dyspepsia, a causal role for delayed emptying in inducing symptoms has not been demonstrated.

Aim  To investigate the influence of delaying gastric emptying rate in healthy volunteers on the occurrence of meal‐related symptoms.

Methods  Fourteen healthy subjects (six men, mean age 23 ± 1) underwent gastric emptying studies twice using the 14C octanoic acid and 13C glycin breath test after pre‐treatment with saline or sumatriptan 6 mg s.c. Breath samples were taken before meal and at 15‐min intervals for a period of 360 min postprandially. At each breath sampling, the subject was asked to grade the intensity (0–6) of four dyspeptic symptoms.

Results  Sumatriptan pre‐treatment significantly delayed solid but not liquid gastric emptying (t1/2 respectively 159 ± 11 vs. 112 ± 9 min, P < 0.005 and 134 ± 11 vs. 116 ± 12 min, N.S.). Sumatriptan significantly decreased the mean cumulative symptom score (21.3 ± 5.5 vs. 8.0 ± 2.6, P = 0.01), as well as scores for each individual symptom.

Conclusion  A moderate delay in gastric emptying in health is not associated with an increase of meal‐related symptoms. This observation argues against a causal role for delayed gastric emptying in the pathogenesis of dyspeptic symptoms.
Type I autoimmune hepatitis: clinical course and outcome in an Italian multicentre study
Authors: FLOREANI A. , NIRO G. , ROSA RIZZOTTO E. , ANTONIAZZI S. , FERRARA F. , CARDERI I. , BALDO V. , PREMOLI A. , OLIVERO F. , MORELLO E. , DURAZZO M.
Published: September 2006

Background  Many reports of autoimmune hepatitis (AIH) were written in the ‘pre‐Hepatitis C era’ and data on the natural history are still incomplete.

Aim  To evaluate the clinical presentation and the natural history of type I AIH.

Methods  Seventy‐three consecutive patients with a regular follow‐up of at least 2 years were prospectively included in the study. The mean follow‐up was 91 ± 61 months.

Results  Patients with ‘acute’ onset at presentation were significantly older than patients with ‘chronic’ onset (P < 0.05) and had significantly higher serum levels of transaminase, γ‐glutamyltransferase and bilirubin; Prothrombin time was significantly lower in the said group compared with AIH patients with ‘chronic’ onset. In 4 of 63 (6.3%) female patients, AIH had the onset during pregnancy; in all of them the outcome of pregnancy was favourable. The major events during the follow‐up included oesophageal varices (n = 9) and ascites (n = 4), and 60 patients remained in remission while receiving immunosuppression. None of the patients died during the follow‐up, but seven patients were transplanted. The cumulative transplant‐free probability of survival was 73.5% at 280 months.

Conclusions  Elderly patients have more frequently an acute onset at presentation. Survival in AIH is apparently good; with early diagnosis, and improved medical therapy, liver transplantation for AIH will become a rare event in future.
Evaluation of a pharmacotherapy context‐learning programme for preclinical medical students
Authors: Vollebregt J. A. , Van Oldenrijk J. , Kox D. , Van Galen S. R. , Sturm B. , Metz J. C. M. , Richir M. C. , De Haan M. , Hugtenburg J. G. , De Vries T. P. G. M.
Published: September 2006

What is already known about this subject

• Context‐learning in medicine is mainly based on theories explaining how medical expertise is achieved, particularly with regard to diagnostic problem solving.

• By frequently solving diagnostic clinical problems doctors generate so‐called networks of organized knowledge in their memory.

• Preclinical medical students are well able to learn to choose and prescribe drugs.

What this study adds

• Preclinical pharmacotherapy context learning for medical students has a modest but positive effect on learning cognitive pharmacotherapeutic skills, i.e. choosing a drug treatment and determining patient information.

• The effect can be obtained with role‐play sessions, a suboptimal form of context learning, with a minimal study load and a high appreciation by students.

Aim

To evaluate a context‐learning pharmacotherapy programme for approximately 750 2nd, 3rd and 4th year preclinical medical students with respect to mastering cognitive pharmacotherapeutic skills, i.e. choosing a (drug) treatment and determining patient information.

Methods

The context‐learning pharmacotherapy programme consists of weekly organized role play sessions in the form of consulting hours. Fourth year students sit for a therapeutic Objective Structured Clinical Examination (OSCE) in the form of consulting hours at the outpatient clinic. Sixty‐one 2nd, 74 3rd and 49 4th year medical students who attended the role play sessions and the OSCE were randomly selected. Their performances were assessed by clinical examiners and clinical experts and compared with a reference group of 6th year graduated students. Additionally, the scores of a questionnaire on study load and appreciation were collected.

Results

The level of the pharmacotherapeutic skills of the 4th year students who followed the pharmacotherapy context‐learning programme was not far below that of 6th year graduates who had finished their clinical clerkships, but had not followed the pharmacotherapy programme. The time spent on the programme was about 1% of the total study load per year. The students appreciated the role play sessions and OSCE by around 80% and 99% of the maximum possible scores.

Conclusions

Preclinical pharmacotherapy context learning has a modest but positive effect on learning cognitive pharmacotherapeutic skills, i.e. choosing a drug treatment and determining patient information. This effect has been obtained with role play sessions, a suboptimal form of context learning, with a minimal study load and a high appreciation by students.
Transfer of dexamphetamine into breast milk during treatment for attention deficit hyperactivity disorder
Authors: Ilett Kenneth F. , Hackett L. Peter , Kristensen Judith H. , Kohan Rolland
Published: September 2006

What is already known about this subject

• There are presently no published data on dexamphetamine transfer into breast milk or on its effects in the breast‐fed infant.

What this study adds

• We have provided quantitative data on the absolute and relative infant doses of dexamphetamine for the breast‐fed infant.

• We have also documented a lack of overt adverse effects in breast‐fed infants despite measurable dexamphetamine concentrations in the infants’ plasma.

• Hence we now make recommendations for infant safety and monitoring when mothers taking the drug wish to breastfeed.

Aims

To investigate dexamphetamine transfer into milk, infant doses and effects in the breast‐fed infant.

Methods

Four women taking dexamphetamine, and their infants were studied.

Results

The median maternal dexamphetamine dose was 18 mg day−1 (range 15–45 mg day−1). Median (interquartile range) descriptors were 3.3 (2.2–4.8) for milk/plasma ratio, 21 µg kg−1 day−1 (11–39) for absolute infant dose and 5.7% (4–10.6%) for relative infant dose. No adverse effects were seen. In three infants tested, dexamphetamine in plasma was undetected in one (limit of detection 1 µg l−1) and present at 18 µg l−1 and 2 µg l−1 in the other two.

Conclusion

Dexamphetamine readily transfers into milk. The relative infant dose was <10% and within a range that is generally accepted as being ‘safe’ in the short term.
Effectiveness of β‐blocker therapy in daily practice patients with advanced chronic heart failure; is there an effect‐modification by age?
Authors: Dobre Daniela , DeJongste Mike J. L. , Lucas Carolien , Cleuren Ger , Van Veldhuisen Dirk J. , Ranchor Adelita V. , Haaijer‐Ruskamp Flora
Published: September 2006

Aims

The effects of β‐blockers in daily practice patients with advanced chronic heart failure (CHF) and a broad range of ejection fraction (EF) are not well established. We aimed to assess, first, the association between β‐blocker prescription at discharge and mortality in a cohort of patients with advanced CHF, and second, whether this association is modified by the age of the patient.

Methods

Patients diagnosed with advanced CHF (n = 625) were prospectively followed after discharge from the Cardiology Department. The mean age was 76 years, 53% male, mean EF 42 ± 16%. Overall, 308 (49%) patients had a β‐blocker prescribed at discharge, 140 (22%) low‐dose and 168 (27%) high‐dose therapy. We used multivariate Cox analysis to assess the association between β‐blocker use at discharge and mortality.

Results

After a mean follow‐up of 22 months, 117 (27%) patients died. Prescription of a β‐blocker was associated with a 45% relative risk reduction (hazard ratio 0.55, 95% confidence interval 0.39, 0.78). The relative risk reduction was similar with low and high doses of β‐blockers (42% and 49%). However, the relative risk reduction was higher in younger than in older patients (P = 0.006). In patients ≤75 years old prescription of a β‐blocker was associated with 71% risk reduction, whereas in patients >75 years old it was associated with 21% risk reduction.

Conclusions

In this daily practice cohort of patients with advanced CHF, prescription of a β‐blocker was associated with significant mortality reduction. However, the beneficial effects of β‐blockers appear to be greater in younger patients.
Iron enhances endothelial cell activation in response to Cytomegalovirus or Chlamydia pneumoniae infection
Authors: Kartikasari A. E. R. , Georgiou N. A. , De Geest M. , Van Kats‐Renaud J. H. , Bouwman J. J. M. , Van Asbeck B. S. , Marx J. J. M. , Visseren F. L. J.
Published: September 2006

Background  Chronic inflammation has been implemented in the pathogenesis of inflammatory diseases like atherosclerosis. Several pathogens like Chlamydia pneumoniae (Cp) and cytomegalovirus (CMV) result in inflammation and thereby are potentially artherogenic. Those infections could trigger endothelial activation, the starting point of the atherogenic inflammatory cascade. Considering the role of iron in a wide range of infection processes, the presence of iron may complicate infection‐mediated endothelial activation.

Materials and methods  Endothelial intercellular adhesion molecule‐1 (ICAM‐1), vascular cell adhesion molecule‐1 (VCAM‐1) and endothelial selectin (E‐selectin) expression were measured using flow cytometry, as an indication of endothelial activation. Cytotoxicity was monitored using the 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide (MTT) assay. Immunostaining was applied to measure Cp and CMV infectivity to endothelial cells.

Results  An increased number of infected endothelial cells in a monolayer population leads to a raised expression of adhesion molecules of the whole cell population, suggesting paracrine interactions. Iron additively up‐regulated Cp‐induced VCAM‐1 expression, whereas synergistically potentiated Cp‐induced ICAM‐1 expression. Together with CMV, iron also enhanced ICAM‐1 and VCAM‐1 expression. These iron effects were observed without modulation of the initial infectivity of both microorganisms. Moreover, the effects of iron could be reversed by intracellular iron chelation or radical scavenging, conforming modulating effects of iron on endothelial activation after infections.

Conclusions  Endothelial response towards chronic infections depends on intracellular iron levels. Iron status in populations positive for Cp or CMV infections should be considered as a potential determinant for the development of atherosclerosis.
Increased cardiac endothelial nitric oxide synthase expression in patients taking angiotensin‐converting enzyme inhibitor therapy
Authors: Morawietz H. , Rohrbach S. , Rueckschloss U. , Schellenberger E. , Hakim K. , Zerkowski H.‐R. , Kojda G. , Darmer D. , Holtz J.
Published: September 2006

Background  The efficacy of angiotensin‐converting enzyme (ACE) inhibitors has been demonstrated in large clinical trials, but knowledge of the underlying mechanisms remains incomplete. Therefore, this study investigated the impact of ACE inhibitor therapy on cardiac nitric oxide (NO) synthases in patients with coronary artery disease (CAD) or heart failure.

Patients and methods  The mRNA expression was quantified by standard calibrated competitive RT‐PCR, protein expression by Western blotting and NOS activity by monitoring the conversion of [3H]arginine to [3H]citrulline during enzymatic formation of NO in tissue homogenates of myocardium of patients with, or without, ACE inhibitor treatment before elective coronary artery bypass grafting or heart transplantation.

Results  The mRNA expression (amol µg−1 RNA) of endothelial NO synthase (eNOS) was higher (22·5 ± 4·8, n = 23) in the atrial myocardium of patients taking ACE inhibitor treatment, before elective coronary artery bypass grafting, compared with patients not taking this therapy (8·9 ± 0·7, n = 33, P < 0·0001). The ACE inhibitor therapy increased eNOS protein expression from [(9 ± 0·7) relative units (RUs) to (12 ± 0·9) RUs, P < 0·05, respectively] and cardiac NOS activity from 17·6 ± 1·3 to 23·7 ± 1·1 pmol mg protein−1 min−1 (P < 0·001, respectively). Inducible and neuronal NO synthase expression was not changed by the ACE inhibition. A similar up‐regulation of eNOS by ACE inhibition was found in the left ventricles of patients with heart failure. The augmented endothelial NOS expression and activity was not the result of differences in clinical characteristics and concomitant therapy between the patient groups.

Conclusion  Increased eNOS expression and activity might contribute to the beneficial effects of ACE inhibitor therapy in the treatment of CAD and heart failure.
Patient stories of living with a pressure ulcer
Authors: Hopkins Alison , Dealey Carol , Bale Sue , Defloor Tom , Worboys Fran
Published: September 2006

Aim.  This paper reports the findings of a pilot study exploring the experience of older people living with pressure ulcers.

Background.  Pressure ulcers are known to be a significant health burden, but little is known of the impact on the quality of life of the sufferer. They mainly affect older people, and this is a neglected group in previous studies of this topic.

Methods.  A Heideggerian phenomenological approach was used and patients were recruited if they were over 65 years of age and had a grade 3 or 4 pressure ulcer that had been present for more than a month. Patients were recruited from multiple centres but the data were analysed centrally. The study took place in 2003–2004.

Findings.  Analysis of the transcripts revealed three main themes, all with associated subthemes: pressure ulcers produce endless pain; pressure ulcers produce a restricted life; coping with a pressure ulcer. The endless pain theme had four subthemes: constant presence, keeping still, equipment pain and treatment pain. Some patients found that keeping still reduced their pain. Several patients also reported that pain was exacerbated by their pressure relieving equipment and at dressing change. There were three subthemes for the restricted life theme: impact on self, impact on others and consequences. Patients found that the pressure ulcer restricted their activities and had an impact on their families. In addition, for some, the restrictions delayed their rehabilitation. To cope with their pressure ulcers, patients developed ways of accepting their situation or comparing themselves with others.

Conclusions.  Although a pilot, this study has produced a wealth of data that demonstrates the impact of pressure ulcers on people. While a larger study is required to obtain a European perspective, it is still reasonable to conclude that the issues of pain and restrictions should be considered in the development of pressure ulcer treatment and prevention guidelines.
The art of public health nursing: using confession technè in the sexual health domain
Authors: Holmes Dave , O'Byrne Patrick
Published: September 2006

Aim.  This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self‐surveillance (self‐regulation).

Background.  The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health worker's mandate.

Method.  Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain.

Findings.  As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the client's subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at‐risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere.

Conclusion.  Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy‐makers may be better able to design and implement more user‐oriented, population‐sensitive sexual health services.
Nursing is different than medicine: ethical difficulties in the process of care in surgical units
Authors: Torjuul Kirsti , Sorlie Venke
Published: September 2006

Aim. This paper describes a study of the kinds of ethical difficulties nurses face in the process of care in surgical units.

Background. Nurses face ethically difficult situations in trying to find the most appropriate actions to take for patients. Differences of opinion with doctors about the treatment and care of patients and conflicts between nurses’ value systems and those in the organization where they are employed are described as sources of ethical difficulty. Nurses experience moral distress when institutional constraints restrict them from carrying out appropriate moral actions.

Methods. Ten female nurses working in surgical units at one university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and doctors about being in ethically difficult situations. The transcribed interview texts were subjected to a phenomenological–hermeneutic interpretation. The study was conducted during 2004.

Findings. The main ethically difficult care situations described by the nurses concerned being open and honest, trusting patients’ complaints, and creating limits to their involvement. Differences in opinion with doctors about the treatments, the absence of doctors in the unit and limited interest in holistic treatment and care resulted in nurses not receiving the medical orders they needed. A heavy workload, lack of time and staffing problems resulted in difficult ethical prioritizations and reduced standards of care. Shared rooms and beds in the corridors made it difficult to preserve patients’ rights to privacy and confidentiality.

Conclusion. Interventions and investments are needed to improve the work environment of nurses, especially modifying the job constraints of the work environment. The moral responsibility for upholding the quality of care in surgical services and hospital performance should be more equally distributed between nurses, doctors and hospital managers. Discussions and collaboration between and within healthcare disciplines and managers should be initiated to establish shared moral understanding of the standards of care in hospitals.
Spatial relationships between intensive land cover and residual plant species diversity in temperate farmed landscapes
Authors: SMART SIMON M. , MARRS ROBERT H. , LE DUC MIKE G. , THOMPSON KEN , BUNCE ROBERT G. H. , FIRBANK LES G. , ROSSALL MARTIN J.
Published: September 2006

In temperate farmed landscapes conservation policies increasingly emphasize large‐scale reductions in land‐use intensity. Yet despite a managed reversion to more favourable abiotic conditions, depleted regional species pools may prevent the re‐assembly of target communities.

Using national‐scale survey data recorded across Great Britain in 1998, we investigated the extent to which grassland indicator plant species persisted on potential refuge habitats across a spatial gradient of intensive land cover in lowland 1‐km squares. These habitats comprised road verges, field boundaries, watercourse banks and small biotope fragments. Intensive land cover comprised built land, arable and improved grassland.

The rate of reduction in indicator species richness across the intensive land cover gradient was significantly lower in all potential refuge features than in surrounding fields and larger areas of habitat.

The best refuge locations were watercourse banks and small biotopes. In both cases, indicator species richness was higher than adjacent fields at the lowest intensive land cover and stayed higher as intensive land cover increased.

However, as intensive land cover increased, plant traits associated with higher nutrient availability were more prominently represented among indicator species.

Although richer assemblages of indicator species persisted on refuge features, population sizes are likely to be small, because of species–area effects, and also vulnerable to nutrient surpluses and reduced or inappropriate disturbance.

Synthesis and applications. Across the British lowlands, linear landscape features and small habitat fragments can provide limited safe havens for unimproved grassland plant species. However, the identity of refuge features and their species richness and composition are likely to vary with local conditions. Three activities are therefore paramount in assessing their role in larger scale extensification schemes: (i) development of rapid ways of assessing the plant diversity and distribution of refuge features in local areas; (ii) quantification of the risks posed to the viability of residual source populations through implementation of different options for incorporating them into extensification schemes; (iii) maximization of scheme performance by targeting landscapes with sufficient residual diversity to enable increases in population size of the target species in the medium term.
The effect of organic farming on butterfly diversity depends on landscape context
Authors: RUNDLÖF M. , SMITH H. G.
Published: September 2006

The recent dramatic decline in farmland biodiversity is often attributed to agricultural intensification and structural changes in the agricultural landscape. One suggested farm practice seen to benefit biodiversity and reverse declines is organic farming. Because organic farming is viewed as a more sustainable form of agriculture it is currently subsidized by European agri‐environment schemes. However, the efficiency of agri‐environment schemes to preserve biodiversity has recently been questioned, partly because their uptake has been highest in extensively farmed more heterogeneous landscapes.

We investigated the effect of farming practice on butterfly species richness and abundance along cereal field headlands and margins on 12 matched pairs of organic and conventional farms in contrasting landscapes (homogeneous and heterogeneous landscape diversity).

Both organic farming and landscape heterogeneity significantly increased butterfly species richness and abundance. There was also a significant interaction between farming practice and landscape heterogeneity, because organic farming only significantly increased butterfly species richness and abundance in homogeneous rather than heterogeneous landscapes.

An analysis of the distribution of organic farming in Sweden in relation to productivity of the arable land (yield of spring barley, kg ha−1) indicated that the distribution of organic farms was skewed towards extensively farmed agricultural areas.

Synthesis and applications. The species richness and abundance of butterflies can be enhanced by actions aimed at both promoting organic farming and increasing landscape heterogeneity. However, the beneficial effect of organic farming was only evident in intensively farmed homogeneous landscapes. Currently, the majority of organic arable land in Sweden is located in heterogeneous landscapes where changing the type of farming practice adds little to the existing biodiversity. We therefore propose that the interaction between landscape heterogeneity and farming practice must be considered when promoting farmland biodiversity, for example in Europe by developing context‐based agri‐environment schemes to increase the amount of organic farming in intensively farmed landscapes. We also propose that in homogeneous agricultural landscapes, organic farming could be used as a more efficient tool to restore landscape heterogeneity if the creation of semi‐natural landscape elements was mandatory in the regulations associated with organic agri‐environment schemes.
Ecological patterns of plant diversity in a plantation forest managed by clearfelling
Authors: EYCOTT A. E. , WATKINSON A. R. , DOLMAN P. M.
Published: September 2006

Commercial forests represent an important but often neglected biological resource. This study related the understorey plant species composition of a coniferous plantation forest managed by clearfelling to environmental factors (stand structure, soil pH and previous land use) and ecological patterns (abundance‐occupancy relationships, species dispersal and life history).

Plant species richness and composition were recorded in 326 managed stands of different ages, soil types and land‐use histories in a 185‐km2 lowland forest planted onto heath and arable land.

Stands replanted in the last 10 years had the greatest species richness, typically containing in the order of 18 plant species. Stands on soils of high pH had greater plant species richness, as did those on previously arable land.

Less than a quarter (23%) of all species persisted in the above‐ground vegetation throughout the growth cycle. The majority recolonized forest stands during the cycle, by physical dispersal or from the seed bank, largely after canopy opening in mature stands (26%) or after felling (47%). Annual species and species with plumed seeds were most abundant in early growth stages, while shrubs with berries were more abundant in mature stands.

We found a strong positive interspecific relationship between frequency of stand occupancy and mean abundance within occupied stands. For species not persisting above‐ground throughout the forestry cycle (i.e. patch colonizers), the slope of the abundance‐occupancy relationship was steeper for those with a long‐distance dispersal mechanism than for those lacking such a mechanism.

Synthesis and applications. Rotational clearfelling of plantations may be an appropriate form of forest and conservation management in forests planted on former open areas such as heaths, where the conservation interest is not in old‐growth species but in earlier successional species. Maximizing representation of young growth stages will help maximize plant diversity in such cases. These prescriptions contradict guidance for sustainable forestry; however, it is appropriate to vary guidelines according to land‐use history and species composition. Our findings confirm the importance of dispersal to species persistence within landscapes comprising successional patch networks.
Genetic structure and gene flow in wild beet populations: the potential influence of habitat on transgene spread and risk assessment
Authors: CURETON A. N. , NEWBURY H. J. , RAYBOULD A. F. , FORD‐LLOYD B. V.
Published: September 2006

The consequences of the movement of transgenes from genetically modified (GM) crops into wild populations of plants continues to be of concern to ecologists and conservationists because of the possible threat posed to those populations in terms of their continued survival and because of the further knock‐on effects that might occur to habitats in which they occur.

We examined five UK sea beet Beta vulgaris ssp. maritima populations from each of two major habitat types, cliff top and drift line. We assessed population genetic parameters, genetic diversity, gene flow, population differentiation and isolation by distance, to enable determination of the likelihood and consequences of spread to wild populations of genes from cultivated sugar beet group Beta vulgaris ssp. vulgaris, which could in the future be transgenic.

Drift line populations were more diverse than cliff top populations and also showed greater levels of gene flow.

Isolation by distance was identified in both habitats, but the relationship between genetic and geographical distance was detectable over longer distances for drift line populations. However, clear indications of vicariance (the subdivision of a population into distinct taxa by the appearance of a geological barrier) between cliff and drift line populations were also evident, because of the restriction of gene flow between the two habitats occurring more in one direction than the other.

Synthesis and applications. The likelihood of transgene spread from crop to wild populations is habitat dependent and conservation management decisions could therefore vary from one population to another, for example water courses were found to facilitate seed dispersal. This should be taken into account when estimating isolation distances for GM beet, and when predicting transgene frequencies (exposure estimates) for environmental risk assessments of GM beet.
Mealtimes in hospital – who does what?
Authors: Xia Chenfan , McCutcheon Helen
Published: September 2006

Aim.  This paper describes the findings of a descriptive study about what nurses do at mealtimes in relation to monitoring/assisting the eating practices of older patients in an acute care facility.

Background.  The prevalence of under nutrition is known to be high in hospitalized older patients and insufficient dietary intake is regarded as a major cause. However, most of the research tends to concentrate on the nursing home setting. Little is known about the situation in acute care facilities.

Methods.  Two medical wards participated in the study. Ward 1 had introduced a change of nurses’ meal break time and ward 2 continued with normal practice. Convenience sampling was used. Fifty nurses and 48 patients were observed at different mealtimes during two weeks. Four nurses and four patients who were observed were also interviewed. Data were analysed using descriptive statistics and thematic analysis.

Results.  Kitchen staff delivered all meals and collected the majority of the meal trays. Older patients did not receive enough assistance during mealtimes. Interruptions happened frequently and social interaction was neglected. About one‐third of patients observed left more than two‐third of their meals.

Conclusion.  Nutrition issues appeared to receive less priority in the ward than other nursing care activities and nurses’ assistance was generally insufficient and not provided in a timely manner.

Relevance to clinical practice.  Findings highlight the deficiency in practice that should suggest to nurses that they examine their practice and put into place strategies to ensure older patients are properly/adequately hydrated and receive sufficient nutrient intake.