bluuebunny/crossref_metadata_2025 huggingface dataset:
Could sex be maintained through harmful males?
Authors: Dagg Joachim L.
Published: January 2006

All else being equal, parthenogenetic females should produce as many surviving daughters as sexual couples produce daughters plus sons. Hence the resources spent on producing sons are a cost of sex and parthenogenetic females economize on sons. It has recently been shown that a small competitive advantage of sexual individuals can recoup this large reproductive disadvantage, while the adaptation behind the competitive advantage might differ from case to case. One hypothesis that has not yet been considered as a potential competitive advantage is that males could differentially harm parthenogenetic females, for example, through harassment, toxic seminal fluids, or infanticide. Harmful male functions result from the selection for males that maximise their fitness at the expense of females in the context of sexual conflict. Unless parthenogenetic lineages can maintain their resistance against harmful male functions, a competitive advantage for sex should be a by‐product benefit of sexual conflict.

Mutations that make males harm parthenogenetic females worse than sexual ones, however, can be seen as evolutionary spite. The spiteful trait is not the production of costly sons, but the production of males that discriminate against parthenogenetic females. Spiteful behaviour can be positively selected, if it acts against negatively related victims. Sexual and parthenogenetic individuals within a population should usually be negatively related, because the genomes of the sexual individuals are bound together by recombination while those of parthenogenetic individuals will be identical except for divergence through mutation.

Some unusual cases of parthenogenesis are discussed in the light of this new hypothesis and an experimental approach for testing it is suggested.
A comparison of the species–time relationship across ecosystems and taxonomic groups
Authors: P. White Ethan , B. Adler Peter , K. Lauenroth William , A. Gill Richard , Greenberg David , M. Kaufman Dawn , Rassweiler Andrew , A. Rusak James , D. Smith Melinda , R. Steinbeck John , B. Waide Robert , Yao Jin
Published: January 2006

The species–time relationship (STR) describes how the species richness of a community increases with the time span over which the community is observed. This pattern has numerous implications for both theory and conservation in much the same way as the species–area relationship (SAR). However, the STR has received much less attention and to date only a handful of papers have been published on the pattern. Here we gather together 984 community time‐series, representing 15 study areas and nine taxonomic groups, and evaluate their STRs in order to assess the generality of the STR, its consistency across ecosystems and taxonomic groups, its functional form, and its relationship to local species richness. In general, STRs were surprisingly similar across major taxonomic groups and ecosystem types. STRs tended to be well fit by both power and logarithmic functions, and power function exponents typically ranged between 0.2 and 0.4. Communities with high richness tended to have lower STR exponents, suggesting that factors increasing richness may simultaneously decrease turnover in ecological systems. Our results suggest that the STR is as fundamental an ecological pattern as the SAR, and raise questions about the general processes underlying this pattern. They also highlight the dynamic nature of most species assemblages, and the need to incorporate time scale in both basic and applied research on species richness patterns.
On testing for a tradeoff between constitutive and induced resistance
Authors: Morris William F. , Traw M. Brian , Bergelson Joy
Published: January 2006

Plants possess two types of resistance against herbivores: ever‐present constitutive resistance and induced resistance triggered by attack. As the production of both resistance types entails a metabolic cost, a tradeoff between them has frequently been hypothesized. Over twenty published studies have tested for the existence of this tradeoff, but this literature is marred by three methodological problems. The first problem is lack of agreement about how to measure induced resistance, a complex trait that typically involves comparison between damaged and undamaged plants. Some metrics of induced resistance confound constitutive and induced resistance, creating evidence for a tradeoff when one does not exist or obscuring real tradeoffs. On both biological and statistical grounds, we argue for the difference in mean resistance between damaged and control plants from the same family or genotype as the best metric of induced resistance. The second problem is that limited sampling (e.g. of families or of individuals within families) or errors in measuring resistance traits of individuals can generate spurious evidence for a tradeoff even when our preferred induced resistance metric is used. The third problem is that some families may show induced susceptibility (lower resistance in damaged than in undamaged plants). To provide a better test for a tradeoff, we devise a Monte Carlo procedure that accounts for sampling variation, measurement error and induced susceptibility without producing unrealistic negative resistance values, and we illustrate it with simulated data. Until the problems we describe are widely addressed and the tools we propose are widely applied, the resistance tradeoff hypothesis cannot be considered to have been adequately evaluated. Our approach also applies whenever the plasticity of a trait (measured as the difference between treatments or environments) is compared to the value of that trait in a single environment.
Treating chronic hepatitis C with pegylated interferon alfa‐2a (40 KD) and ribavirin in clinical practice
Authors: LEE S. S. , BAIN V. G. , PELTEKIAN K. , KRAJDEN M. , YOSHIDA E. M. , DESCHENES M. , HEATHCOTE J. , BAILEY R. J. , SIMONYI S. , SHERMAN M. ,   THE CANADIAN PEGASYS STUDY GROUP
Published: January 2006

Background

Pegylated interferon alfa‐2a (40 KD) plus ribavirin therapy induces sustained virological response rates up to 63% in randomized‐controlled trials.

Aim

To conduct a prospective open‐label programme to examine the efficacy and safety of this therapy in routine clinical practice.

Methods

Treatment‐naive patients with chronic hepatitis C received, at the discretion of the investigator, pegylated interferon alfa‐2a 180 μg/week + ribavirin 800 mg/day for 24 or 48 weeks. In total, 508 patients were enrolled [334 non‐cirrhotic; 174 cirrhotic (defined as stage F3 and F4)].

Results

In genotype 1 patients treated for 48 weeks, sustained virological response rates were 41% in non‐cirrhotics and 34% in cirrhotics. Sustained virological response rates in genotype 2 or 3 non‐cirrhotics were 79% (24 weeks) and 72% (48 weeks). Corresponding values for cirrhotic genotype 2/3 were 66% and 44%. The negative predictive value of an early virological response at week 12 was 94%. Predictive factors for sustained virological response on multivariate analysis were genotype (2/3 vs. 1), low viral load and degree of fibrosis. Rates of serious adverse events (≤5%) and adverse events inducing withdrawal (≤8%) were comparable with the phase III trials.

Conclusion

Efficacy and safety of pegylated interferon alfa‐2a + ribavirin in clinical practice is comparable with results of randomized‐controlled trials.
Cost‐of‐disease analysis in patients with gastro‐oesophageal reflux disease and Barrett's mucosa
Authors: WILLICH S. N. , NOCON M. , KULIG M. , JASPERSEN D. , LABENZ J. , MEYER‐SABELLEK W. , STOLTE M. , LIND T. , MALFERTHEINER P.
Published: January 2006

Background

Gastro‐oesophageal reflux disease (GERD) is a common and frequently chronic condition that causes considerable costs.

Aim

To estimate the economic burden caused by patients with erosive and non‐erosive reflux disease, and Barrett's oesophagus.

Methods

The Progression of Gastro‐oesophageal Reflux Disease study includes a total of 6215 patients. At baseline, patients were categorized as non‐erosive reflux disease, erosive reflux disease, or Barrett's oesophagus according to endoscopic findings alone or as confirmed by histology. Direct and indirect disease‐related costs were calculated based on 5273 patients with complete information in the second year of the study.

Results

A total of 73% of the Progression of Gastro‐oesophageal Reflux Disease patients had taken GERD medication, 61% had visited a doctor, and 2% had been hospitalized because of GERD during the previous 12 months. Of all employed persons, 6% reported days off work because of GERD. This health resource utilization caused direct costs of €342 ± 864 (mean ± s.d.) and indirect costs of €40 ± 473 per patient and year. Total costs for patients with Barrett's oesophagus or erosive reflux disease were higher than those for patients with non‐erosive reflux disease.

Conclusion

Patients with GERD frequently need long‐term medication and doctor care. The disorder is associated with a considerable health economic burden to society.
Lansoprazole, levofloxacin and amoxicillin triple therapy vs. quadruple therapy as second‐line treatment of resistant Helicobacter pylori infection
Authors: WONG W. M. , GU Q. , CHU K.‐M. , YEE Y. K. , FUNG F. M. Y. , TONG T. S. M. , CHAN A. O. O. , LAI K. C. , CHAN C. K. , WONG B. C. Y.
Published: January 2006

Aim

To test the efficacy of levofloxacin‐based second‐line therapy for resistant Helicobacter pylori infection.

Methods

One hundred and six patients who failed H. pylori eradication were randomized to receive (i) lansoprazole 30 mg, amoxicillin 1 g, levofloxacin 500 mg, all given twice daily for 7 days (LAL); or (ii) lansoprazole 30 mg twice daily, metronidazole 400 mg thrice daily, bismuth subcitrate 120 mg and tetracycline 500 mg four times daily for 7 days (quadruple). Post‐treatment H. pylori status was determined by 13C‐urea breath test.

Results

Intention‐to‐treat and per‐protocol H. pylori eradication rates were 57/60% for the LAL group and 71/76% for the quadruple group respectively. Metronidazole, clarithromycin, amoxicillin and levofloxacin resistance were found in 76%, 71%, 0% and 18% of patients, respectively. Levofloxacin resistance led to treatment failure in the LAL group. For patients with dual resistance to metronidazole and clarithromycin, the eradication rates were 79% in the LAL group (levofloxacin‐sensitive) and 65% in the quadruple group (P = 0.34).

Conclusion

Lansoprazole, amoxicillin plus levofloxacin second‐line therapy is comparable with quadruple therapy in efficacy. Subjects, especially those with dual resistance to metronidazole and clarithromycin, may consider levofloxacin‐based therapy for levofloxacin‐sensitive strains.
Influence of citalopram, a selective serotonin reuptake inhibitor, on oesophageal hypersensitivity: a double‐blind, placebo‐controlled study
Authors: BROEKAERT D. , FISCHLER B. , SIFRIM D. , JANSSENS J. , TACK J.
Published: January 2006

Background

Tricyclic antidepressants, which have multiple pharmacological influences, have a therapeutic effect in non‐cardiac chest pain, but selective serotonin reuptake inhibitors have a single pharmacological effect.

Aim

To evaluate the acute effect of citalopram on oesophageal hypersensitivity.

Methods

On two separate occasions, 10 healthy subjects (seven men, mean age 25 years) with established oesophageal hypersensitivity, underwent oesophageal manometry with evaluation of mechanical and chemical sensitivity. Subjects received placebo or citalopram 20 mg i.v. in a randomized, crossover, double‐blind fashion.

Results

Citalopram did not alter oesophageal motility. Citalopram significantly increased the threshold inducing first perception (4.6 ± 0.3 vs. 6.7 ± 0.4 mL, P < 0.005) and discomfort (8.6 ± 0.4 vs. 9.9 ± 0.6 mL, P < 0.01) during balloon distention. It also significantly prolonged the acid perfusion time to induce perception of heartburn (6.0 ± 0.9 vs. 10.7 ± 0.6 min, P < 0.005) and discomfort (12.2 ± 0.8 vs. 16.7 ± 0.7 mL, P < 0.001). Seven subjects experienced a retrosternal sensation during edrophonium provocation with placebo, and this was reduced to two of 10 after citalopram (P = 0.02).

Conclusions

Acute administration of citalopram significantly lowers chemical and mechanical oesophageal sensitivity in oesophageal hypersensitivity, without altering the motility.
Chronic lymphocytic leukaemia profiled for prognosis using a fluorescence in situ hybridisation panel
Authors: Reddy K. S.
Published: January 2006

A panel of fluorescence in situ hybridisation (FISH) probes was used on 894 cases to target chromosome 11q, 13q, 17p deletions (del), trisomy 12 (+12) in all and 6q deletion in 59. Chronic lymphocytic leukaemia (CLL) immunophenotype (CD5 and CD19 with CD23) was found in 509 cases (average age 67·7 years, 319 males and 190 females). Among the 509 CLL cases 349 (68·6%) had FISH (4‐probe panel) abnormalities: 160 del 13q [45·8% (122‐del 13q, 18‐biallelic del 13q, 20‐monoallelic/biallelic del 13q)], 71 tri 12 (20·3%), 17 del ATM (5%), 12 del p53 (3·4%) and 89 ≥ 2 FISH abnormalities (25·5%). Of 151/509 cases karyotyped, 108 were normal and 43 (43/151 = 28·5%) abnormal. Del 6q was found in 1/59 (1·6%) FISH cases and in 6/151 (4%) karyotypes. In 14 CD23 negative cases IGH/BCL1 FISH detected t(11;14) and was confirmed to be mantle cell lymphoma. Multiple probes/panels that included IGH probe were ordered for 57 CLL cases, 11 had an IGH rearrangement with an unidentified partner. This study favours the inclusion of del 6q and IGH probes in the CLL panel. The FISH panel could also serve to monitor 13q deletion for secondary changes with adverse prognosis. Understanding prognosis in specific types of 13q deletion would enhance outcome prediction.
Expression levels of asparagine synthetase in blasts from children and adults with acute lymphoblastic leukaemia
Authors: Leslie M. , Case M. C. , Hall A. G. , Coulthard S. A.
Published: January 2006

l‐asparaginase is active in the treatment of acute lymphoblastic leukaemia (ALL) through the depletion of serum asparagine. Here we report that median asparagine synthetase (AS) mRNA levels were higher in acute myeloid leukaemia (AML) than ALL blasts in both children and adults, with intermediate levels in normal peripheral blood mononuclear cells (NPBMC). NPBMC versus child ALL (Tukeys multiple comparison test, P < 0·05); child ALL versus child AML (P < 0·001) and adult ALL versus adult AML (P < 0·01) were all significant and support the hypothesis that selectivity to treatment with l‐asparaginase is due, at least in part, to lower AS expression.
Role of the C‐terminal actin binding domain in BCR/ABL‐mediated survival and drug resistance
Authors: Underhill‐Day N. , Pierce A. , Thompson S. E. , Xenaki D. , Whetton A. D. , Owen‐Lynch P. J.
Published: January 2006

Philadelphia chromosome‐positive, chronic myeloid leukaemia (CML) stem and progenitor cells have a survival and growth advantage compared with their normal counterparts. The mechanisms through which the BCR/ABL protein tyrosine kinase (PTK) induces these effects and the important domains within this protein are not fully defined. The F‐ and G‐actin binding region of the BCR/ABL C‐terminus may be important in BCR/ABL‐mediated events, and we have investigated this by expressing a C‐terminus deletion mutant of the temperature‐sensitive BCR/ABL PTK, in a haemopoietic progenitor cell line, which models the chronic phase of CML. The truncated BCR/ABL PTK displayed similar levels of PTK activity when compared with wild type and activation of second messenger formation (in the form of sn‐1,2‐diacylglycerol) remains intact. On fibronectin substrata, localisation of the protein to the periphery of the cell was, however, dependent on the C‐terminus of BCR/ABL PTK. Deletion of the C‐terminus reversed both BCR/ABL‐mediated apoptotic suppression and drug resistance although the progenitor cells did retain a proliferative advantage at low concentrations of growth factor. These results demonstrated that the C‐terminal actin‐binding domain of BCR/ABL is important for some of BCR/ABL PTK‐mediated leukaemogenic effects.
Near‐total splenectomy for hereditary spherocytosis: clinical prospects in relation to disease severity
Authors: Stoehr Gerhard A. , Sobh Julian N. , Luecken Jan , Heidemann Kathrin , Mittler Uwe , Hilgers Reinhard , Eber Stefan W.
Published: January 2006

We prospectively studied the efficacy of near total splenectomy (NTS) for managing hereditary spherocytosis (HS) based on haemoglobin (Hb), total bilirubin and splenic remnant regrowth in 30 children receiving NTS for HS between November 1996 and December 2004 (mean followup 3·6 years). Patients were classified into three severity groups. At followup, mean Hb had increased by 2·9–5·0 g/dl (P = 0·110) and bilirubin dropped by 15·4–56·4 μmol/l. Remnant regrowth was moderate, within the weight‐specific norm. Amongst spleen‐preserving techniques, NTS shows markedly lower rates of recurrent haemolysis, remnant regrowth and secondary operations, thus potentially benefiting all clinical forms of HS.
IgV gene intraclonal diversification and clonal evolution in B‐cell chronic lymphocytic leukaemia
Authors: Bagnara Davide , Callea Vincenzo , Stelitano Caterina , Morabito Fortunato , Fabris Sonia , Neri Antonino , Zanardi Sabrina , Ghiotto Fabio , Ciccone Ermanno , Grossi Carlo Enrico , Fais Franco
Published: January 2006

Intraclonal diversification of immunoglobulin (Ig) variable (V) genes was evaluated in leukaemic cells from a B‐cell chronic lymphocytic leukaemia (B‐CLL) case over a 2‐year period at four time points. Intraclonal heterogeneity was analysed by sequencing 305 molecular clones derived from polymerase chain reaction amplification of B‐CLL cell IgV heavy (H) and light (C) chain gene rearrangements. Sequences were compared with evaluating intraclonal variation and the nature of somatic mutations. Although IgV intraclonal variation was detected at all time points, its level decreased with time and a parallel emergence of two more represented VHDJH clones was observed. They differed by nine nucleotide substitutions one of which only caused a conservative replacement aminoacid change. In addition, one VLJL rearrangement became more represented over time. Analyses of somatic mutations suggest antigen selection and impairment of negative selection of neoplastic cells. In addition, a genealogical tree representing a model of clonal evolution of the neoplastic cells was created. It is of note that, during the period of study, the patient showed clinical progression of disease. We conclude that antigen stimulation and somatic hypermutation may participate in disease progression through the selection and expansion of neoplastic subclone(s).
Missing years of abuse in children's homes
Authors: Stein Mike
Published: January 2006

This paper reflects upon the historic abuse of young people living in children's homes. Beginning with a recognition of ‘individual abuse’, it explores, first of all, the reasons why young people were abused, including: (1) the status of childhood and being in care; (2) the application of ‘approved’ treatment methods; (3) the failure of managerial, organizational and inspection systems; and (4) the institutional critique and the popularity of preventative policies. Second, by identifying common themes arising from this account, it is suggested we need to rethink the way abuse has been conceptualized. Individual direct abuse, sanctioned abuse, organized systematic abuse and system outcome abuse are discussed. Finally, the paper reviews recent changes in law, policy and practice, including the Children Act 2004, designed to prevent abuses happening again. It is argued that challenges still remain in addressing structural inequalities, improving protection, balancing needs and rights, extending protection to different groups of young people and in having a preventative vision for children's homes.
Widening our knowledge concerning young looked after children: the case for research using sociological models of childhood
Authors: Winter Karen
Published: January 2006

The Assessment and Action framework for looked after children, designed to improve outcomes for all children in public care and those at home on care orders, is now well established in the UK. This paper offers a critical evaluation of the framework by examining the model of childhood upon which it is premised and by exploring its relationship to children's rights as conceptualized in the United Nations Convention on the Rights of the Child (1989). It will be argued that the particular child development model which underpins the framework addresses the rights of looked after children to protection and provision but does not allow for their participation rights to be sufficiently addressed. A critical review of the research concerning the education and health of looked after children is used to illustrate these points. It will be argued that what are missing are the detailed accounts of looked after children themselves. It is concluded that there is a need for the development of additional research approaches premised upon sociological models of childhood. These would allow for a greater engagement with the participation rights of this group of children and complement the pre‐existing research agenda.
Young families under stress: assessing maternal and child well‐being using a mixed‐methods approach
Authors: McAuley Colette , McCurry Nyree , Knapp Martin , Beecham Jennifer , Sleed Michelle
Published: January 2006

Supporting parents has been reinforced as central to improving children's lives. Assessment of needs, however, is crucial to the provision of effective support. This paper focuses upon the assessment of well‐being of mothers and their children in 162 young families experiencing stress in south‐east England and Northern Ireland. A mixed‐methods approach to assessment was adopted and the strengths of using face‐to‐face interviews alongside standardized measures are explored.
Safeguarding children: challenges to the effective operation of core groups
Authors: Harlow Elizabeth , Shardlow Steven M.
Published: January 2006

Founded on an evaluative review of core group practice in a northern metropolitan borough of England, this paper highlights the tensions and difficulties that might inhibit the quality of post‐registration services to children and their families. Insights from the empirical data as well as theoretical literature have been explored in the light of current and developing policies. This exploration is focused on inter‐agency coordination; inter‐professional relationships; and partnership with parents and children. The recruitment and retention of social workers, the potential contribution of Children's Trusts, as well as unconscious processes relating to child abuse and child protection, are all given consideration.
Impact of cytopathologist expert on diagnosis and treatment of pancreatic lesions in current clinical practice. A series of 106 endoscopic ultrasound‐guided fine needle aspirations
Authors: Alsibai K. Drak , Denis B. , Bottlaender J. , Kleinclaus I. , Straub P. , Fabre M.
Published: January 2006

Objectives:  To evaluate the role of a cytopathologist expert in interpreting difficult pancreatic endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) in terms of impact on diagnostic yield and therapy in current clinical practice.

Methods:  Retrospective study of 106 EUS‐FNA performed between January 2002 and September 2004. Forty‐seven cases of difficult interpretation by the local cytopathologist were mailed to an expert cytopathologist. The final diagnosis was established by histology obtained by either surgery (n = 30), non‐equivocal FNA (n = 40) or core (n = 8) biopsies, or by a mean follow‐up of 14 months (n = 28).

Results:  EUS‐FNA involved 68 solid lesions (SL). Specimens collected were adequate in 63%. The overall sensitivity of EUS‐FNA for the diagnosis of malignancy of SL was 88% versus 72% for local cytopathologist and 89% for expert. EUS‐FNA with the reevaluation by expert of 39 SL gave a therapeutic impact in 47% of SL. Thirty‐eight cystic lesions (CL) were evaluated. Specimens collected were adequate for cytology in 84% of cases and for biochemistry in 79%. The sensitivity of imaging + EUS‐FNA ± biochemistry for the diagnosis of a surgical CL was 58% with a therapeutic impact in 39.5%.

Conclusion:  Pancreatic EUS‐FNA is an easy technique for experienced endosonographers, which can be safely performed on an outpatient basis. The possibility of mailing difficult cases to an expert cytopathologist increases the diagnostic yield. In these circumstances, EUS‐FNA has a therapeutic impact in current practice in nearly one out of two pancreatic lesions.
Endoscopic ultrasound‐guided tissue sampling by combined fine needle aspiration and trucut needle biopsy: a prospective study
Authors: Wittmann J. , Kocjan G. , Sgouros S. N. , Deheragoda M. , Pereira S. P.
Published: January 2006

Background and aims:  Endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) has a diagnostic accuracy of 70–90%, depending on the site under evaluation. In order to improve EUS‐guided tissue sampling a novel 19‐gauge trucut‐type needle has been designed to obtain core biopsies during EUS. We prospectively evaluated the safety and accuracy of EUS‐FNA alone versus combined EUS‐FNA and trucut needle biopsy (TNB) in patients referred to our Unit over a 3‐year period.

Patients and methods:  A total of 159 patients underwent EUS‐FNA alone (lesions <2 cm) or the combination of both sampling modalities (lesions ≥2 cm). The adequacy of sampling, sensitivity, specificity and overall accuracies of EUS‐FNA or EUS‐TNB alone and combined EUS‐FNA/TNB were determined.

Results:  Adequate samples were obtained by EUS‐FNA, EUS‐TNB and EUS‐FNA/TNB in 91%, 88% and 97% of patients, respectively. From the pancreas (n = 83), adequate samples were obtained by FNA in 94% and by TNB in 81%, compared with 87% and 92% from non‐pancreatic sites (n = 76), respectively. The combination of both techniques resulted in more adequate samples from non‐pancreatic cases than EUS‐FNA alone (P = 0.044). The specificity was 100%. Overall accuracy for EUS‐FNA alone was 77%, for EUS‐TNB alone 73% and for EUS‐FNA/TNB 91% (P = 0.008). For pancreatic sampling, the accuracy of EUS‐FNA alone was 77%, for EUS‐TNB alone 56% and for EUS‐FNA/TNB 83%. For non‐pancreatic sampling, the accuracy for EUS‐FNA alone was 78%, for EUS‐TNB alone 83% and for EUS‐FNA/TNB 95% (P = 0.006). The complication rate was 0.6%.

Conclusions:  Combined EUS‐FNA/TNB for lesions ≥2 cm improves adequacy of sampling and diagnostic accuracy compared with either technique alone and is safe.
Molecular diagnostics of non‐small cell lung cancer using mediastinal lymph nodes sampled by endoscopic ultrasound‐guided needle aspiration
Authors: Al‐Haddad M. , Wallace M. B.
Published: January 2006

Non‐small cell lung cancer is a common cancer with significant mortality. Accurate and early staging of this cancer has a significant impact on outcome. Endoscopic ultrasound‐guided fine needle aspiration of involved mediastinal lymph nodes is critical for staging. Several molecular markers have been identified recently in association with non‐small cell carcinoma of the lung that are promising to make early detection of metastatic disease more reliable.
Effects of nutrient additions on ecosystem carbon cycle in a Puerto Rican tropical wet forest
Authors: LI YIQING , XU MING , ZOU XIAOMING
Published: January 2006

Wet tropical forests play a critical role in global ecosystem carbon (C) cycle, but C allocation and the response of different C pools to nutrient addition in these forests remain poorly understood. We measured soil organic carbon (SOC), litterfall, root biomass, microbial biomass and soil physical and chemical properties in a wet tropical forest from May 1996 to July 1997 following a 7‐year continuous fertilization. We found that although there was no significant difference in total SOC in the top 0–10 cm of the soils between the fertilization plots (5.42±0.18 kg m−2) and the control plots (5.27±0.22 kg m−2), the proportion of the heavy‐fraction organic C in the total SOC was significantly higher in the fertilized plots (59%) than in the control plots (46%) (P<0.05). The annual decomposition rate of fertilized leaf litter was 13% higher than that of the control leaf litter. We also found that fertilization significantly increased microbial biomass (fungi+bacteria) with 952±48 mg kg−1soil in the fertilized plots and 755±37 mg kg−1soil in the control plots. Our results suggest that fertilization in tropical forests may enhance long‐term C sequestration in the soils of tropical wet forests.
Discursive practices in the documentation of patient assessments
Authors: Irving Kate , Treacy Margaret , Scott Annie , Hyde Abbey , Butler Michelle , MacNeela Padraig
Published: January 2006

Aim.  This paper reports a study analysing the various functions of nurses’ documentation of patient assessments.

Background.  Modes of documentation have received much attention in the nursing press since the integration of the nursing process and nursing models. Previous research has shown that current documentation practices do not consistently promote effective communication and evaluation of patient care. A recent systematic review found no evidence that any particular system of documentation improved this situation. However, nurses’ documentation serves not only to communicate information to others, but also has a political function as a presentation of what is important and ethically ‘right’ to report.

Method.  A Foucauldian approach to discourse analysis was used to analyse 45 patient records.

Findings.  The findings indicate that nurses employ three discernible discursive practices in the documentation of patient assessments: medical, nursing and informal. Each practice has an effect on the presentation of nursing in the documentation. Because of the complex interplay between these practices, nurses present themselves as aligned with the medical profession, as distinct and professional, and as informal in their descriptions of non‐biological information. The use of these practices appears to be motivated by the type of information being reporting.

Conclusion.  Existing literature highlights the functional aspects of nursing documentation. In contrast, this paper explores the way in which nurses, through their documentation, constitute themselves and the nursing profession. In this way, nursing documentation is viewed as a social practice and a conduit through which particular power effects are produced and reproduced, rather than simply a matter of, for example, knowledge, individual choice or good practice.
Client‐centred empowering partnering in nursing
Authors: Brown Darlene , McWilliam Carol , Ward‐Griffin Catherine
Published: January 2006

Aim.  This paper explores nurses’ experiences 1 year after an organization's commitment to providing a client‐centred and client‐empowering partnering approach to care.

Background.  Historically, nurses’ approach to providing care in all nursing contexts has been one of doing for clients, and previous studies have focused more on in‐hospital care than on home care. However, the isolation inherent in in‐home nursing and nurses’ limited professional autonomy and power associated with physician control over patients in home care have been reported, as has their difficulty in finding the meaning and satisfaction of human connectedness and mutuality in nurse–client relationships. Overall, research to date does not inform us about how nurses might make a change toward a more client‐centred and client‐empowering approach to nursing.

Methods.  An interpretive phenomenological design was used to elicit in‐depth understanding about Registered Nurses’ experiences of providing care using this innovative empowerment model. A purposefully selected sample of eight Registered Nurses participated in in‐depth interviews. Data were generated during 2002. Hermeneutic analysis was used to elicit themes and patterns emerging from the data.

Findings.  Caring, client‐centredness and the context of in‐home care were important in implementing the new partnering approach. Barriers encountered at system, organizational and personal levels distracted nurses from fully comprehending and enacting the approach. After a year, they had begun to contemplate potential strategies for partnering with clients, but had not yet explored the power of their professional autonomy.

Conclusion.  Nurses are inclined to practise within the expert model of service delivery. They need to work through issues of professional autonomy and rise to the challenge of exercising their autonomy within the current healthcare context if they are to attend more consistently to client‐centred empowering partnering. The home care setting offers an excellent environment for achieving these aims.
Patients’ assessments of consulting a nurse practitioner: the time factor
Authors: Williams Anne , Jones Melanie
Published: January 2006

Aim.  This paper reports a study exploring patients’ views about consulting with a primary care nurse practitioner.

Background.  United Kingdom based randomized controlled trials comparing the work of doctors and nurse practitioners add considerable weight to the view that patients tend to be more satisfied with primary care nurse practitioner consultations. However, there is a need for qualitative research to explore issues raised by the trials.

Methods.  A judgement sample of 10 patients consulting with a primary care nurse practitioner was drawn. In‐depth interviews were conducted and analysed thematically. The data were collected in 2000–2001.

Findings.  The following themes were identified in the data: time spent in the consultation; and time as a commodity in patients’ lives. Time matters to patients when they consult on their health, whether it is time to discuss problems or time saved as a result of having issues resolved, thus minimizing further visits. Factors associated with the style and emphasis of consultations are also important.

Conclusions.  Understanding the relationship between time, and style and emphasis of consultation may help to explain patients’ satisfaction with primary care nurse practitioners.
Issues in data generation using email group conversations for nursing research
Authors: Kralik Debbie , Price Kay , Warren Jim , Koch Tina
Published: January 2006

Aim.  The purpose of this paper is to provide an overview of the issues we have confronted when generating and analysing dialogue data by using electronic mail.

Background.  The decision to use email for our research arose from our developing understanding of some of the consequences of illness that people living with chronic illness confront in their lives. As researchers, we recognized the potential of the Internet for computer‐mediated communication using email for communication between researchers and research participants.

Discussion.  We consider the functional aspects of generating data by email, such as the software needed, and then explore the issues encountered during the research process including ethical considerations, fluctuating participation, participants’ familiarity with using email, facilitating lurkers towards participation, establishing group norms, and the role of the facilitator.

Conclusion.  As a collaborative inquiry, email conversation allowed us to spend time with participants over 2 years to explore chronic illness experience. However the scope and viability of computer‐mediated communication as a qualitative method of research remains relatively unexplored, hence this paper.
Nurses’ attitudes towards adult patients who are obese: literature review
Authors: Brown Ian
Published: January 2006

Aims.  This paper presents a review of all empirical studies focusing on nurses’ attitudes towards adult overweight or obese patients, with the aim of clarifying the dimensions and patterns of these attitudes and the methods by which they have been studied.

Background.  Obesity has become a common condition and a major public health concern, but it is often associated with negative attitudes and discrimination. Nurses play a key role in providing support and care to patients who are obese.

Methods.  Electronic searches were carried out on seven databases from inception to December 2004, along with hand‐searching of references in relevant studies. The search terms were built around obesity (and related terms), nursing (and its branches) and attitudes (and related terms). Eleven studies met the inclusion criteria. Data were extracted and summarized in tabular form and analysed in relation to the aims of this review during January 2005.

Findings.  There is relatively little research about nurses’ attitudes towards obese patients, and the studies reviewed mostly have weaknesses of sampling and measurement. However, they do consistently suggest that a proportion of nurses have negative attitudes and beliefs, reflecting wider stereotypes within Western cultures. There is also a hint of a more complex mix of attitudes among nurses, some of which may counter the consequences of negative attitudes, but these have not been adequately investigated. A number of variables that influence attitudes of nurses can be identified, including age, gender, experience and the weight/body mass index of the nurse.

Conclusion.  Further research (both qualitative and quantitative) is needed with more rigorous sampling and, where appropriate, more consistency of measurement. A shift in focus towards the sets of attitudes (positive as well as negative) and behaviours that influence health service quality and outcomes for obese persons would be useful.
Discursive patterns in multiprofessional healthcare teams
Authors: Kvarnström Susanne , Cedersund Elisabet
Published: January 2006

Aim. The aim of this paper is to report a study exploring how members of multiprofessional healthcare teams talk about their team. Specifically, the team members’ talk was analysed to explore the discursive patterns that emerged and their functions.

Background. Over recent decades there has been an increasing demand in Western countries to change care organizations and to coordinate resources and professional competencies to meet the needs of patients/service users better. Because society promotes this kind of work, it may be valuable to explore the self‐presentations of a multiprofessional healthcare team.

Methods. A discourse analysis was carried out on existing empirical data from focus group interviews with a member‐identified category sample comprising 32 healthcare professionals in six authentic multiprofessional teams in south‐east Sweden. The analysis focused on the participants’ discursive constructions of multiprofessional teamwork, on the way they talked about their group, and, in particular, on their use of the pronounswe,theyandI.

Findings. The constructions of ‘we’ by multiprofessional healthcare teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross‐learning and personal chemistry. The pronounwewas also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus.

Conclusion. These discursive patterns provided powerful rhetorical resources for team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (the others) by linking to a societal discourse that promotes collaboration.
Economics of home vs. hospital breastfeeding support for newborns
Authors: Stevens Bonnie , Guerriere Denise , McKeever Patricia , Croxford Ruth , Miller Karen‐Lee , Watson‐MacDonell Jo , Gibbins Sharyn , Dunn Michael , Ohlsson Arne , Ray Karen , Coyte Peter
Published: January 2006

Aim. This paper presents the findings of research comparing the incremental costs associated with the provision of home‐based vs. hospital‐based support for breastfeeding by nurse lactation consultants for term and near‐term neonates during the first week of life.

Background. A consequence of both consumer demands and increasing health resource constraints is that alternative care delivery models for safe, efficacious and cost‐effective breastfeeding programmes have steadily evolved. To date, the economic impact of the setting (home or hospital) where lactation support is delivered has received little research attention.

Methods. Mother–infant dyads were stratified by gestational age as term (>37 weeks gestational age;n = 101) or near term (35–37 weeks gestational age;n = 37) and randomized to standard hospital care and postpartum follow‐up (standard care), or to standard hospital care plus home support from certified nurse lactation consultants (experimental). Data collection occurred at study entry, hospital discharge and at a seventh day postpartum follow‐up session. Costs to the family (out‐of‐pocket and time costs) and to the healthcare system (during hospitalization and after hospital discharge) were measured. Total societal costs were defined as the sum of both family and healthcare system costs.

Results. Compared with standard hospital‐based care, home support by nurse lactation consultants showed no statistically significant differences in either time costs to the family or total societal costs. Term infants who received home support had statistically significantly greater postdischarge system costs (P < 0·0001), with a trend towards lower out‐of‐pocket expenses to their families (P = 0·12). There were no statistically significant differences between the two groups in overall combined family and healthcare system costs.

Conclusions. These results suggest that the cost of home lactation support programmes were comparable with the costs of hospital‐based standard care. Breastfeeding support at home by lactation consultants should be considered as an option as it was no more costly than support from lactation consultants in the hospital setting. The findings for near‐term infants need to be interpreted with caution, given the small sample size.
Using clinical skills laboratories to promote theory–practice integration during first practice placement: an Irish perspective
Authors: Morgan Raph
Published: January 2006

Aims and objectives.  This aim of this study was designed to investigate how a select cohort of nursing students experienced their first practice placement in a large Irish teaching hospital. The objectives of this study were to investigate whom do students learn from, what skills they learnt during their first practice placement and to identify if the use of clinical skills laboratories before their first practice placement helped students relate theory to practice during their first practice placement. The aim of this paper is to discuss if the sessions taught in the clinical skills laboratory prior to the first placement helped students integrate theory to practice during their first practice placement.

Background.  The debate regarding theory–practice integration has been ongoing in nursing for decades. Many studies across Europe have consistently demonstrated that the use of clinical skills laboratories have helped students integrate theory to practice during practice placements. Others have identified the difficulty students have relating theory to practice. However, as there appears to be a gap in current literature, from an Irish perspective, it is essential to highlight if Irish students can integrate theory to practice during their first practice placement.

Design.  A qualitative method incorporating the Heideggarian approach of phenomenology was utilized.

Methods.  A purposeful sampling technique was used to select six participants from all first year students. Interviews were conducted using a semi‐structured interview schedule. Data were analysed using the Giorgi method of analysing phenomenological data.

Results.  The participants identified that sessions taught in the clinical skills laboratory before the first practice placement, which they identified as ‘basic nursing skills such as taking and recording vital signs and hygiene needs of patients were useful and helped them to integrate theory to practice during their first practice placement. These results are relevant to this paper as they identify the use of teaching sessions in the clinical skills laboratories, enabling students to link theory to practice during practice placements.

Conclusions.  Nursing students must be adequately prepared to carry out clinical skills competently and efficiently. Educators and practitioners must display the knowledge and skills required to promote theory–practice integration, to enhance nursing students education, which in turn will optimize high standards of patient care.

Relevance to clinical practice.  Clinical skills laboratories are essential to help students develop the collaborative skills required for a profession like nursing. It is essential that students are adequately prepared to carry out clinical skills during their first practice placement, and have the ability to link theory to practice.
Use of technological equipment in critical care units: nurses’ perceptions in Greece
Authors: Kiekkas Panagiotis , Karga Maria , Poulopoulou Maria , Karpouhtsi Irini , Papadoulas Vasileios , Koutsojannis Constantinos
Published: January 2006

Aims and objectives.  The aim of this study was to determine the perceptions of nurses who work in critical care units about positive and negative effects related to the use of technological equipment and identify relationships between these perceptions and demographic characteristics of participants.

Background.  Previous researchers have investigated the perceptions of nursing personnel about the effects of technology on clinical practice. However, most of them focus on specific negative effects. Positive and negative effects have never been studied as a whole.

Design.  Critical care nurses were surveyed to elicit their perceptions regarding the use of technological equipment. The instrument comprised a 14‐item questionnaire and a series of demographic characteristics. A five‐point Likert scale was used for each of these 14 questions.

Methods.  The questionnaire was administered to 122 nurses working at the four critical care units of a major academic hospital in Patras, Greece, from 1/10/2003 to 31/12/2003. The completion of the questionnaires was achieved by means of a personal interview.

Results.  A total of 118 questionnaires were completed. The majority of nurses recognized the positive effects of equipment regarding patient care and clinical practice. At the same time, they agreed that use of equipment possibly leads to increased risk due to human errors or mechanical faults, increased stress and restricted autonomy of nursing personnel.

Conclusions.  The use of machines does not add to nursing prestige and this may be related to decreased autonomy. Human errors, mechanical faults and increased stress do not seem to come as a result of time constriction but rather of inadequate education. Undergraduate and continuing education should respond efficiently to the needs of contemporary critical care.

Relevance to clinical practice.  Recognition of positive and negative effects of machines through the investigation of perceptions of nurses is the first step before looking for ways of maximizing advantages and facing disadvantages of equipment use.