bluuebunny/crossref_metadata_2025 huggingface dataset:
Docosahexaenoic Acid in Red Blood Cells of Term Infants Receiving Two Levels of Long‐Chain Polyunsaturated Fatty Acids
Authors: Hoffman Dennis R. , Wheaton Dianna K. H. , James Kathy J. , Tuazon Myla , Diersen‐Schade Deborah A. , Harris Cheryl L. , Stolz Suzanne , Berseth Carol Lynn
Published: March 2006

Objectives:

A randomized, double‐blind, prospective trial assessed effects of different formula levels of polyunsaturated fatty acids on blood phospholipid docosahexaenoic (DHA; 22:6ω3) and arachidonic acids (ARA; 20:4ω6) in term infants at 120 days of age.

Methods:

Healthy, formula‐fed term infants (n = 78) were randomized to 1) routine milk‐based formula with 8 mg DHA, 21 mg ARA, 110 mg α‐linolenic (ALA; 18:3ω3), and 1,000 mg linoleic acids (LA; 18:2ω6) per 100 kcal (Lower‐long‐chain polyunsaturated fatty acids [LCPUFA]; n = 39) or 2) routine milk‐based formula with 17 mg DHA, 34 mg ARA, 85 mg ALA, and 860 mg LA per 100 kcal (Higher‐LCPUFA; n = 39). Fatty acid methyl esters from red blood cell (RBC) and plasma phospholipid fractions were assessed using capillary column gas chromatography.

Results:

Compared with infants fed Lower‐LCPUFA formula, the Higher‐LCPUFA group had significantly greater percentages of fatty acids as DHA in RBC phosphatidylethanolamine (PE), RBC phosphatidylcholine (PC), total RBC, and plasma phospholipids (P < 0.001). Infants fed Lower‐LCPUFA formula had higher percentages of precursor ω6 fatty acids in the desaturation/elongation pathway but lower percentages of ARA (RBC PE, RBC PC, and plasma phospholipid, P < 0.001; total RBC, P = 0.017) compared with the Higher‐LCPUFA group.

Conclusions:

Greater amounts of dietary ALA do not produce as great an increase in DHA in blood lipids as preformed dietary DHA. Infants fed DHA at levels similar to human milk had significantly greater percentage of DHAat 120 days of age compared with the Lower‐LCPUFA group despite higher precursor levels of ALA.
Electrogastrography in Pediatric Functional Dyspepsia
Authors: Friesen Craig A. , Lin Zhiyue , Hyman Paul E. , Andre Linda , Welchert Elly , Schurman Jennifer Verril , Cocjin Jose T. , Burchell Nanci , Pulliam Shelia , Moore Anne , Lavenbarg Teri , McCallum Richard W.
Published: March 2006

Objectives:

The aims of this study were to determine the electrogastrographic patterns in children with functional dyspepsia and to investigate the correlations among electrogastrogram (EGG), gastric emptying (GE), and pain severity.

Methods:

We studied 30 children (19 F; mean age 11.4 years) with functional dyspepsia. Electrogastrography was performed for 30 minutes fasting and for 1 hour during a GE test after ingestion of an isotope‐labeled solid meal. The percent emptying was measured every 10 minutes for 1 hour after the meal. The dominant frequency of the EGG, the change in the postprandial peak power (δP), and percent dysrhythmia during each recording session were calculated. Specific symptoms were graded from 0 (none) to 4 (severe) by the patient.

Results:

Of 30 patients, 14 (47%) had slow GE, and 15 (50%) had abnormal EGG (dysrhythmia ≥ 30% or δP < 0). GE was slow in 73% of patients with an abnormal EGG but was slow in only 20% of patients with normal EGG (P = 0.009). GE was negatively correlated with fasting bradygastria (r = −0.383, P = 0.04). Abdominal pain was the most severe dyspeptic symptom, both during fasting and after the meal. Patients with an abnormal EGG had an increased mean pain severity score (3.5 ± 0.2 vs. 2.5 ± 0.2, P = 0.002).

Conclusions:

Sixty percent of functional dyspepsia subjects had either slow GE or abnormal EGG. Patients with abnormal EGG were more likely to have slow GE. EGG abnormalities were associated with more severe postprandial pain and should be considered a possible mechanism for dyspeptic symptoms.
Estimates of Body Fat in Children by Hologic QDR‐2000 and QDR‐4500A Dual‐Energy X‐ray Absorptiometers Compared With Deuterium Dilution
Authors: Robotham Delphine R. , Schoeller Dale A. , Mercado Arlene B. , Mirch Margaret C. , Theim Kelly R. , Reynolds James C. , Yanovski Jack A.
Published: March 2006

We evaluated the accuracy with which the Hologic QDR‐4500A and QDR‐2000 densitometers measure fat mass (FM) in 95 children. FM was derived from total body water measured by deuterium dilution (DD) in all children, by QDR‐4500A in 50, and by QDR‐2000 in 45 children. Compared with DD, both instruments underestimated FM (QDR‐4500A: 3.35 ± 2.5 kg, P < 0.0001; QDR‐2000: 1.05 ± 1.5 kg, P < 0.0001). Both absorptiometers showed magnitude biases relative to DD (QDR‐4500: r = +0.70, P < 0.001; QDR‐2000: r = −0.51, P < 0.001). We conclude that neither densitometer is equivalent to DD for estimation of children's FM. The QDR‐4500A's current calibration seems to provide an even greater underestimate of FM than the QDR‐2000.
Neonatal Herpes Simplex Virus Infection Presenting as Acute Liver Failure
Authors: Verma Anita , Dhawan Anil , Zuckerman Mark , Hadzic Nedim , Baker Alastair J. , Mieli‐Vergani Giorgina
Published: March 2006

Background:

Acute liver failure (ALF) in neonates is rare but carries a high mortality without liver transplantation. Herpes simplex virus (HSV) is one of the microbes that more commonly causes ALF and is potentially treatable; hence, early diagnosis and treatment are important to avoid progression to liver failure.

Patients and Results:

We have analysed retrospectively the case notes of 11 patients with HSV‐induced ALF. A history of possible herpes infection was elicited in 5 parents, but HSV had not been suspected clinically. All patients were asymptomatic when discharged from postnatal units and were presented with nonspecific symptoms of poor feeding and lethargy within 2 weeks from birth. Seven of the 11 patients had HSV‐1 infection, 4 HSV‐2. Only 2 patients who received early treatment with intravenous acyclovir survived.

Conclusions:

HSV‐related ALF in the neonatal period carries high morbidity and mortality and needs a high index of suspicion so that life‐saving treatment can be started promptly. Both HSV‐1 and HSV‐2 can cause severe neonatal infection. It is important to recognise HSV infection in women of childbearing age and their sexual partners.
Collusion in Differentiated Duopolies with Quadratic Costs
Authors: Collie David R.
Published: March 2006

The analysis of collusion in infinitely repeated duopoly games has generally assumed that marginal cost is constant, but this note uses quadratic costs (linear marginal costs) to compare the sustainability of collusion under Bertrand and Cournot duopoly with differentiated products. It is shown that when marginal costs are sufficiently increasing in output, then it is always easier to sustain collusion under Cournot duopoly than under Bertrand duopoly for any degree of product substitutability.
Understanding Gender Differences in Context: Implications for Young Children's Everyday Lives
Authors: Morrow Virginia
Published: March 2006

This article reviews recent UK‐based research that has prioritised children's accounts of their experiences of their daily lives, and focuses on gender differences in these accounts of family life, friendships, use of public space, use of out‐of‐school care, popular culture and consumption, and children's views of gender differences—drawing mainly from research with children in middle childhood. It then discusses some of the implications for practice and training for a range of professionals working with children. The article suggests that a re‐evaluation of theories of gender differences in practitioner textbooks could usefully be undertaken to integrate more sophisticated, contextual notions of gender identities based on children's experiences. Copyright © 2006 The Author(s).
Locality Matters: Ethnic Segregation and Community Conflict—the Experience of Protestant Girls in Belfast
Authors: Healy Julie
Published: March 2006

Research continues to illustrate the resonance and intensity of feeling that attachment to a locality can generate, within this highlighting the gender‐specific impacts created by the intersection of ethnicity and locality. Within the ethnically segregated working class communities of Belfast, the importance of locality takes on added significance.

By focusing on a case study of Protestant girls aged 7–8 and 10–11 years living in a predominantly Loyalist community in Belfast, the study demonstrates the significance of locality and the girls’ experience of sectarian residential segregation and community conflict in Belfast. The findings highlight the importance of engaging with children to increase our understanding of their lived experiences and to inform policy and decision‐making on matters of importance to their lives. Copyright © 2006 Barnardo's Northern Ireland.
From Home to the Home Corner: Observing Children's Identity‐Maintenance in Early Childhood Settings
Authors: Brooker Liz
Published: March 2006

This article draws on data from two recent studies of young children in early childhood settings. One study was of children in a Korean private kindergarten, the other of children in a UK reception class. In each study, the data discussed include both evidence from ‘home’ (including parent interviews) and evidence from ‘school’ (including conversations with the children themselves) on the gendered and ethnic identities the children display in the classroom. The children's stated beliefs and preferences, and their observed choice of activities and friends, appear to be influenced both by the beliefs and behaviour of their families, and by the early childhood environments they are offered. The transition from home to group settings, it is suggested, may reinforce rather than diminish the stereotyping along gendered and ethnic lines, while participation in ‘research’ conversations may provide a rare opportunity for the children to question and reflect on stereotypes.  Copyright © 2006 The Author(s).
The Masculine Habitus as ‘Distributed Cognition’: A Case Study of 5‐ to 6‐Year‐Old Boys in an English Inner‐City, Multi‐Ethnic Primary School
Authors: Connolly Paul
Published: March 2006

This article provides a case study demonstrating the active role that 5‐ to 6‐year‐old boys in an English inner‐city, multi‐ethnic primary school play in the appropriation and reproduction of their masculine identities. It is argued that the emphasis on physicality, violence and racism found among the boys cannot be understood without reference to the immediate contexts of the local community and the school within which they are located. In making this argument the article draws upon and applies the concept of the habitus and develops this with the notion of ‘distributed cognition’ as proposed in sociocultural theory. Some of the implications of this analysis for working with boys in early years settings are discussed in the conclusion. Copyright © 2006 The Author(s).
The Mental Capacity Act 2005 – implications for anaesthesia and critical care
Authors: White S. M. , Baldwin T. J.
Published: March 2006

The Mental Capacity Act 2005 is due to come into force in April 2007. The Act provides a protective statutory framework for decision‐making on behalf of incompetent adults, representing, in the main, a codification of the common law that had already developed in this area. For example, ‘advance decisions’ are now given formal statutory recognition. Importantly, the Act creates a new specialist ‘Court of Protection’ to manage the Act's enforcement, and an office of ‘Public Guardian’ to act as registering authority for new ‘Lasting Powers of Attorney’ and ‘court‐appointed deputies’, both of which will be able to make proxy decisions about medical treatment for adult patients without capacity. There is also considerable regulation concerning the participation of adults without capacity in research. Given that their practice routinely involves the medical treatment of adults who lack legal capacity, anaesthetists and intensivists should familiarise themselves with the Act's key precepts.
Comparison of computer integrated patient controlled epidural analgesia vs. conventional patient controlled epidural analgesia for pain relief in labour
Authors: Lim Y. , Sia A. T. , Ocampo C. E.
Published: March 2006

Computer integrated‐patient controlled epidural analgesia (CI‐PCEA) is a novel drug delivery system. It automatically titrates the background infusion rate based on the individual parturient's need. In this randomised trial, we compared the local anaesthetic consumption by parturients using CI‐PCEA with demand only patient controlled epidural analgesia (PCEA) for labour analgesia. We recruited 40 parturients after approval by the ethics committee. Group PCEA (n = 20) received demand only PCEA. Group CI‐PCEA (n = 20) received a similar PCEA regimen but the computer integration titrated the background infusion to 5, 10 or 15 ml.h−1 if the patient required one, two or three demand boluses, respectively, in the previous hour. The background infusion decreased by 5 ml.h−1 if there was no demand bolus in the previous hour. The sample size was calculated to show equivalence in local anaesthetic used. The time weighted consumption of local anaesthetic was similar in both groups (mean difference 0.7 mg.h−1, 95% confidence interval [CI: −2.5, 1.1]; p = 0.425). The CI‐PCEA group had higher maternal satisfaction scores: mean (SD) 93 (7) vs. 86 (11), p = 0.042. CI‐PCEA does not increase the use of local anaesthetic when compared with demand only PCEA but does increase patient satisfaction.
Pseudohypoparathyroidism: a series of three cases and an unusual presentation of ocular tetany
Authors: Sunder R. A. , Singh M.
Published: March 2006

Pseudohypoparathyroidism is a heterogeneous group of disorders characterised by hypocalcaemia, hyperphosphataemia, increased serum parathormone and insensitivity to the biological activity of parathormone. These patients may present for incidental surgery, procedures related to kidney stones, cataract removals and renal transplants. No particular anaesthetic agent or technique is indicated except that respiratory alkalosis should be avoided as it may further decrease ionised calcium levels and thereby precipitate tetany. In this report, we present the peri‐operative management of three patients with this rare condition and describe an unusual presentation of hypocalcaemic extra‐ocular muscle spasm.
Urinary catecholamine excretion in tetanus
Authors: Thwaites C. L. , Yen L. M. , Cordon S. M. , Binh N. T. , T. N. , Nga Ngoc , White N. J. , Soni N. , MacDonald I. A. , Farrar J. J.
Published: March 2006

Imperfect understanding of the pathophysiology of tetanus has limited therapeutic advances. Autonomic disturbance is a major cause of mortality and is believed to be associated with catecholamine release, predominantly norepinephrine. We measured epinephrine and norepinephrine concentrations in 24‐h urine collections from tetanus and critically ill patients suffering from other severe diseases. In patients with severe tetanus, mean (SD) epinephrine was 164.18 (129.37) nmol.day−1 compared with 45.18 (37.74) nmol.day−1 in mild‐moderate disease (p = 0.008). In the severe group, mean (SD) norepinephrine was 411.64 (208.5), and 121.00 (81.81) nmol.day−1 in moderately ill patients (p < 0.001). Compared with critically ill control patients, median epinephrine was 331.77 in tetanus patients and 89.70 nmol.day−1 in controls (p < 0.001). Median norepinephrine concentration was 788.02 nmol.day−1 in tetanus and 300.05 nmol.day−1 in control patients, p = 0.006. The study finds a novel result of increased epinephrine excretion in tetanus and confirms that catecholamine excretion in tetanus exceeds that in other critically ill patients. These results should be considered in designing more effective therapeutic strategies.
A novel type II membrane receptor up‐regulated by IFN‐α in fibroblasts functions in cell proliferation through the JAK‐STAT signalling pathway
Authors: Liu L.‐D. , Dong C.‐H. , Shi H.‐J. , Zhao H.‐L. , Wang L.‐C. , Ma S.‐H. , Li Q.‐H.
Published: March 2006

Abstract.  A type II membrane protein similar to CD69 (TIIMPSC) has been isolated in human embryo fibroblasts treated with IFN‐α. Structural analysis and immunofluorescence detection has suggested that this protein is located on the surface of fibroblasts, generally considered, a receptor. Cell proliferation assay has revealed that activation of TIIMPSC elevates the level of fibroblast proliferation. Further, examination of signal transduction has indicated that expression of this protein is up‐regulated by IFN‐α stimulation, and that it is involved in the regulation of fibroblast growth through the JAK‐STAT signalling pathway.
Effects of rapamycin on number activity and eNOS of endothelial progenitor cells from peripheral blood
Authors: Chen T.‐G. , Chen J. Z. , Wang X.‐X.
Published: March 2006

Abstract.  The aim of this investigation is to determine whether rapamycin treatment has any effect on endothelial progenitor cells (EPCs). Total mononuclear cells (MNCs) were isolated from peripheral blood by Ficoll density gradient centrifugation, and then the cells were plated on fibronectin‐coated culture dishes. After 7 days in culture, attached cells were stimulated with rapamycin (in a series of final concentrations: 0.1, 1.0, 2.0 and 5.0 g/ml) for 6, 12, 24 and 48 h. EPCs were characterized as adherent cells, double positive for DiLDL uptake and lectin binding by direct fluorescence staining. EPC proliferation and migration were determined using the MTT assay and a modified version of the Boyden chamber assay, respectively. An EPC adhesion assay was performed by replating the cells on fibronectin‐coated dishes; adherent cells were then counted. Tube formation activity was assayed by using a tube formation assay kit and endothelial nitric oxide synthase (eNOS) was assayed by Western blot analysis. Incubation of isolated human MNCs with rapamycin decreased the number of EPCs present; rapamycin also decreased EPCs proliferative, migratory, adhesive, tube formation capacity and eNOS production in a concentration‐ and time‐dependent manner. Rapamycin was found to decrease the number, proliferative, migratory, adhesive and tube formation capacities of the EPCs, and also was found to decreases eNOS in the EPCs.
The historical analysis of aspirin discovery, its relation to the willow tree and antiproliferative and anticancer potential
Authors: Mahdi J. G. , Mahdi A. J. , Mahdi A. J. , Bowen I. D.
Published: March 2006

Abstract.  For several millennia, the willow tree and salicin have been associated with salicylic acid, the key precursor molecule that has contributed to the discovery of acetylsalicylic acid, traded as aspirin. These molecules have been shown to possess phyto‐ and chemotherapeutic activities as analgesic drugs. In recent decades, aspirin has become the focus of extensive investigation into antiproliferative and anticancer activities. The historical steps that led to the discovery of aspirin, and its antiproliferative and anticancer potential are highlighted in this review.
Subcutaneous tissue thickness in children with type 1 diabetes
Authors: Shin Hyunsook , Kim Mi Ja
Published: March 2006

Aim.  This paper reports a study to measure the thickness of subcutaneous tissue at three major injection sites and to identify frequently used injection sites and injection methods.

Background.  Glycaemic control is the key factor in the management of children with type 1 diabetes, and subcutaneous injection of insulin plays a major role in glycaemic control. However, only limited studies have examined the thickness of subcutaneous tissue at various injection sites.

Methods.  The subcutaneous thickness in a convenience sample of 65 children aged 8–16 years attending a diabetes camp in 2002 was measured once per child at the outer arm, anterior thigh, and abdomen by one investigator using a Lange caliper. Injection sites and the method of injection were observed daily for four days by a trained investigator using a checklist.

Results.  Median values of subcutaneous thicknesses at the outer arm, anterior thigh, and anterior abdomen for girls were respectively 18·00, 18·00 and 19·75 mm, and for boys were 17·00, 12·50 and 17·00 mm. In 40% of participants, the thickness of the subcutaneous tissue of the abdomen was <12·5 mm. Boys over 14 years old had statistically significantly thinner subcutaneous tissue at all injection sites than that of age‐matched girls. The anterior abdomen was the most common injection site in boys, and the anterior thigh in girls. Perpendicular injection without skin‐folding was the most frequently used injection method. Body Mass Index was statistically significantly correlated with subcutaneous tissue thickness at all sites.

Conclusion.  A needle shorter than a 12·5‐mm needle should be used, particularly for boys. Injection with skin‐folding may decrease the possibility of intramuscular injection.
Collaboration and control: nurses’ constructions of the role of family in nursing home care
Authors: Bauer Michael
Published: March 2006

Aim. This paper reports a study examining how nursing home staff experienced working with residents’ families.

Background. Working collaboratively with the family in residential aged care to provide care is consistent with nursing philosophy. The quality of the experience, however, is frequently fraught with problems for both the family and staff involved. Little research has focused on the nature of family involvement in nursing homes from the perspective of nursing home staff.

Methods. The study adopted a naturalistic paradigm. Data were collected from 30 nursing home staff members drawn from a range of metropolitan and rural facilities in Victoria, Australia by means of conversational in‐depth interviews. Issues concerned with how participants constructed the role of the family in the nursing home were explored. The data were collected in 2001–2002.

Results. Four key elements are presented in this paper: (1)Making the transition; (2)Forming ties; (3)Keeping them at a distanceand (4)Unacceptable behaviour. Some nursing home staff have developed a substantive family orientation and had adopted practices which were inclusive of the family. Equally, many attitudes which cast the family into an adversarial and competitive role were noted, and many staff members outlined practices which were indicative of a need to control the family.

Conclusion. A rhetoric of family partnerships is prevalent in some nursing homes. The activities of staff in these homes are still primarily geared towards provision of physical care, and families’ needs become secondary to getting the work done. A new model of practice is needed that sees working collaboratively with families as a legitimate and necessary part of the staff role.
Role of nurses in institutional ethics policies on euthanasia
Authors: Gastmans Chris , Lemiengre Joke , de Casterlé Bernadette Dierckx
Published: March 2006

Aim.  This paper reports the findings of a survey that investigated whether Flemish Catholic hospitals and nursing homes had developed written ethics policies on euthanasia and how the role of nurses was described in these policies.

Background.  International research shows undeniably that nurses are confronted with patients requesting euthanasia. Euthanasia has been legal in Belgium since 2002 and in Holland since 2001. Because of the vagueness in formal documents and policies on the role of nurses in euthanasia, there is an increasing need to establish institutional ethics policies that clearly describe the role of nurses in the euthanasia process.

Methods.  We used a cross‐sectional descriptive mail questionnaire to survey the general directors of Catholic hospitals and nursing homes in Belgium (Flanders). Data were collected between October 2003 and February 2004.

Results.  Of the 298 institutions targeted for survey, 81% of hospitals, 62% of nursing homes returned completed questionnaires. Of these, 79% of the hospitals and 30% of the nursing homes had a written ethics policy on euthanasia. The ethics policies of 87% of the hospitals and 77% of the nursing homes explicitly addressed the role of nurses in the euthanasia process. In the majority of hospitals and nursing homes, the ethics policies addressed the conscientious objections of nurses to euthanasia. Most hospitals and nursing homes voluntarily communicated their ethics policies to the nurses they employed.

Conclusion.  The written ethics policies of most Catholic healthcare institutions give explicit attention to the role of nurses in the euthanasia process. However, the meaning and content of the role of nurses, as indicated in these ethics policies, continue to be an issue. Further research is needed to verify how these policies are actually implemented within the institutions and whether they contribute to better support for nurses and to ethical care for patients.
Discourse analysis: theoretical and historical overview and review of papers in the Journal of Advanced Nursing 1996–2004
Authors: Traynor Michael
Published: March 2006

Aim.  The aim of the paper is (1) to offer an overview of different theoretical approaches to discourse analysis and (2) to review papers published in the Journal of Advanced Nursing from 1996–2004 in which discourse analysis is identified as a method of data analysis.

Background.  Discourse analysis offers rigorous approaches to analysing naturally occurring talk and texts. Forms of discourse analysis have developed across broad theoretical bases. Such development has created challenges for researchers wishing to adopt this methodology and readers wishing to evaluate the quality of discourse analytic work.

Methods.  First, key documents which describe the theoretical range of discourse analysis are used to provide (i) a comprehensive overview of the approach, (ii) the identification of categories of discourse analysis and (iii) minimum criteria for determining if an individual paper can realistically claim to be adopting discourse analysis. Secondly, an electronic search followed by hand search of the Journal of Advanced Nursing full‐ contents between 1996 and 2004 was undertaken. The papers were grouped into the types of approach identified in i, and evaluated to see whether they met the ‘minimum criteria’ also identified in i.

Findings.  The search of Journal of Advanced Nursing revealed 24 papers where the authors stated that discourse analysis was among the methods or was the sole method of data analysis. The majority of the papers cluster around critical approaches to discourse analysis. Only a few approach discourse analysis primarily as analysis of conversation. Some papers are excellent, while others offer analysis that bears little resemblance to any form of discourse analysis.

Conclusions.  A strategy for improvement could include more rigorous attention on the part of those practising discourse analysis to methodology and the key features that differentiate the different approaches to discourse analysis from other qualitative methods. Authors should include sufficient detail of their approach.
Issues in weaning from mechanical ventilation: literature review
Authors: Rose Louise , Nelson Sioban
Published: March 2006

Aim.  The aim of this paper is to raise questions on the effect of skill mix and organizational structure on weaning from mechanical ventilation.

Background.  Mechanical ventilation is an essential life‐saving technology. There are, however, numerous associated complications that influence the morbidity and mortality of patients receiving intensive care. Therefore, it was essential to use the safest and most effective form of ventilation for the shortest possible duration. Because of the potential complications and costs of mechanical ventilation, research to date have focused on accurate weaning readiness assessment, methods and organizational aspects that influence the weaning process.

Method.  In early 2005, the literature was reviewed from 1986 to 2004 by accessing the following databases: Medline, Proquest, Science Direct, CINAHL, and Blackwell Science. The keywords mechanical ventilation, weaning, protocols, critical care, nursing role, decision‐making and weaning readiness were used separately and combinations.

Discussion.  Controversy exists in weaning practices about appropriate and efficacious weaning readiness assessment indicators, the best method of weaning and the use of weaning protocols. Arguably, the implementation of weaning protocols may have little effect in an environment that favours collaboration between nursing and medical staff, autonomous nursing decision‐making in relation to weaning practices, and high numbers of nurses qualified at postgraduate level.

Conclusion.  Further research is required that better quantifies critical care nurses’ role in weaning practices and the contextual issues that influence both the nursing role and the process of weaning from mechanical ventilation.
Feeding and dementia: a systematic literature review
Authors: Watson Roger , Green Sue M.
Published: March 2006

Aim.  This paper reports a systematic review of the literature on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty between 1993 and 2003.

Background.  Older people with dementia commonly experience difficulty with feeding, especially in the later stages of the condition. This topic and related nursing care was reviewed in 1993 and the conclusion was that there was little research into interventions that nurses could use to alleviate feeding difficulty.

Method.  A systematic review of the literature was carried out using the CINAHL, Medline, EMBASE and Cochrane databases and the search terms ‘feeding’, ‘eating’ and ‘dementia’ combined as follows: ‘(feeding or eating) and (dementia)’. A second search was carried out combining the search terms ‘mealtimes’ and ‘dementia’ as follows: ‘mealtimes and dementia’. The literature search was carried out on 1 December 2003 and papers were included in the review if retrieved by 31 December 2003. English language papers only were retrieved.

Results.  Sixty‐seven papers were retrieved, of which 13 addressed interventions aimed at helping older people with dementia to feed. All studies reported positive outcomes but only one randomized controlled trial was reported. Music was the most common intervention but there were no standardized interventions or outcomes across the studies and none reported the use of power analysis to decide on sample size. There were problems in some studies with confounding variables.

Conclusions.  Further research is needed into interventions aimed at how nurses can help older people with dementia to feed. There are some promising lines of enquiry, with music being one of these, but future studies need to use adequate samples and to use power calculations and account adequately for confounding variables. There is also a need to standardize interventions and outcomes across such studies to facilitate meta‐analysis.
Risk assessment scales for pressure ulcer prevention: a systematic review
Authors: Pancorbo‐Hidalgo Pedro L. , Garcia‐Fernandez Francisco Pedro , Lopez‐Medina Isabel Ma , Alvarez‐Nieto Carmen
Published: March 2006

Aim.  This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer.

Background.  Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses’ clinical judgement. However, some of these have not undergone proper validation.

Method.  A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review.

Findings.  Thirty‐three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57·1%/67·5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4·08, CI 95% = 2·56–6·48). The Norton Scale has reasonable scores for sensitivity (46·8%), specificity (61·8%) and risk prediction (OR = 2·16, CI 95% = 1·03–4·54). The Waterlow Scale offers a high sensitivity score (82·4%), but low specificity (27·4%); with a good risk prediction score (OR = 2·05, CI 95% = 1·11–3·76). Nurses’ clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50·6%) and specificity (60·1%), but is not a good pressure ulcer risk predictor (OR = 1·69, CI 95% = 0·76–3·75).

Conclusion.  There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses’ clinical judgement in predicting pressure ulcer risk.
Differential working memory impairment in bipolar disorder and schizophrenia: effects of lifetime history of psychosis
Authors: Glahn David C , Bearden Carrie E , Cakir Sibel , Barrett Jennifer A , Najt Pablo , Serap Monkul E , Maples Natalie , Velligan Dawn I , Soares Jair C
Published: March 2006

Background:  Although bipolar disorder and schizophrenia have long been viewed as distinct illnesses, there is growing evidence that these two complex diseases share some common genes, which may manifest as overlapping neuropsychological impairments. Although working memory dysfunction has been proposed to be central to the pathophysiology of schizophrenia, it has received less attention in studies of bipolar disorder.

Method:  We applied measures of working memory to patients with schizophrenia (n = 15), patients with schizoaffective disorder (n = 15), patients with psychotic (n = 11) and non‐psychotic (n = 15) bipolar disorder, and demographically matched healthy subjects (n = 32), in order to determine the extent to which these groups show common or unique impairments.

Results:  While patients with bipolar disorder (with and without psychotic features) and those with schizophrenia/schizoaffective disorder were impaired on backward digit span, only patients with a lifetime history of psychotic features, regardless of diagnosis, were impaired on spatial delayed response task.

Conclusions:  Backward digit span performance is comparable in bipolar disorder and schizophrenia, and may be an appropriate endophenotypic marker that cuts across diagnostic categories. In contrast, spatial working memory performance clearly distinguishes non‐psychotic bipolar disorder patients from patients with functional psychosis.
Life‐Chart Methodology: a long past and a short history
Authors: Livianos‐Aldana Lorenzo , Rojo‐Moreno Luis
Published: March 2006

Objectives:  Nowadays, the use of the Life‐Chart Methodology is common in bipolar disorder clinics. Our aim was to present a chart from the Archives of the University Heidelberg (Germany).

Methods:  The clinical case records dating from Emil Kraepelin's direction of the Psychiatric Clinic at Heidelberg were systematically screened.

Results:  Among the clinical records of patients suffering from manic depressive illness we located one record with a detailed charting of the clinical course.

Conclusions:  The chart reviewed shows that the Life‐Chart Method was used more than a hundred years ago and for the same purpose, as an aid to clinicians.
Effects of lamotrigine and lithium on body weight during maintenance treatment of bipolar I disorder
Authors: Sachs Gary , Bowden Charles , Calabrese Joseph R , Ketter Terence , Thompson Thomas , White Robin , Bentley Beth
Published: March 2006

Objective:  The effect of lamotrigine maintenance therapy on body weight was assessed retrospectively in analyses of data from two double‐blind, placebo‐ and lithium‐controlled, 18‐month studies in patients with bipolar I disorder (n = 227 for lamotrigine, 190 for placebo, 166 for lithium).

Methods:  Endpoints included mean change in weight, the percentage of patients with ≥7% change (increase, decrease, fluctuation) in weight, and the percentage of patients with weight‐related adverse events during double‐blind treatment.

Results:  Mean weight remained stable during maintenance therapy with lamotrigine. In a mixed‐model repeated‐measures analysis, mean changes in weight (kg) at week 52 were −1.2 with lamotrigine, +0.2 with placebo, and +2.2 with lithium [estimated difference (95% CI) lamotrigine minus placebo = −1.3 (−3.6, 0.9), p = 0.237; lithium minus placebo = +2.0 (−0.3, 4.4), p = 0.094; lithium minus lamotrigine = +3.4 (1.4, 5.4), p < 0.001]. Analyses were truncated at week 52 because of the high incidence of missing data at later time points. The percentages of patients with a ≥7% weight gain, during randomized treatment, were 10.9%, 7.6% and 11.8% for the lamotrigine, placebo, and lithium groups, respectively. The percentages of patients with a ≥7% weight loss, during randomized treatment, were 12.1%, 11.5%, and 5.1% for the lamotrigine, placebo, and lithium groups, respectively. The percentage of patients with a ≥7% weight loss did not significantly differ between lamotrigine and placebo but was significantly higher with lamotrigine than lithium. The incidences of ≥7% weight changes and of weight changes reported as adverse events were comparable between active treatments and placebo.

Conclusion:  Lamotrigine was associated with stable body weight during 1 year of treatment and was comparable to placebo in mean weight change, incidence of clinically significant weight change, and incidence of weight changes reported as adverse events in patients with bipolar disorder. Lithium was associated with weight gain, but the magnitude of lithium‐associated weight gain was lower in the current analysis than in previous studies.
Prospective open‐label study of pharmacokinetics, efficacy and safety of a new 10% liquid intravenous immunoglobulin in patients with hypo‐ or agammaglobulinemia
Authors: Björkander J. , Nikoskelainen J. , Leibl H. , Lanbeck P. , Wallvik J. , Lumio J. T. , Braconier J. H. , Pavlova B. G. , Birthistle K. , Engl W. , Walter S. , Ehrlich H. J.
Published: March 2006

Background and Objectives The aim of this study was to evaluate the pharmacokinetics, efficacy and safety of a newly developed 10% liquid immunoglobulin preparation in patients with primary immunodeficiency diseases. This new preparation for intravenous use includes three dedicated virus clearance steps in its manufacturing process to ensure a high margin of viral safety.

Materials and Methods This was a prospective, open‐label, non‐controlled, multicentre study. Twenty‐two subjects with primary immunodeficiency were treated initially with three infusions of a licensed intravenous immunoglobulin to standardize the immunoglobulin G (IgG) replacement therapy of all subjects to the same intravenous product. A total of nine infusions of the new 10% liquid preparation were subsequently administered.

Results The median terminal half‐life of total IgG following administration of the new preparation was 30·1 days. Median terminal half‐lives for IgG subclasses IgG1, IgG2, IgG3and IgG4were 28·3, 31·3, 20·9 and 24·2 days, respectively. The median total serum IgG steady‐state trough level was 8·51 g/l. No severe infection episodes started after initiation of treatment with the new preparation. The median rate of mild or moderate infection episodes was 0·48 per month. A total of 194 infusions with the new 10% liquid immunoglobulin preparation were administered. The mean dose per infusion was 0·41 g/kg body weight and the maximum infusion rates recorded were 8 ml/kg/h. Adverse experiences were mostly mild and unrelated to the study drugs. Only 4% of infusions with the new product were followed by one or more related adverse experiences.

Conclusion The new 10% liquid immunoglobulin preparation was well tolerated and shown to have an excellent pharmacokinetic, efficacy and safety profile. The liquid formulation provides convenience to patients and healthcare professionals.
Pall leukotrap affinity prion‐reduction filter removes exogenous infectious prions and endogenous infectivity from red cell concentrates
Authors: Sowemimo‐Coker S. O. , Pesci S. , Andrade F. , Kim A. , Kascsak R. B. , Kascsak R. J. , Meeker C. , Carp R.
Published: March 2006

Background and Objectives  Three recent probable cases of transmission of a variant of human Creutzfeldt–Jakob disease (vCJD) through blood transfusion suggest that the disease can be transmitted through transfusion of blood components from presymptomatic blood donors. In this study, we investigated the performance of a new filter for reducing the levels of infectious prions (PrPSc) from red cell concentrates (RCC).

Materials and Methods  Endogenous Infectivity: A pool of 500 ml of whole blood was collected from 263K‐strain scrapie‐infected hamsters into an anticoagulant, processed into non‐leucoreduced RCC (NL‐RCC), and then passed through a prion‐reduction filter. Pre‐ and postfiltration samples were tested for PrPSc by Western blot and infectivity by inoculation of healthy hamsters. Results of the endogenous infectivity study after 200 days post‐inoculation are discussed. Exogenous (Spiking) Study: Scrapie‐infected hamster brain homogenates containing PrPSc were added to human RCC and then filtered. Levels of PrPSc were determined by Western blot assay. The effect of prior leucodepletion of ‘spiked’ RCC on PrPSc removal by the prion‐removal filter was also assessed.

Results In the endogenous infectivity study, at 200‐day observation time, the prefiltered RCC transmitted disease to six of the 187 hamsters, whereas the filtered RCC did not transmit disease to any of 413 animals, P = 0·001. The prion filter also significantly reduced the concentration of leucocytes in the RCC by about 4 logs, P < 0·05. In the exogenous (spiking) study, the level of PrPres was significantly reduced in RCC P < 0·05. Prior leucodepletion of the RCC with a leucoreduction filter did not significantly reduce the concentration of exogenously spiked PrPSc, P > 0·05.

Conclusion  The use of this new prion‐reduction filter should reduce the risk of vCJD transmission through transfusion of RCC, the most widely transfused blood component.
A crack tip field estimation technique for the high‐temperature cyclic loading of structures
Authors: HABIBULLAH M. S. , PONTER A. R. S.
Published: March 2006

The purpose of this paper is to present a methodology for the assessment of the near‐crack tip fields in structures operating at elevated temperatures in the creep range and subjected to cyclic mechanical and thermal loads. The method involves generating simplified extreme solutions, which corresponds to very short (rapid cycle) and long (slow cycle) cycle times, bounding the behaviour for intermediate cycle times. In such situations, by examining the increments of strain over a cycle of loading at the crack tip, the solutions may be related to the HRR fields and, hence, related to an equivalent constant load. Here, these solutions are generated using a nonlinear programming method, the linear matching method (LMM), on two bounding constitutive relationships with identical uniaxial data, Norton's law and the Bailey–Orowan model. These solutions are generated for the classical cracked axisymmetric Bree problem, presented as a contour of an equivalent path‐independent integral in creep, C*, by using a sampling point within an identified best‐matched HRR field.
A Test of Basic Assumptions of Affective Events Theory (AET) in Call Centre Work1
Authors: Wegge Jürgen , Dick Rolf van , Fisher Gary K. , West Michael A. , Dawson Jeremy F.
Published: March 2006

Based on data from 2091 call centre representatives working in 85 call centres in the UK, central assumptions of affective events theory (AET) are tested. AET predicts that specific features of work (e.g. autonomy) have an impact on the arousal of emotions and moods at work that, in turn, co‐determine job satisfaction of employees. AET further proposes that job satisfaction is an evaluative judgement that mainly explains cognitive‐based behaviour, whereas emotions and moods better predict affective‐based behaviour. The results support these assumptions. A clear separation of key constructs (job satisfaction, positive and negative emotions) was possible. Moreover, correlations between several work features (e.g. supervisory support) and job satisfaction were, in part, mediated by work emotions, even when controlling for gender, age, call centre type (in‐house versus outsourced centres) and call centre size. Predictions regarding consequences of satisfaction and affect were partly corroborated as continuance commitment was more strongly related to job satisfaction than to positive emotions. In addition, affective commitment and health complaints were related to both emotions and job satisfaction to the same extent. Thus, AET is a fruitful framework for explaining why and how specific management strategies used for designing work features influence important organizational attitudes and well‐being of employees.
Classification of Illumination Methods for Mixed Reality
Authors: Jacobs Katrien , Loscos Céline
Published: March 2006

A mixed reality (MR) represents an environment composed both by real and virtual objects. MR applications are used more and more, for instance in surgery, architecture, cultural heritage, entertainment, etc. For some of these applications it is important to merge the real and virtual elements using consistent illumination. This paper proposes a classification of illumination methods for MR applications that aim at generating a merged environment in which illumination and shadows are consistent. Three different illumination methods can be identified: common illumination, relighting and methods based on inverse illumination. In this paper a classification of the illumination methods for MR is given based on their input requirements: the amount of geometry and radiance known of the real environment. This led us to define four categories of methods that vary depending on the type of geometric model used for representing the real scene, and the sdifferent radiance information available for each point of the real scene. Various methods are described within their category.

The classification points out that in general the quality of the illumination interactions increases with the amount of input information available. On the other hand, the accessibility of the method decreases since its pre‐processing time increases to gather the extra information. Recent developed techniques managed to compensate unknown data with clever techniques using an iterative algorithm, hardware illumination or recent progress in stereovision. Finally, a review of illumination techniques for MR is given with a discussion on important properties such as the possibility of interactivity or the amount of complexity in the simulated illumination.