bluuebunny/crossref_metadata_2025 huggingface dataset:
Nurses Improving Care for Healthsystem Elders – a model for optimising the geriatric nursing practice environment
Authors: Capezuti Elizabeth , Boltz Marie , Cline Daniel , Dickson Victoria Vaughn , Rosenberg Marie‐Claire , Wagner Laura , Shuluk Joseph , Nigolian Cindy
Published: October 2012

Aims and objectives.  To explain the relationship between a positive nurse practice environment (NPE) and implementation of evidence‐based practices. To describe the components of NICHE (Nurses Improving Care for Healthsystem Elders) programmes that contribute to a positive geriatric nursing practice environment.

Background.  The NPE is a system‐level intervention for promoting quality and patient safety; however, there are population‐specific factors that influence the nurses’ perception of their practice and its’ relationship with patient outcomes. Favourable perceptions of the geriatric‐specific NPE are associated with better perceptions of geriatric care quality.

Designs.  Discursive paper.

Method.  In this selective critical analysis of the descriptive and empirical literature, we present the implementation of geriatric models in relation to the NPE and components of the NICHE programme that support hospitals’ systemic capacity to effectively integrate and sustain evidence‐based geriatric knowledge into practice.

Results.  Although there are several geriatric models and chronic care models available, NICHE has been the most successful in recruiting hospital membership as well as contributing to the depth of geriatric hospital programming.

Conclusions.  Although all geriatric care models require significant nursing input, only NICHE focuses on the nursing staff’s perception of the care environment for geriatric practice. Studies in NICHE hospitals demonstrate that quality geriatric care requires a NPE in which the structure and processes of hospital services focus on specific patient care needs.

Relevance to clinical practice.  The implementation of evidence‐based models addressing the unique needs of hospitalised older adults requires programmes such as NICHE that serve as technical resources centre and a catalyst for networking among facilities committed to quality geriatric care. Unprecedented international growth in the ageing population compels us to examine how to adapt the successful components of NICHE to the distinctive needs of health systems throughout the world that serve older adults.
Determination of older people’s level of loneliness
Authors: Koc Zeliha
Published: October 2012

Aims and objectives.  To determine levels of loneliness of individuals aged 60 and above.

Background.  Loneliness stands out as a social problem observed amongst old individuals living in both urban and rural areas.

Design.  Descriptive study.

Methods.  A total of 330 individuals aged 60 and above who visited a local health care centre at Sinop, Turkey, because of various health problems are included in the research. Data were collected using a questionnaire that determines the patients’ socio‐demographics and clinic specifications and uses the UCLA Loneliness Scale, Satisfaction with Life Scale and the instrumental activities of daily living list. For data analysis, percentage calculation, one‐way anova, the student t‐test and regression analysis were used.

Results.  It has been determined that older people’s UCLA Loneliness Scale point average is 47·3 ± 8·6; most of them (49·1%) were seen to have a middle‐level loneliness point. Older people’s Satisfaction with Life Scale point average has been determined as 12·7 ± 6·8. There is no statistically meaningful relationship between older people’s life‐satisfaction score average and socio‐demographic and clinical specifications (p > 0·05). Older people’s points in IADL are 18·8 ± 7·6. Most of them are independent in terms of fulfilment of the instrumental activities.

Conclusions.  In the study, when compared with the other groups, loneliness point averages were found significantly higher for men, those who had never married, primary school graduates, the childless, those who lived alone, those had a chronic disease or those who used continual medication.

Relevance to clinical practice.  The social and health care systems need to recognise and address loneliness problems amongst older people. It is important to develop and test new interventions aimed at alleviating loneliness.
The diagnostic value of the numeric pain rating scale in older postoperative patients
Authors: van Dijk Jacqueline FM , Kappen Teus H , van Wijck Albert JM , Kalkman Cor J , Schuurmans Marieke J
Published: October 2012

Aims and objectives

To measure the diagnostic value of the Numeric Rating Scale by comparing it to a Verbal Rating Scale in older patients.

Background

Pain management in older patients is an important challenge because of their greater susceptibility to adverse effects of analgesics. Nurses play an important role in applying guidelines for postoperative pain treatment. However, effective pain management is dependent upon valid and reliable pain assessment.

Design

Cross‐sectional study.

Methods

In total, 2674 older patients scored their postoperative pain on an 11‐point numeric rating scale (NRS) and an adjective scale (VRS) including no pain, little pain, painful but bearable, considerable pain and terrible pain. The diagnostic value of different NRS cut‐off values for administering analgesics is determined by an ROC curve.

Results

Sensitivity of NRS > 3 for ‘unbearable’ pain in older patients was 72% with a specificity of 97·2%. With a cut‐off point NRS > 4, sensitivity increased to 83%, while specificity was 96·7%. With a cut‐off point NRS > 5, sensitivity was 94%, while specificity was 85%. A high proportion (75%) of older old patients (≥ 75 years) with ‘painful but bearable’ considers NRS 4, 5 and 6 to this VRS category.

Conclusion

Using an NRS cut‐off point > 3 or > 4, a large group of older patients with ‘bearable’ pain would incorrectly classified as ‘unbearable’. When we make the assumption that bearable pain means no wish for additional analgesics, this misclassification might result in overtreatment with analgesics, while 3% would be undertreated. With NRS cut‐off point > 5, 6% have a risk of overtreatment and 15% of undertreatment.

Relevance to clinical practice

Nurses should not rely solely on the NRS score in determining pain treatment; they need to communicate with older patients about their pain, the need for analgesics and eventual misconceptions about analgesics.
Systematic pain assessment using an observational scale in nursing home residents with dementia: exploring feasibility and applied interventions
Authors: Zwakhalen Sandra MG ,  van't Hof Charlotte E , Hamers Jan PH
Published: October 2012

Aims and objectives

To investigate the feasibility of regular pain assessment using an observational scale in nursing home residents with dementia and; determine interventions applied after diagnosing possible pain.

Background

Pain occurs regularly among nursing home residents with dementia and is frequently undertreated. Over the last decade a variety of observational scales have been developed to assess pain in elderly people with dementia. One of these observational scales is pain assessment using an observational scale. There are indications that the regular use of pain assessments scales can contribute to an adequate diagnosis of pain and therefore would improve pain treatment.

Design

In this exploratory descriptive observational study regular pain assessment using an observational scale as an intervention was evaluated.

Methods

Data were collected during a 6‐week period (August–September 2009) where pain was measured twice a week among 22 residents of a psychogeriatric nursing home ward, using the pain assessment using an observational scale scale. Interventions undertaken as a result of the pain score were recorded on a datasheet. After the third and sixth week the implementation of pain assessment was evaluated with staff members using interviews.

Results

In total, 264 pain assessments were conducted using the pain assessment using an observational scale. Of all scheduled standardized assessments, 90% were completed. Sixty out of 264 assessment resulted in a pain score. The completed datasheets (n = 39), including information on the selected intervention and the reason for selecting a specific intervention, showed that a pain score (n = 17) did not often result in any intervention. The majority of interventions undertaken consisted of a non‐pharmacological approach (n = 19).

Conclusion

This study demonstrates that although there was a high compliance rate, pain relieving interventions were not frequently applied. Interventions undertaken after pain assessment were mainly non‐pharmacological.

Relevance to clinical practice

Providing nursing staff with adequate pain assessment tools alone is not sufficient to change the pain management practices.
Decision‐making related to complementary and alternative medicine use by people with Type 2 diabetes: a qualitative study
Authors: Chang Hsiao‐Yun Annie , Wallis Marianne , Tiralongo Evelin , Wang Hui Lan
Published: October 2012

Aims and objectives

To explore how complementary and alternative medicine (CAM) users make decisions about CAM use. Specifically, an exploration of the processes used by people with Type 2 diabetes, related to the assessment of information sources, factors influencing decision‐making and the role of other key individuals, was undertaken.

Background

Patients with chronic illnesses increasingly seek to use CAM to improve their well‐being. Currently, however, the decision‐making processes related to CAM use among people with Type 2 diabetes are poorly understood.

Methods

An exploratory study using a naturalistic design, with in‐depth semi‐structured interviews, was undertaken. Purposive sampling was used to recruit participants with Type 2 diabetes who used CAM alongside conventional medicine. The data were analysed in a three‐step coding process. Ethical approval was gained from a human research ethics committee.

Results

Evidence about CAM use from interview data was consistent with a multi‐dimensional decision‐making processes used by participants. Four major categories emerged: recognising the need for using CAM; assessing the potential CAM before use; matching CAM use to personal philosophy; and ongoing evaluation of CAM.

Conclusion

As diabetes affects the entirety of a person's being self‐management, incorporating CAMs has become a way of controlling the condition and improving well‐being. It is important for health professionals to consider clients' CAM use and to incorporate this information, where appropriate, into management plans.

Relevance to clinical practice

Health care professionals should be aware of patients who use CAM while under conventional medical care and should discuss CAM use at various points in the client journey to facilitate better communication.
Sex offenders with intellectual disabilities and their academic observers: popular methodologies and research interests
Authors: Hollomotz A.
Published: October 2012

Background

Over the past two decades, disability activists and scholars have developed research paradigms that aim to place (some of the) control over the research process in the hands of disabled people. This paper discusses the appropriateness of applying such paradigms to sex offenders with intellectual disabilities (ID). It exposes to what extent current research about this population is affected by these developments.

Methods

A content analysis of a sample of 80 articles across 20 academic journals was carried out. This recorded the data collection methods used, to what extent the views of people with ID were represented, subject affiliations of the authors and the subject matter discussed.

Results

Few studies make sense of the personal accounts of this population. Social scientists have mostly not engaged in this area of research, which results in significant gaps in knowledge.

Conclusions

We currently know little about the subjectivity of sex offenders with ID. Research that seeks to explore this may enhance our understanding of this population and thus contribute towards the effectiveness of preventative work and risk management.
Corrigendum: Strange bedfellows: glacial diamictite and cap carbonate from the Marinoan (635 Ma) glaciation in Namibia
Authors: HOFFMAN PAUL F.
Published: October 2012

Tectonic fold tests conducted in Namibia demonstrate that the inclination with respect to bedding of geoplumb (palaeovertical) tubular structures in the Marinoan (635 Ma) syndeglacial cap dolostone is mainly the result of tectonic strain. Therefore, tubestone inclination data cannot be used to estimate the gradient of the sea floor on the foreslope of the Otavi carbonate platform during the Marinoan glaciation. A gradient steeper than 0·1 (slope angle ca 5·7°), implying a glacial base‐level fall ≥0·5 km, is nevertheless supported by boulder‐size intraclast debrite in the falling‐stand wedge directly beneath the glacigenic sequence. Cryogenian oceans lacked skeletal carbonate production, raising the carbonate saturation state and persistent deep water anoxia excluded acid‐producing aerobic respiration, facilitating early diagenetic carbonate precipitation, lithification and steep submarine slopes.
Quantification of the relation between surface morphodynamics and subsurface sedimentological product in sandy braided rivers
Authors: Parker Natalie O. , Sambrook Smith Gregory H. , Ashworth Philip J. , Best James L. , Lane Stuart N. , Lunt Ian A. , Simpson Christopher J. , Thomas Roberte.
Published: October 2012

This study uses digital elevation models and ground‐penetrating radar to quantify the relation between the surface morphodynamics and subsurface sedimentology in the sandy braided South Saskatchewan River, Canada. A unique aspect of the methodology is that both digital elevation model and ground‐penetrating radar data were collected from the same locations in 2004, 2005, 2006 and 2007, thus enabling the surface morphodynamics to be tied explicitly to the associated evolving depositional product. The occurrence of a large flood in 2005 also allowed the influence of discharge to be assessed with respect to the process–product relationship. The data demonstrate that the morphology of the study reach evolved even during modest discharges, but more extensive erosion was caused by the large flood. In addition, the study reach was dominated by compound bars before the flood, but switched to being dominated by unit bars during and after the flood. The extent to which the subsurface deposits (the ‘product’) were modified by the surface morphodynamics (the ‘process’) was quantified using the changes in radar‐facies recorded in sequential ground‐penetrating radar surveys. These surveys reveal that during the large flood there was an increase in the proportion of facies associated with bar margin accretion and larger dunes. In subsequent years, these facies became truncated and replaced with facies associated with smaller dune sets. This analysis shows that unit bars generally become truncated more laterally than vertically and, thus, they lose the high‐angle bar margin deposits and smaller scale bar‐top deposits. In general, the only fragments that remain of the unit bars are dune sets, thus making identification of the original unit barform problematic. This novel data set has implications for what may ultimately become preserved in the rock record.
Will intra‐specific differences in transpiration efficiency in wheat be maintained in a high CO2 world? A FACE study
Authors: Tausz‐Posch Sabine , Norton Robert M. , Seneweera Saman , Fitzgerald Glenn J. , Tausz Michael
Published: October 2012

This study evaluates whether the target breeding trait of superior leaf level transpiration efficiency is still appropriate under increasing carbon dioxide levels of a future climate using a semi‐arid cropping system as a model. Specifically, we investigated whether physiological traits governing leaf level transpiration efficiency, such as net assimilation rates (Anet), stomatal conductance (gs) or stomatal sensitivity were affected differently between two Triticum aestivum L. cultivars differing in transpiration efficiency (cv. Drysdale, superior; cv. Hartog, low). Plants were grown under Free Air Carbon dioxide Enrichment (FACE, approximately 550 µmol mol−1 or ambient CO2 concentrations (approximately 390 µmol mol−1). Mean Anet (approximately 15% increase) and gs (approximately 25% decrease) were less affected by elevated [CO2] than previously found in FACE‐grown wheat (approximately 25% increase and approximately 32% decrease, respectively), potentially reflecting growth in a dry‐land cropping system. In contrast to previous FACE studies, analyses of the Ball et al. model revealed an elevated [CO2] effect on the slope of the linear regression by 12% indicating a decrease in stomatal sensitivity to the combination of [CO2], photosynthesis rate and humidity. Differences between cultivars indicated greater transpiration efficiency for Drysdale with growth under elevated [CO2] potentially increasing the response of this trait. This knowledge adds valuable information for crop germplasm improvement for future climates.
ALK‐positive anaplastic large cell lymphoma presenting as intradural spinal mass: First reported case and review of literature
Authors: Novello Mariangela , Lauriola Libero , Della Pepa Giuseppe Maria , La Rocca Giuseppe , Coli Antonella , Visocchi Massimiliano
Published: October 2012

Anaplastic large cell lymphoma (ALCL) is characterized by large anaplastic cells of T‐cell or null‐cell phenotype expressing CD30 (Ki‐1 antigen). In most cases this neoplasm expresses the anaplastic lymphoma kinase (ALK), a chimeric protein resulting from the t(2;5)(p23;q35) translocation. ALK‐positive anaplastic large cell lymphoma is most frequent in the first three decades of life and shows a male predominance, involving both nodal and extranodal sites, but rarely the CNS. We report a 21‐year‐old patient with a previous history of nodal ALK‐positive ALCL, lymphohistiocytic subtype, who was admitted for recent occurrence of left‐sided anesthesia with pain and progressive motor weakness of both legs. An MRI of the spine documented an intradural extramedullary mass dislocating the thoracic cord, suggesting a meningioma and the patient underwent surgical decompression. Histological examination revealed a lymphoproliferative neoplasm with morphology and immunophenotype of ALK‐positive anaplastic large cell lymphoma. After surgery, all preoperative symptoms disappeared. To our knowledge, no cases of ALCL presenting as secondary localization with an intradural extramedullary spinal mass have been reported in the literature.
Heavy metal pollution negatively correlates with anuran species richness and distribution in south‐eastern Australia
Authors: FICKEN KRISTINA L. G. , BYRNE PHILLIP G.
Published: October 2012

Heavy metal pollution has likely played an important role in global biodiversity decline, but there remains a paucity of information concerning the effects of metals on amphibian diversity. This study assessed anuran species richness and distribution in relation to sediment metal content and water chemistry in wetlands located along the Merri Creek corridor in Victoria, south‐eastern Australia. Anurans were present in 60% (21/35) of study sites, with a total of six species detected: the eastern common froglet (Crinia signifera), the eastern sign‐bearing froglet (Crinia parinsignifera), the southern brown tree frog (Litoria ewingii), the growling grass frog (Litoria raniformis), the eastern banjo frog (Limnodynastes dumerilii) and the spotted marsh frog (Limnodynastes tasmaniensis). Mean species richness was 1.77 ± 0.32 per site, and species richness ranged from zero to six species per site. Across sites, species richness correlated negatively with sediment concentrations of six heavy metals: copper, nickel, lead, zinc, cadmium and mercury. Species richness also correlated negatively with wetland water electrical conductivity (a proxy for salinity) and concentrations of orthophosphate. Distributions of the three most commonly observed frog species (C. signifera, L. tasmaniensis and L. ewingii) were significantly negatively associated with the total level of metal contamination at individual sites. The study is the first to provide evidence for an association between metal contamination and anuran species richness and distribution in the southern hemisphere, adding to a small but growing body of evidence that heavy metal pollution has contributed to global amphibian decline.
Assortative Mating and Divorce: Evidence from Austrian Register Data
Authors: Frimmel Wolfgang , Halla Martin , Winter-Ebmer Rudolf
Published: October 2012

We show that changes in assortative mating patterns along the dimensions of age, ethnicity, religion and education are not responsible for the increasing marital instability over the last four decades in Austria. Without the rise in the age at marriage, divorce rates would be considerably higher. Immigration and secularization, and the resulting supply of spouses with diverse ethnicity and religious denominations had no overall effect on divorce rates. Countervailing effects—in line with theoretical predictions–offset each other. The rise in the incidence of divorce is most probably caused by increased social acceptance of divorce.
Quantifying the Effect of Area Deprivation on Child Pedestrian Casualties by Using Longitudinal Mixed Models to Adjust for Confounding, Interference and Spatial Dependence
Authors: Graham Daniel J. , McCoy Emma J. , Stephens David A.
Published: October 2012

The paper investigates the link between area-based socio-economic deprivation and the incidence of child pedestrian casualties. The analysis is conducted by using data for small spatial zones within major British cities over the period 2001–2007. Spatial longitudinal generalized linear mixed models, estimated by using frequentist and Bayesian approaches, are used to address issues of confounding, spatial dependence and transmission of deprivation effects across zones (i.e. interference). The results show a consistent strong deprivation effect across model specifications. The incidence of child pedestrian casualties in the most deprived zones is typically greater than 10 times that in the least deprived zones. Modelling interference through a spatially auto-regressive covariate uncovers a substantially larger effect.
Brain structure abnormalities in adolescent girls with conduct disorder
Authors: Fairchild Graeme , Hagan Cindy C. , Walsh Nicholas D. , Passamonti Luca , Calder Andrew J. , Goodyer Ian M.
Published: October 2012

Background:  Conduct disorder (CD) in female adolescents is associated with a range of negative outcomes, including teenage pregnancy and antisocial personality disorder. Although recent studies have documented changes in brain structure and function in male adolescents with CD, there have been no neuroimaging studies of female adolescents with CD. Our primary objective was to investigate whether female adolescents with CD show changes in grey matter volume. Our secondary aim was to assess for sex differences in the relationship between CD and brain structure.

Methods:  Female adolescents with CD (n = 22) and healthy control participants matched in age, performance IQ and handedness (n = 20) underwent structural magnetic resonance imaging. Group comparisons of grey matter volume were performed using voxel‐based morphometry. We also tested for sex differences using archive data obtained from male CD and control participants.

Results:  Female adolescents with CD showed reduced bilateral anterior insula and right striatal grey matter volumes compared with healthy controls. Aggressive CD symptoms were negatively correlated with right dorsolateral prefrontal cortex volume, whereas callous‐unemotional traits were positively correlated with bilateral orbitofrontal cortex volume. The sex differences analyses revealed a main effect of diagnosis on right amygdala volume (reflecting reduced amygdala volume in the combined CD group relative to controls) and sex‐by‐diagnosis interactions in bilateral anterior insula.

Conclusions:  We observed structural abnormalities in brain regions involved in emotion processing, reward and empathy in female adolescents with CD, which broadly overlap with those reported in previous studies of CD in male adolescents.
Identification of novel virulence genes and metabolic pathways required for full fitness of Pseudomonas savastanoi pv. savastanoi in olive (Olea europaea) knots
Authors: Matas Isabel M. , Lambertsen Lotte , Rodríguez‐Moreno Luis , Ramos Cayo
Published: October 2012

Comparative genomics and functional analysis of Pseudomonas syringae and related pathogens have mainly focused on diseases of herbaceous plants; however, there is a general lack of knowledge about the virulence and pathogenicity determinants required for infection of woody plants.

Here, we applied signature‐tagged mutagenesis (STM) to Pseudomonas savastanoi pv. savastanoi during colonization of olive (Olea europaea) knots, with the goal of identifying the range of genes linked to growth and symptom production in its plant host.

A total of 58 different genes were identified, and most mutations resulted in hypovirulence in woody olive plants. Sequence analysis of STM mutations allowed us to identify metabolic pathways required for full fitness of P. savastanoi in olive and revealed novel mechanisms involved in the virulence of this pathogen, some of which are essential for full colonization of olive knots by the pathogen and for the lysis of host cells.

This first application of STM to a P. syringae‐like pathogen provides confirmation of functional capabilities long believed to play a role in the survival and virulence of this group of pathogens but not adequately tested before, and unravels novel factors not correlated previously with the virulence of other plant or animal bacterial pathogens.
ANALYSIS OF TRADITIONAL HISTORICAL CLOTHING: AUTOMATED PRODUCTION OF A TWO‐DIMENSIONAL PATTERN*
Authors: JENSEN K. , SCHMIDT A. L. , PETERSEN A. H.
Published: October 2012

A recurrent problem for scholars who investigate traditional and historical clothing is the measuring of items of clothing and subsequent pattern construction. The challenge is to produce exact data without damaging the item. The main focus of this paper is to present a new procedure for establishing a three‐dimensional model and the corresponding two‐dimensional pattern for items of skin clothing that are not flat. The new method is non‐destructive, and also accurate and fast. Furthermore, this paper presents an overview of the more traditional methods of pattern documentation and measurement. Their weaknesses and strengths are also assessed.
Consistent assessments of pathways toward sustainable development and climate stabilization
Authors: Akimoto Keigo , Sano Fuminori , Hayashi Ayami , Homma Takashi , Oda Junichiro , Wada Kenichi , Nagashima Miyuki , Tokushige Kohko , Tomoda Toshimasa
Published: October 2012

Many of the numerous difficult issues facing the world today involve relationships entailing trade‐offs and synergies. This study quantitatively assesses some alternative scenarios using integrated assessment models, and provides several indicators relating to sustainable development and climate change, such as indicators of income (per capitaGDP), poverty, water stress, food access, sustainable energy use, energy security, and ocean acidification, with high consistencies among the indicators within a scenario. According to the analyses, economic growth helps improve many of the indicators for sustainable development. On the other hand, climate change will induce some severe impacts such as ocean acidification under a non‐climate intervention scenario (baseline scenario). Deep emission reductions, such as to 2°Cabove the pre‐industrial level, could cause some sustainable development indicators to worsen. There are complex trade‐offs between climate change mitigation levels and several sustainable development indicators. A delicately balanced approach to economic growth will be necessary for sustainable development and responses to climate change.
Attenuated stress‐evoked anxiety, increased sucrose preference and delayed spatial learning in glucocorticoid‐induced receptor‐deficient mice
Authors: E. Vollmer L. , Ghosal S. , A. Rush J. , R. Sallee F. , P. Herman J. , Weinert M. , Sah R.
Published: October 2012

The glucocorticoid‐induced receptor (GIR) is a stress‐responsive gene that is abundantly expressed in forebrain limbic regions. Glucocorticoid‐induced receptor has been classified as a Neuropeptide Y‐like receptor, however, physiological attributes have not been investigated. In this study, mice lacking GIR (−/−) were screened in various paradigms related to stress, anxiety, activity, memory, fear and reward. GIR −/− mice elicited behavioral insensitivity to the anxiogenic effects of restraint stress. However, hypothalamic pituitary adrenal axis response to stress was not impacted by GIR deficiency. Increased preference for sucrose was observed in GIR −/− mice suggestive of modulation of reward‐associated behaviors by the receptor. A delayed acquisition of spatial learning was also observed in GIR −/− mice. There were no effects of genotype on the modulation of anxiety‐like behavior, activity, fear‐conditioning and
extinction. Our data extend previous studies on GIR regulation by glucocorticoids and provide novel evidence for a role of GIR in reward, learning and the behavioral outcomes of stress.
Penile Abscess and Urethrocutaneous Fistula Following Intracavernous Injection: A Case Report
Authors: Jinga Viorel , Iconaru Virgil
Published: October 2012

Introduction

Intracavernous injection with pharmacological agents is described as a safe and efficient method for erectile dysfunction treatment. Among other adverse events, penile abscess is a potentially difficult-to-treat complication.

Aim

We present a rare case of penile abscess presenting 6 months after intracavernous papaverine injection. The etiology, diagnosis, and management of this condition are discussed briefly.

Methods

A 49-year-old afebrile man presented with the development of distal penile shaft swelling. A 6 × 4-cm tender lump was palpable on the left ventrolateral side, with mobile overlying skin but fixed to underlying tissue, without any local or general signs of infection. The swelling gradually increased in volume over a period of 2 weeks following intracavernous papaverine injection. However, the patient did not seek medical advice for 6 months because of the minimal symptoms associated with his condition.

Results

The abscess was revealed through sub-coronal circumferential skin degloving incision. The thick abscess sheath was incised and pus drained, followed by blunt excision down to the intact cavernosal tunica albuginea. On the 12th postoperative day, the case was further complicated by development of an urethrocutaneous fistula, 6 mm in diameter, on the ventral side of the spongy urethra. The patient was initially managed by suprapubic cystostomy and an Orandi urethroplasty was performed after 3 months. On day 14, post-urethroplasty, the fistula was completely closed and no complaints concerning micturition were reported. At follow-up, the patient showed good functional results in terms of maintained normal sexual function and absent penile curvature.

Conclusion

Penile abscess after intracavernous injection is a rare condition. This unusual case speaks to the importance of a thoughtful surgical management with the need of operating team collaboration in order to resolve the abscess and manage potential complications.
Apocynin Improves Erectile Function in Diabetic Rats through Regulation of NADPH Oxidase Expression
Authors: Li Mingchao , Zhuan Li , Wang Tao , Rao Ke , Yang Jun , Yang Jun , Quan Weihe , Liu Jihong , Ye Zhangqun
Published: October 2012

Introduction

Diabetes is a risk factor for erectile dysfunction (ED). The proposed mechanisms responsible for diabetic ED are associated with an increase in reactive oxygen species (ROS) production, overactivity of RhoA/ROCK signaling pathway and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, as seen in experimental models of diabetic rats.

Aim

The aim of this study was to investigate whether NADPH oxidase inhibitor apocynin can ameliorate Streptozotocin (STZ)-induced diabetes-related ED by reducing the ROS production and inhibiting the activity of RhoA/ROCK signaling pathway.

Methods

The diabetic rats were treated with and without the NADPH oxidase inhibitor apocynin.

Main Outcome Measures

Erectile responses were evaluated by determining mean arterial blood pressure (MAP) and intracavernosal pressure (ICP) with electrical stimulation of the cavernous nerve. Levels of mRNA expression were measured by real-time polymerase chain reaction (RT-PCR). Levels of protein expression were examined by Western Blot. ROS production was measured by dihydroethidium (DHE) staining and thiobarbituric acid reactive substances assay.

Results

The ratio of Maximum ICP-to-MAP (MaxICP/MAP) was significantly decreased in diabetic ED rats, compared to that of age-matched control rats (P < 0.05). Apocynin improved erectile function of diabetic rats (P < 0.05). Expression levels of RhoA (cytosol), nNOS and eNOS were reduced, compared to those of control rats (P < 0.05). Apocynin significantly elevated their expression levels in diabetic rats (P < 0.05). Expression levels of ROCK1, RhoA (membrane fraction), p-MYPT1 and NADPH oxidase subunits p47phox and p67phox were increased in diabetic rats when compared to those of control rats (P < 0.05), and it was observed that apocynin significantly reduced their expression levels in diabetic rats (P < 0.05). ROS production was increased in diabetic rats when compared to that of control rats (P < 0.05), the effect of apocynin was a reduction in the ROS production in diabetic rats (P < 0.05).

Conclusion

NADPH oxidase inhibitor apocynin can ameliorate diabetes-related ED by reducing the ROS production and inhibiting the activity of RhoA/ROCK signaling pathway.
Shaeer’s Glans Augmentation Technique: A Pilot Study
Authors: Shaeer Osama
Published: October 2012

Introduction

Augmentation of the glans penis may be indicated for cosmetic reasons, lack of glans tumescence following implantation of a penile prosthesis, or asymmetry following girth augmentation of the shaft. Many augmentation techniques have been offered to increase the length and girth of penile shaft, but not the glans penis, with the exception of hyaluronic acid gel injection that is known to decrease sensitivity of the glans and is restricted for cases with premature ejaculation.

Aim

This work is the first report on glans augmentation by grafting.

Main Outcome Measures

Maximum circumference of the glans, self-reported impression of the augmented volume and glans sensitivity.

Methods

Ten males requesting augmentation of the glans were selected for the study after failing counseling, with normal erectile function and ejaculatory control. Two ventral incisions were cut along the ventral aspects of the coronal sulcus, one on either side of the frenulum. Lateral glans flaps were dissected on either side. The urethra was circumvented, creating a plane all around it. A dermal fat graft was inserted into the space created. The flaps were closed by simple absorbable sutures.

Results

Maximum circumference of the glans increased by 16.6%, declining to 14.2% by the last follow-up visit (10–12 months), a 2.3% decline. Self-reported impression of the augmented volume was high and well maintained over the follow-up period. Glans sensation, engorgement, erectile function, and ejaculatory control were preserved.

Conclusion

This pilot study on glans augmentation by grafting reports promising results with retention of the added volume at 1-year follow-up, preservation sensitivity and engorgement, and no adverse effects on erectile function or ejaculatory control.
Job-Related Strain and Sexual Health Difficulties Among Heterosexual Men from Three European Countries: The Role of Culture and Emotional Support
Authors: Štulhofer Aleksandar , Træen Bente , Carvalheira Ana
Published: October 2012

Introduction

Epidemiological evidence for the association between job-related stress and sexual difficulties in men is largely lacking. Little is known about the factors that may mediate or moderate this relationship.

Aim

This study analyzes the association between job-related difficulties and men's sexual difficulties.

Main Outcome Measures

Job-related difficulties were measured by 10 yes/no questions that addressed a range of adverse workplace situations. The experience of sexual difficulties in the past 12 months was assessed by using seven dichotomous indicators developed in the National Study of Sexual Attitudes and Lifestyles (NATSAL) 2000.

Method

Analyses were carried out using data from a 2011 online study of Portuguese, Croatian, and Norwegian men (N = 2,112). Multivariate logistic regression and mediation analysis were used to test the hypothesized association.

Results

Men with job-related concerns reported lower sexual satisfaction than men without such concerns did (F = 7.53, P < 0.001). Multivariate analysis confirmed the association between job-related and sexual health concerns. The odds of experiencing one or more sexual health difficulties in the past 12 months were about 1.8 times higher among men who reported the highest levels of workplace difficulties than among men who experienced no such difficulties. The odds of reporting sexual health difficulties were significantly reduced by a higher income (adjusted odds ratio [AOR] = 0.87, P < 0.01), emotional intimacy with one's partner (AOR = 0.93, P < 0.001), having children (AOR = 0.62–0.66, P < 0.01), and country-specific effects (AOR = 1.98–2.22, P < 0.001). In all three countries, the relationship between job-related and sexual health difficulties was mediated by anxiety and depression.

Conclusions

The findings suggest that negative mood is the mechanism behind the association between workplace strain and sexual difficulties. Emotional support, such as couple intimacy and fatherhood, can reduce—independently from sociocultural and socioeconomic factors—the risk of sexual health concerns.
Salvage Management of Prolonged Ischemic Priapism: Al-Ghorab Shunt Plus Cavernous Tunneling with Blunt Cavernosotomy
Authors: Shiraishi Koji , Matsuyama Hideyasu
Published: October 2012

Introduction

The management of ischemic priapism (IP), especially in cases of prolonged IP (PIP), is enigmatic. The T-shaped shunt and intracavernous tunneling and the corporal “snake” maneuver have been reported as effective surgical procedures for PIP; however, management of the PIP that is refractory to these procedures is controversial.

Aim

The present study is a report of two PIP cases that were successfully treated by a novel technique.

Methods

Two cases with 5- and 7-day histories of IP that were refractory to T-shaped shunt and intracavernous tunneling or the corporal “snake” maneuver, respectively, were included in this study. After creating the Al-Ghorab distal shunts, part of the cavernous tissue was bluntly excised with Pean forceps through the shunts to create a large drainage route. The effectiveness, safety and effect on erectile function after this procedure were assessed.

Results

In both cases, the erection and penile pain were immediately diminished, and corporal blood flow measured by color Doppler ultrasonography was restored after the surgery. There was no urethral injury or perforation of the tunica albuginea. Pathological findings showed that the excised tissues were fibrotic and necrotic. There was no recurrence of IP after the salvage surgery. One patient noticed partial erection, and the administration of sildenafil was effective for completing sexual intercourse.

Conclusion

Al-Ghorab distal shunt plus cavernous tunneling with blunt cavernosotomy creates a large blood drainage route by removing the necrotic or fibrous cavernous tissues. Further investigation regarding to erectile function is needed; however, this procedure is safe and effective even in repeat cases after T-shaped shunt and intracavernous tunneling or the corporal “snake” maneuver.
The Global Online Sexuality Survey (GOSS): The United States of America in 2011. Chapter I: Erectile Dysfunction Among English-Speakers
Authors: Shaeer Osama , Shaeer Kamal
Published: October 2012

Introduction

The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders, based on validated questionnaires and applying age adjustment to the World Standard Population (WSP) by the World Health Organization. In 2010, the first report of GOSS came from the Middle East, describing an erectile dysfunction (ED) prevalence rate of 47%.

Aim

This report studies the prevalence rate of ED in the United States as of 2011–2012 and evaluates risk factors for ED.

Main Outcome Measures

Prevalence of ED.

Methods

GOSS was randomly deployed to English-speaking male web surfers in the United States via paid advertising on Facebook, comprising 146 questions including the abbreviated 5-item International Index of Erectile Function.

Results

Two thousand twenty-two males participated; with a mean age was 52.38 years ± 14.5. Prevalence of ED was 37.7%, adjusted to 33.7% according to WSP, comparable across ethnic groups. The following risk factors were associated with higher risk for ED: diabetes mellitus, hypertension with and without antihypertensive treatment, coronary heart disease, obesity (defined by body mass index), difficult micturition, subjectively reported depression, interpersonal distress, subjectively reported impotence, in addition to novel factors such as subjectively reported premature ejaculation (PE) and concerns over genital size (not a smaller penis per se), low libido, and irregular coitus. Frequency of smoking and alcohol were not associated with higher prevalence of ED, although duration of smoking was.

Conclusion

Adjusted to WSP, prevalence rate of ED in the United States of America is 33.7% in the year 2011, in contrast to the adjusted prevalence in the Middle East (47%). Most of the classical risk factors for ED play the same role in the United States and the World, including diabetes, hypertension, and aging. Concerns over genital size and PE are emerging risk factors for ED.
The Sexual Disgust Questionnaire; a Psychometric Study and a First Exploration in Patients with Sexual Dysfunctions
Authors: van Overveld Mark , de Jong Peter J. , Peters Madelon L. , van Lankveld Jacques , Melles Reinhilde , ter Kuile Moniek M.
Published: October 2012

Introduction

Disgust may be involved in sexual problems by disrupting sexual arousal and motivating avoidance of sexual intercourse. To test whether heightened disgust for sexual contaminants is related to sexual dysfunctions, the Sexual Disgust Questionnaire (SDQ) has recently been developed. Previous research showed that particularly women with vaginismus display a generally heightened dispositional disgust propensity and heightened disgust toward stimuli depicting sexual intercourse.

Aim

To determine the psychometric properties of the SDQ and test whether heightened disgust toward sexual stimuli is specific to vaginismus or can be observed in other sexual dysfunctions as well.

Methods

First, a large sample of undergraduates and university employees completed the SDQ (N = 762) and several trait disgust indices. Next, women with vaginismus (N = 39), dyspareunia (N = 45), and men with erectile disorder (N = 28) completed the SDQ and were compared to participants without sexual problems (N = 70).

Main Outcome Measure

SDQ to index sexual disgust.

Results

The SDQ proved a valid and reliable index to establish disgust propensity for sexual stimuli. Supporting construct validity of the SDQ, sexual disgust correlated with established trait indices. Furthermore, sexual disgust and willingness to handle sexually contaminated stimuli were associated with sexual functioning in women, but not in men. Specifically women with vaginismus displayed heightened sexual disgust compared to women without sexual problems, while men with erectile disorders demonstrated a lower willingness to handle sexually contaminated stimuli compared to men without sexual problems.

Conclusions

The SDQ appears a valid and reliable measure of sexual disgust. The pattern of SDQ-scores across males and females with and without sexual dysfunctions corroborates earlier research suggesting that disgust appraisals are involved especially in vaginismus and supports the view that the difficulty with vaginal penetration experienced by women in vaginismus may partly be due to disgust-induced defensive reflexes that could disrupt sexual arousal.
The Role of Culture in Eating Disorders
Authors: Kadish Yael A.
Published: October 2012

A comprehensive understanding of eating disorders should include engagement with the role of contemporary cultural trends. Feminists and critical social theorists have made significant contributions in this regard. Using two clinical cases, this paper contemplates the relationship between culture and psyche in eating disorder, proposing a psychoanalytic conceptualization underpinned by John Steiner's (1982, 1987, 1993, 2011) theory of pathological organizations and psychic retreats. Two conceptual terms will be introduced, namely ‘the normalized body order’ and ‘the abject body object’ to develop the argument. One of the clinical cases will be used to explore a particular kind of therapeutic impasse that can occur when therapist and patient are both female. In this particular case, the normalized body order emerged temporarily obstructing therapeutic progress; the impasse was understood to be an example of the so‐called anti‐analytic third (Straker, ).
Cognitive‐Analytic Therapy in a Group: Reflections on a Dialogic Approach
Authors: Hepple Jason
Published: October 2012

Cognitive‐Analytic Therapy (CAT) (Ryle & Kerr, ) is a brief, integrative psychological therapy developed by Dr Anthony Ryle and others over the last 25 years. CAT is often used as an individual therapy for clients with personality disorder and is widespread within the NHS and private sectors in the UK and several countries abroad. CAT is being increasingly applied in group settings in the NHS. CAT, being at its heart a psychotherapy based on a relational understanding of human development, would seem to have much to offer in a group setting. This paper briefly reviews previous ways that the CAT model has been used in groups and then goes on to describe the author's experience of a one‐year group carried out in South‐West England. The therapeutic approach used adapts the CAT tools to a group setting, draws on CAT's dialogic underpinnings and shares some broader concepts with psychodynamic approaches.
Recurrent polymyositis triggered by bronchiectasis‐associated infections
Authors: Ku Bon D. , Shin Hyun Young
Published: October 2012

Polymyositis is a cell‐mediated autoimmune disease and various systemic infections can trigger it. However, there have been only rare reports of recurrent polymyositis triggered by systemic infections. We report the case of a 69‐year‐old woman with recurrent polymyositis triggered by bronchiectasis‐associated infections. This case indicates that recurrent polymyositis triggered by systemic infections suggests a non‐specific autoimmune antigenic response of polymyositis.