bluuebunny/crossref_metadata_2025 huggingface dataset:
Toward an Unequivocal Definition and Classification of Patient Outcomes
Authors: Van der Bruggen Harry , Groen Maike
Published: February 2008

PURPOSE.
To determine the extent possible of developing an unequivocal formulation of a conceptual, structural, and contextual definition of “patient outcomes,” and the possibility of coming to an agreement on the criteria for classification of patient outcomes.

METHODS.
An international Delphi survey of 33 experts.

FINDINGS.
A conceptual, structural, and contextual definition of patient outcomes and priorities for the characteristics of patient outcome classification.

CONCLUSIONS.
The authors recommend the unequivocalness of nursing terminology, not only for reasons of effectiveness and efficiency, but also to clarify the nursing vocabulary for epistemological reasons.
Fear and Anxiety: A Simultaneous Concept Analysis
Authors: Bay Esther Jean , Algase Donna L.
Published: February 2008

TOPIC.
A simultaneous concept analysis of fear and anxiety.

PURPOSE.
To develop a process model that reflects distinct characteristics of fear and anxiety.

SOURCES.
Existing biopsychology empirics and theory from peer review with and external to nursing literature.

CONCLUSIONS.
Fear and anxiety are distinct diagnoses guided by separate brain mechanisms. The author offers a process model for further critique by peers and clinical populations.
Utilization of Nursing Diagnoses in Iowa Child Health Specialty Clinics
Authors: Sieleman Jane
Published: February 2008

PURPOSE.
To determine nursing diagnoses utilization in the Iowa Child Health Specialty Clinics (CHSC).

METHODS.
A review of charts of 631 children seen in CHSC's Integrated Evaluation and Planning Clinic (IEPC) and of 108 children served in the CHSC Home and Community Care (HCC) programs.

FINDINGS.
For the 21 patients in the HCC group, 12 (57%) had at least one documented nursing diagnosis. Forty‐six different nursing diagnoses were documented, with a range of 2 to 8 nursing diagnoses (average 3.75) per patient. Of the 46 nursing diagnoses, 12 (26%) were exact matches, 25 (54%) were close matches, and 9 (20%) were no matches to NANDA. For the IEPC group, 126 children (46%) had at least one documented nursing diagnosis. Ninety different nursing diagnoses were used 157 times, with a range of 1 to 8 diagnoses (average 2.6) per patient. Nineteen (21%) different nursing diagnoses used 27 times were considered to be exact matches to NANDA diagnoses. Fifteen (17%) different diagnoses used 28 times were considered to be close NANDA matches. Fifty‐six (62%) different nursing diagnoses used 102 times were considered to be no matches.

CONCLUSIONS.
The documentation of nursing diagnoses for select groups of CHSC patients has provided information about the patient phenomena of concern addressed by CHSC nurses.
Factors Associated With Nursing Diagnosis Utilization in Canada
Authors: Higuchi Kathryn A. Smith , Dulberg Corinne , Duff Viola
Published: February 2008

PURPOSE. To investigate factors associated with nursing diagnosis utilization.

METHODS.
A retrospective chart audit was conducted on four hospital units over a 5‐month period and linked to the nurses (N =65) who participated in a survey on attitudes toward nursing diagnosis.

FINDINGS.
Computer‐generated nursing care plans resulted in the greatest frequency of nursing diagnosis documentation. Nurses who did not document nursing diagnoses, and nurses employed in hospitals without nursing diagnosis implementation programs, had more positive attitudes toward the value of nursing diagnosis in practice compared with nurses who documented nursing diagnoses and nurses employed in hospitals with implementation programs.

CONCLUSIONS.
Nurses have a greater tendency to document nursing diagnoses when institutions have formal educational programs and computer‐generated care plans.
Environmental Nursing Diagnoses for Aggregates and Community
Authors: Green Pauline M. , Slade Diane S.
Published: February 2008

PURPOSE.To describe the application of group‐appropriate methods to derive actual nursing diagnoses for a community.

METHODS.A triangulation method using multiple sources of data, including an environmental survey, fish consumption survey, government reports, publications, and community assessments

FINDINGS.
Three priority community environmental nursing diagnoses for aggregates within the community: Knowledge deficit among community residents related to lack of awareness of contaminants in the Anacostia River; “risk for adverse human health effects” among pregnant and nursing women and preschoolers related to consumption of chemically contaminated fish; and knowledge deficit among community residents related to lack of awareness of health effects of consuming chemically contaminated fish.

CONCLUSIONS. The diagnoses serve as the basis for community education and other interventions. The methods are practical and useful for this type of research.

PRACTICE IMPLICATIONS. The nursing profession is experiencing a growing awareness of the close relationship between environmental health and the health of individuals and communities. There is a need for diagnostic labels to describe the responses of aggregates and communities to environmental hazards and conditions.
Naming Nursing: Evidence‐Based Nursinga
Authors: Evers Georges C.M.
Published: February 2008

Viewpoint provides a forum for scholarly discussion about the theoretical, philosophical, and practical issues related to nursing language and classification systems. The sometimes controversial views are intended to stimulate reader comments and perspectives. We welcome brief, informal responses to published viewpoints. If you have a viewpoint you want to submit or if you want to discuss it beforehand, contact the column editor: judithwilkins@att.net
Environmental Nursing Diagnoses: A Proposal for Further Development of Taxonomy II
Authors: Green Pauline M. , DNSc Laura V. Polk , Slade Diann S.
Published: February 2008

PURPOSE. To propose further development of environmental diagnoses and to offer recommendations for expanding Taxonomy II to include more diagnostic labels that encompass the environmental domain.

SOURCES. Literature in the disciplines of nursing, biology, toxicology, public health, sociology, and anthropology.

DATA SYNTHESIS. Nurses need language to describe the human responses of individuals, families, communities, and global society to environmental health threats.

CONCLUSIONS. New environmental diagnoses will lead to refinement of language that describes the contribution of nursing to an emerging international and community health priority.

PRACTICE IMPLICATIONS. Environmental diagnostic labels will allow nurses to name responses and plan interventions that respond to instances or risks of exposure to threats from the physical and sociocultural environment.

Search terms: Environmental contamination, environmental health threats, exposure, nursing diagnoses
Clinical Validation of Dysfunctional Ventilatory Weaning Response: The Spanish Experience
Authors: Giménez Ana M. , Serrano Pilar , Marín Blanca
Published: February 2008

PURPOSE. To validate dysfunctional ventilatory weaning response (DVWR). METHODS. Descriptive, longitudinal, and prospective study of 80 patients from three different university hospitals in Spain.

FINDINGS. Twenty defining characteristics were associated with DVWR; eight factors from the NANDA model and four non‐NANDA factors were associated with the diagnosis. Adventitious breath sounds, decreased air entry on auscultation, anxiety, and adverse environment resulted as predictive variables of dysfunctional response.

CONCLUSIONS. The incidence of DVWR is high, although clinical nurses do not always recognize it. DVWR has different manifestations and associated factors along the course of the weaning stage, but anxiety is associated with DVWR across the time continuum.

PRACTICE IMPLICATIONS. Validation of DVWR for use in nursing clinical practice is supported. Early detection of predictive variables could help to identify DVWR and facilitate the diagnosis in the clinical practice.

Search terms: Clinical validation, dysfunctional weaning, mechanical ventilation, nursing diagnoses
Policy on Acute Toxic Ingestion or Dermal or Inhalation Exposure
Authors: Goolsby Mary Jo
Published: February 2008

Many nurse practitioners (NPs) practice in emergency and urgent‐care settings, and fir more practical remote settings. NPs in each of these settings should be familiar with the assessment, stabilization, and treatment of patients who seek treatment for suspected intentional or accidental poisoning. This month's Clinical practice guideline (CPG) column reviews the “Clinical Policy for the Initial Approach to Patients Presenting With Acute Toxic Ingestion or Dermal or Inhalation Exposure.”

The ACEP “Clinical Policy for the Initial Approach to Patients Presenting With Acute Toxic Ingestion or Dermal or Inhalation Exposure” includes several helpful resources. In addition to recommending specific clinical actions in response to patient variables, the document includes a table identifying the antidote for many of the most commonly ingested drugs. These include digoxin, iron, opioids, salicylates, acetaminophen, and tricyclic antidepressants. The table also includes both the adult and pediatric dose of each listed antidote. A quick reference is included. This form can be used to guide the history, physical examination, and subsequent actions for treating patients with acute toxic ingestion or dermal or inhalation exposure. Finally, there is a quality assurance form to guide chart reviews.

Many of the attributes of a well‐developed guideline are identified in the report. The authors clearly identify the situations for which the recommendations are intended as well as those in which they do not apply. For instance, the guidance is not intended for use when patients are unstable and stabilization is the primary focus. It is also not intended for cases of radiation, parenteral, or eye exposure or of food poisoning. The authors describe the process used to develop the recommendations and identify the strength of the evidence on which each recommendation is based. The role of provider judgment in application of the guidance is addressed. Prior to its dissemination, the CPG was subjected to external review by dinical experts.

This ACEP policy has applicability for the growing number of NPs working in emergency and urgent cafe settings as well as for those who must provide front line emergency care in remote settings. It provides a framework for responding to acute toxic exposures and provides several useful resources to assist the clinician in responding to situations in which accidental or intentional poisoning is suspected.
What Nurse Practitioners Should Know About Direct‐to‐Consumer Advertising of Prescription Medications
Authors: Viale Pamela Hallquist
Published: February 2008

Purpose

To describe the marketing strategies of direct‐to‐consumer (DTC) advertising and the risks, benefits, and potential influence on the prescribing practices of nurse practitioners (NPs).

Data Sources

Journal articles, media sources, and clinical experience.

Conclusions

The effect of DTC advertising of prescription medications on NPs has not been well studied. Although there are studies that examine the effects of DTC advertising on physician prescribing as well as the effects of this practice on the consumer, opinions on the benefits of DTC advertising are varied.

Implications for Practice

NPs need to recognize the potential influence of DTC advertising and to be prepared to guide patients toward appropriate medication choices by participating in a partnership with patients. Health care providers, including NPs, need to work with the pharmaceutical industry to encourage accountability of DTC advertising, thus improving dissemination of correct information and promoting positive outcomes for health consumers and patients.
Simplified Regimens for Treating HIV Infection and AIDS
Authors: Piliero Peter J. , Colagreco Joseph P.
Published: February 2008

Purpose

To review the variables that greatly affect adherence to the complex treatment regimens used in HIV disease and to examine available options that could improve patient outcomes.

Data Sources

Comprehensive review of current medical and scientific literature, drug‐prescribing literature, and randomized clinical trials of drug treatments.

Conclusions

Effective treatment of HIV infection is dependent on consistent adherence to prescribed antiretroviral medications. A large pill burden, multiple daily doses, and adverse events are some of the complexities that negatively impact patient adherence. For example, lipodystrophy and hyperlipidemia are two serious side effects associated with some agents. Once‐daily antiretroviral agents offer many advantages over historical treatment options but are associated with possible drawbacks.

Implications for Practice

Currently, four single agents are available for once‐daily administration, and a few others are under investigation. In addition, combination therapy with either dual or boosted protease inhibitor regimens is becoming a popular way of overcoming the poor pharmacokinetic characteristics of individual protease inhibitors.
Predictors of Nurse Practitioners' Autonomy: Effects of Organizational, Ethical, and Market Characteristics
Authors: Ulrich Connie , Soeken Karen , Miller Nancy
Published: February 2008

Purpose

To identify the predictors of autonomy of nurse practitioners (NPs) affiliated directly and/or indirectly with managed‐care systems (e.g., HMOs).

Data Sources

A mailed survey sent to a stratified random sample of 254 NPs certified and licensed to practice in the state of Maryland. The measures consisted of selected organizational characteristics; market factors of HMO penetration and percentage of client population enrolled in managed care; and factors of ethical concern, such as ethical ideology, ethics education, and autonomy. The County Surveyor Database was used to assess market penetration in the state.

Conclusions

Although NPs were ethically concerned about their autonomy in a managed‐care environment (70.2%), actual autonomy scores were high. The higher the percentage of HMO penetration, percentage of client population enrolled in managed care, and perceived ethical concern, the lower the perceived autonomy of NPs.

Implications for Practice

Findings may be used for future research to address the complexity of variables that influence the autonomous practice of NPs.
The impact of an institutional review: a change of emphasis towards field conservation programmes
Authors: DURRELL L. , MALLINSON J. J. C.
Published: February 2008

The expanding role of zoos beyond home‐based captive breeding., research and education into field conservation is a welcome but relatively recent phenomenon, which has developed as zoos have begun to recognize the importance of managing metapopulations and of linking captive breeding to conservation efforts for wild populations of threatened taxa and their habitats. An institutional review undertaken by Jersey Wildlife Preservation Trust between 1994 and 1996 has highlighted and stimulated the processes by which a single organization can strengthen its role in field conservation. Various operational tools, such as mission, strategy, objectives, structure, resources and communications, are examined and examples are given of the ways they have been honed by the review to facilitate the shift of emphasis. The review and the implementation of its recommendations reveal a multifarious approach that can be adapted by similar‐sized institutions as they move towards playing a more active role in field conservation.
Hand modulation of vocalization in Siamangs Hylobates syndactylus
Authors: BADRAUN J. C. , MOOTNICK A. R. , DEANER R. O. , AGORAMOORTHY G. , McNEESE K. M.
Published: February 2008

Although hand modulation of vocalization in Siamangs Hjfohates syndactylus in captivity has been reported in the literature its functional significance within the Hylobatidae has not been thoroughly investigated. One‐hundred‐and‐ten sequences of vocalizations were observed in a pair of Siamangs maintained at the International Center for Gibbon Studies, Santa Clarita. The ♀ used both the palmar aspect of the hand and the distal part of the forelimb to modify vocalizations during diphasic barking in the ‘great‐call’ duet. Analysis of this behaviour indicates that it occurs independently of intragroup social context. Data collected for 150 gibbons, representing all four subgenera and 11 species, indicate that hand modulation of vocalization is unique to Siamang. Hand‐rearing did not effect the development of the behaviour in ♂♂ but did appear to be conducive to its development in ♀♀.
Status and management of orang‐utans Pongo pygmaeus ssp in European zoos
Authors: BECKER C.
Published: February 2008

In 1982 the European studbook for orang‐utans Pongo pygrnaeus was established and reported data from 32 institutions in six countries. Since 1988 all facilities in Continental Europe have been included in the studbook, in 1989 a European Endangered Species Programme (EEP) was approved for the species and in 1992 institutions in the UK joined the EEP. As at 1 January 1996 66 facilities maintained 309 orang‐utans, 45% of which were the Bornean subspecies Pongo pygmaeus pygmaeus, 41% were the Sumatran subspecies Pongo pygmaeus abelii and 14% were hybrids. Over 80% of the population is captive‐bred and most of the wild‐born animals are over 20 years old. There are 225 founders represented in the descendant population and since 1976 there have been 309 births and 225 deaths, excluding hybrids. From a demographic and genetic analysis it would appear that the captive population is stable.
Nutritional management of Old World primates with special consideration for vitamin D
Authors: CRISSEY S. , PRIBYL L. , PRUETT‐JONES M. , MEEHAN T.
Published: February 2008

The diversity of Old World primate species means that successful nutritional management should be based on species‐specific studies of feeding ecologies, gut morphologies and nutrient requirements. The effects of food availability and social influences should also be considered. Multi‐species exhibits and group feeding contribute to the challenge of meeting the nutritional requirements of both a species and individuals. Current concerns about primates maintained in captivity which continue to exhibit signs of vitamin D deficiencies are discussed. If a systematic approach is used to formulate appropriate species‐specific diets it should be possible to provide a nutritionally balanced diet for Old World primates maintained in captivity.
Hand‐rearing Ruppell's griffon vulture Gyps rueppellii at Paris Menagerie, Milwaukee County Zoo and Burger's Zoo, Arnhem
Authors: SCHLEE M. A.
Published: February 2008

The hatching procedures followed for a severely dehydrated Ruppell's griffon vulture Gyps rueppellii embryo at Paris Menagerie, as well as rearing techniques, development and vocalizations of the nestling are described. Supplemental data on food, feeding techniques and growth of chicks hand‐reared at Milwaukee County Zoo and Burger's Zoo, Arnhem, are also presented.
Individual variation in food consumption and food preferences in St Lucia parrots Amazona versicolor at Jersey Wildlife Preservation Trust
Authors: FA J. E. , CAVALHEIRO M. L.
Published: February 2008

Individual food consumption and food item preference of 12 St Lucia parrots Amuionu vrrsicolor were studied at Jersey Wildlife Preservation Trust. Diet offered contained a maximum of 29 foods, mostly fruits, vegetables and pulses but also processed foods and commercial parrot pellets. Each day all birds were presented with the same selection of foods and no novel items were introduced during the study period. Birds varied in their average food intake per feeding session (mean ± SD) from 15.1 ± 5.6 g kg‐1 to 89.0 ± 138.3 g kg‐1. Diversity of food items eaten per session was determined by the Simpson's index of diversity. Food preferences were measured by Ivlev's electivity indices from the total amount of each food type consumed relative to the total amount of that food type offered during all sessions. Foods were classified as ‘disliked’ when electivity indices were negative and ‘rejected’ if not consumed at all. The order in which food types were consumed by each parrot was also analysed. Results showed that diet diversity and food intake were significantly higher for ♀♀ than ♂♂. Wild‐born parrots consumed less but ate a wider variety of foods than captive‐born ones. Significant sexual differences in overall food intake as well as in the percentage of disliked and rejected foods were found among captive‐born birds but not in wild‐born parrots. However, because all wild‐born birds in the present study were twice as old as the captive‐born ones, age of bird and origin were confounded variables. Older birds disliked less foods than younger ones but younger parrots ate more than older birds. Within paired birds, ♀♀ were more aggressive towards ♂♂ than vice versa. This may have influenced the lower feeding levels observed by subordinate ♂♂ but single ♂♂ ate even less than those kept in pairs. The results of this study suggest that it is not possible to make generalizations to satisfy optimal diet requirements of the species because of the considerable individual variation found. Quantifying intake and preference from direct observations of the birds during feeding can be a useful technique to help with the formulation of diets. Further studies are required to determine the roles of sex, age and origin on food consumption and preference. The behaviour of paired and single birds should also be assessed in order to identify suitable methods for feeding dominant and subordinate birds in an attempt to optimize nutritional intake of each individual.
Husbandry and breeding of North American ungulates at Burnet Park Zoo, Syracuse, and Thompson Park Conservancy, Watertown
Authors: MOORE D. E.
Published: February 2008

Burnet Park Zoo, Syracuse, and Thompson Park Conservancy, Watertown, developed a series of enclosures for North American ungulates. The exhibits, built at low capital cost, helped to fulfil the conservation education and research aims of the institutions. This paper describes exhibit design, diet, husbandry, veterinary care and hand‐rearing protocols developed at the zoos. Data on reproduction and longevity are also provided.
Breeding and husbandry of the Blind mole rat Nannospalax ehrenbergi at the Zoology Department, Tel Aviv University
Authors: GAZIT I. , TERKEL A. , TERKEL J.
Published: February 2008

The Blind mole rat Nunnospalax ehrenbergi is a solitary and highly aggressive fossorial mammal. Little is known about its behaviour and until recently it had not been bred in captivity. At Tel Aviv University an artificial environment was developed which closely resembled the type of tunnel system that the species would dig in the wild, The system was made up of a series of Perspex tubes (54 mm inner diameter) that could accommodate one animal at a time, interspersed with Perspex boxes (43 cm × 22 cm × 13 cm high) containing 10–15 cm deep soil. The tunnel system was divided into two with a screw barrier and a pair of Blind mole rats was given the opportunity to develop their own territories for 34 months before the breeding season, thus becoming habituated to the enclosure and each other. Each animal covered the screw barrier with soil and scent marked the area until the breeding season when they began to dismantle the soil barrier until they could make contact with each other. This paper describes the management conditions and semi‐natural tunnel system which enabled observation, maintenance and successful breeding of Blind mole rats in captivity. A policy of minimum disturbance and patience appeared to facilitate the successful breeding of this species.
Rights-based justifications for the tort of unlawful interference with economic relations
Authors: Neyers JW
Published: February 2008

The tort of unlawful interference with economic relations is anomalous since it allows a plaintiff to sue a defendant for a loss that is occasioned by an unlawful act committed by that defendant against a third party. This parasitic liability is seemingly in violation of the basic tort law principle that in order to make out a claim what the plaintiff must show is a violation of her own rights, not merely a wrong to someone else. Thus, it appears that the tort is an instance of damnum absque injuria. This paper examines whether this is in fact the case by examining if there are any rights-based theories that can explain the tort in a way that is consistent with basic private law principle. In other words, is it possible to find an independent right of the defendant that has somehow been violated, one which explains why the defendant is able to sue in their own right? Upon examination, it appears that the ‘right to trade’, ‘remoteness’ and ‘abuse of right’ theories are largely incapable of providing such an explanation since they display many seemingly insurmountable problems of coherence and fit with the existing case-law. More promising are the arguments that the tort is a justified exception to basic principle or that it is an example of public rights being vindicated in private law, yet each of these theories is also problematic in some respects. The overall thesis of the paper is that the tort of unlawful interference with economic relations is radically under-theorised and that it, and the other economic torts, could benefit tremendously from more intense academic examination.
Estimation of walrus populations on sea ice with infrared imagery and aerial photography
Authors: Udevitz Mark S. , Burn Douglas M. , Webber Marc A.
Published: February 2008

Abstract

Population sizes of ice‐associated pinnipeds have often been estimated with visual or photographic aerial surveys, but these methods require relatively slow speeds and low altitudes, limiting the area they can cover. Recent developments in infrared imagery and its integration with digital photography could allow substantially larger areas to be surveyed and more accurate enumeration of individuals, thereby solving major problems with previous survey methods. We conducted a trial survey in April 2003 to estimate the number of Pacific walruses (Odobenus rosmarus divergens) hauled out on sea ice around St. Lawrence Island, Alaska. The survey used high altitude infrared imagery to detect groups of walruses on strip transects. Low altitude digital photography was used to determine the number of walruses in a sample of detected groups and calibrate the infrared imagery for estimating the total number of walruses. We propose a survey design incorporating this approach with satellite radio telemetry to estimate the proportion of the population in the water and additional low‐level flights to estimate the proportion of the hauled‐out population in groups too small to be detected in the infrared imagery. We believe that this approach offers the potential for obtaining reliable population estimates for walruses and other ice‐associated pinnipeds.
Changes in diets of individual Baltic ringed seals (Phoca hispida botnica) during their breeding season inferred from stable isotope analysis of multiple tissues
Authors: Sinisalo Tuula , Jones Roger I. , Helle Eero , Valtonen E. Tellervo
Published: February 2008

Abstract

The stable isotope ratios (δ13C and δ15N) of three tissues with different metabolic rates (plasma, liver, and muscle) were used to investigate temporal variation in diet among nine individual Baltic ringed seals (Phoca hispida botnica Gmelin) from the Bothnian Bay, northeast Baltic Sea. The isotope values from plasma should reflect the most recent diet, values from liver the diet of the past weeks prior to sampling, and values from muscle should integrate diet over almost the entire breeding season of the ringed seals. In general, δ13C values of liver were more enriched in 13C than were those of either muscle or plasma, suggesting that the diet of the seals may have included a higher proportion of 13C‐enriched benthic prey in April. Females showed more variable δ13C values than males, suggesting possible gender differences in diet or in foraging locations. The differences that were apparent between females possibly reflect individual variation in the onset and duration of parturition and lactation, both of which likely restrict female foraging. Previous data from parasite infections and from alimentary tract contents of the same seals were linked to the isotope data to assist in drawing inferences about changes in the diets of individual seals.
Using form analysis techniques to improve photogrammetric mass‐estimation methods
Authors: Proffitt Kelly M. , Garrott Robert A. , Rotella Jay J. , Lele Subhash
Published: February 2008

Abstract

Numerical characterization of animal body forms using elliptical Fourier decomposition may be a useful analytic technique in a variety of marine mammal investigations. Using data collected from the Weddell seal (Leptonychotes weddellii), we describe the method of body form characterization using elliptical Fourier analysis and demonstrated usefulness of the technique in photogrammetric mass‐estimation modeling. We compared photogrammetric mass‐estimation models developed from (1) standard morphometric measurement covariates, (2) elliptical Fourier coefficient covariates, and (3) a combination of morphometric and Fourier coefficient covariates and found that mass‐estimation models employing a combination of morphometric measurements and Fourier coefficients outperformed models containing only one covariate type. Inclusion of Fourier coefficients in photogrammetric mass‐estimation models employing standard morphometric measurements reduced the width of the prediction interval by 24.4%. Increased precision of photogrammetric mass‐estimation models employing Fourier coefficients as model covariates may expand the range of ecological questions that can be addressed with estimated mass measurements.
Ontogenetic diet changes in bottlenose dolphins (Tursiops truncatus) reflected through stable isotopes
Authors: Knoff Amanda , Hohn Aleta , Macko Stephen
Published: February 2008

Abstract

The ability of stable isotope analysis to provide insight into ontogenetic dietary changes was examined using bottlenose dolphin tooth and skin samples. Teeth were subsampled to compare tissue produced early in life (outer tooth) to that produced later in life (inner tooth). Outer tooth had significantly higher δ15N values than the corresponding inner sample from the same tooth (n= 60, P= 0.0041), indicating that there was a temporal shift to a lower δ15N diet. There were no significant δ13C differences. Higher δ15N values in young have previously been attributed to the period of suckling. Analysis of skin tissue from stranded animals of different developmental stages similarly indicated that the δ15N values were significantly higher in young animals. Further comparisons indicated that the primary influence for this difference was animals with lengths less than or equal to the largest neonatal dolphin. This difference likely reflects an ontogenetic dietary shift from a sole reliance on milk to a combination of milk and prey species during the first year of life.
State of Hypertension Management in the United States: Confluence of Risk Factors and the Prevalence of Resistant Hypertension
Authors: Sarafidis Pantelis A. , Bakris George L.
Published: February 2008

An improvement in the awareness and treatment of hypertension in the United States has occurred, resulting in the best control rates in the world, which unfortunately are far below the goals of Healthy People 2000 or 2010. This failure to achieve blood pressure (BP) goals is attributed to many factors, including an aging population, higher prevalence of kidney disease and obesity, high salt intake, physician inertia to increase dose and number of antihypertensive medications prescribed, and patient nonadherence with medication regimens. Resistant hypertension is defined as a failure to achieve goal BP in patients who adhere to full doses of an appropriate antihypertensive regimen of 3 drugs that includes a diuretic. The problem of resistant hypertension is projected to increase as the population ages. Efforts on the part of the Veterans Administration hospitals and others clearly indicate that a system can be implemented to help increase the percentage of persons in whom BP goal is achieved and reduce the prevalence of resistant hypertension. Medications specific to the problem of resistant hypertension are also under development. This review analyzes the status of hypertension control in the United States, the frequency of associated diseases, and adherence to guidelines; it further discusses strategies to reduce the prevalence of resistant hypertension.
Lifestyle Modifications to Lower or Control High Blood Pressure: Is Advice Associated With Action? The Behavioral Risk Factor Surveillance Survey
Authors: Viera Anthony J. , Kshirsagar Abhijit V. , Hinderliter Alan L.
Published: February 2008

Routine lifestyle modification advice for managing high blood pressure (BP) is of questionable effectiveness. Using data from the 2005 Behavior Risk Factor Surveillance System, we examined whether receipt of advice is associated with reported adoption of lifestyle modifications. We determined proportions of hypertensive adults taking action to change eating habits, reduce salt intake, exercise, or decrease alcohol consumption to control high BP. We then determined associations between reports of advice given and corresponding actions being taken: 70.1% of respondents reported changing eating habits, 78.7% reported reducing salt intake, 67.1% reported exercising, and 57.9% of those who drank alcohol reported decreasing their consumption. Compared with those who did not recall being given advice, hypertensive adults who recalled being given advice were more likely to change their eating habits (prevalence ratio [PR], 1.62; 95% confidence interval [CI], 1.56–1.67), reduce salt (PR, 1.53; 95% CI, 1.48–1.58), exercise (PR, 1.41; 95% CI, 1.36–1.47), and reduce alcohol consumption (PR, 1.78; 95% CI, 1.70–1.87).
Removal of iron dextran (Cosmofer®) during hemodialysis
Authors: CHEN YUQING , WANG MEI
Published: February 2008

Intravenous iron dextran is widely used in hemodialysis patients receiving erythropoietin (EPO) therapy because of its significant convenience in clinical practice. However, the amount of iron removed by hemodialysis in vivo is unknown. The purpose of this study was to measure the removal of iron dextran in patients undergoing hemodialysis. Six patients were enrolled in this study. All were stable patients treated by hemodialysis for at least 1 month. Both F6 (polysulphone membrane) and GFSplus12 (hemophane membrane) dialyzers were used sequentially in each patient. Each patient received 2 mL of low‐molecular‐weight iron dextran (Cosmofer® aktieselskab/aksjeselskap and supplied by Zhuhai Schwarz Pharma Company Ltd) intravenously, containing 100 mg of elemental iron, administered during the second hour of dialysis over 30 to 60 minutes. A baseline sample of fresh dialysate was collected before the commencement of dialysis. A control sample of spent dialysate was collected during the first hour of dialysis, before the infusion of low‐molecular‐weight iron dextran. Then, all spent dialysate after the iron dextran infusion until the end of dialysis was collected. The samples were treated with lanthanum nitrate solution, and the iron content was measured using an atomic‐absorptive spectrum method. The iron concentration in the control group was 4.31 ± 2.55 µg/L. After the infusion of iron dextran, the iron concentration in the spent dialysate increased significantly, irrespective of whether an F6 or GFSplus12 dialyzer was used. However, the amount of iron eliminated through the dialyzer was minimal, less than 3% of the infusion dose. There was no significant difference in removal of iron through either the F6 or GFSplus12 dialyzer. These results indicate that the removal of iron dextran by hemodialysis when using either a polysulfphone or hemophane membrane dialyzer is negligible. It is time‐efficient and convenient to administer low‐molecular‐weight iron dextran during hemodialysis.
Pelvic surgery in a child with hemophilia C: a rare disease, a real challenge, a simple solution
Authors: HOLTAN ANDERS , KONGSGAARD Ulf E. , BROSSTAD FRANK
Published: February 2008

Coagulation factor XI deficiency, also called hemophilia C, is the least common type of hemophilia in Norway. It differs from hemophilia A and B in its unpredictable clinical pattern. Patients often have no spontaneous bleeding tendency, but they can have serious and life‐threatening bleedings when suffering trauma or undergoing surgical procedures. We report the case of a child with a hitherto undiagnosed factor XI deficiency. She had previously experienced excessive bleeding and required transfusion of saline‐adenine‐glucose erythrocytes after minor surgery. The patient was planned to a major surgical procedure with partial pelvic resection (hemipelvectomy) because of an Ewing sarcoma. Routine preoperative coagulation tests showed a moderately elevated international normalized ratio and a substantially prolonged activated partial thromboplastin time, which were due to a factor XI level at 0.2% of normal. Perioperative management of the patient was planned in collaboration with a coagulation specialist. In addition to replacement of erythrocytes, two different mechanisms were targeted for correcting the hemostatic defect. Substitution of factor XI was done by infusion of plasma, and inhibition of fibrinolysis was achieved by systemic and local administration of tranexamic acid. Surgery was then performed without excessive bleeding, and the patient did not require postoperative blood transfusions.
Different Pathways to Acquiring Resistance Genes Illustrated by the Recent Evolution of IncW Plasmids
Authors: Revilla Carlos , Garcillán-Barcia M. Pilar , Fernández-López Raúl , Thomson Nicholas R. , Sanders Mandy , Cheung Martin , Thomas Christopher M. , de la Cruz Fernando
Published: February 2008

DNA sequence analysis of five IncW plasmids (R388, pSa, R7K, pIE321, and pIE522) demonstrated that they share a considerable portion of their genomes and allowed us to define the IncW backbone. Among these plasmids, the backbone is stable and seems to have diverged recently, since the overall identity among its members is higher than 95%. The only gene in which significant variation was observed was
trwA
; the changes in the coding sequence correlated with parallel changes in the corresponding TrwA binding sites at
oriT
, suggesting a functional connection between both sets of changes. The present IncW plasmid diversity is shaped by the acquisition of antibiotic resistance genes as a consequence of the pressure exerted by antibiotic usage. Sequence comparisons pinpointed the insertion events that differentiated the five plasmids analyzed. Of greatest interest is that a single acquisition of a class I integron platform, into which different gene cassettes were later incorporated, gave rise to plasmids R388, pIE522, and pSa, while plasmids R7K and pIE321 do not contain the integron platform and arose in the antibiotic world because of the insertion of several antibiotic resistance transposons.
Relationship between Antimalarial Activity and Heme Alkylation for Spiro- and Dispiro-1,2,4-Trioxolane Antimalarials
Authors: Creek Darren J. , Charman William N. , Chiu Francis C. K. , Prankerd Richard J. , Dong Yuxiang , Vennerstrom Jonathan L. , Charman Susan A.
Published: February 2008

The reaction of spiro- and dispiro-1,2,4-trioxolane antimalarials with heme has been investigated to provide further insight into the mechanism of action for this important class of antimalarials. A series of trioxolanes with various antimalarial potencies was found to be unreactive in the presence of Fe(III) hemin, but all were rapidly degraded by reduced Fe(II) heme. The major reaction product from the heme-mediated degradation of biologically active trioxolanes was an alkylated heme adduct resulting from addition of a radical intermediate. Under standardized reaction conditions, a correlation (
R
2
= 0.88) was found between the extent of heme alkylation and in vitro antimalarial activity, suggesting that heme alkylation may be related to the mechanism of action for these trioxolanes. Significantly less heme alkylation was observed for the clinically utilized artemisinin derivatives compared to the equipotent trioxolanes included in this study.
Safety, Tolerance, and Pharmacokinetic Studies of OPT-80 in Healthy Volunteers following Single and Multiple Oral Doses
Authors: Shue Y. K. , Sears P. S. , Shangle S. , Walsh R. B. , Lee C. , Gorbach S. L. , Okumu F. , Preston R. A.
Published: February 2008

Current therapies for
Clostridium difficile
infection (CDI) are encumbered by treatment failures and recurrences. Due to its high in vitro activity against
C. difficile
but low activity against the typical intestinal flora, minimal absorption, and durable cure in the hamster model of
C. difficile
infection, OPT-80 was considered for clinical development as a therapy for CDI. This trial consisted of two phases. Four single oral doses of OPT-80 (100, 200, 300, and 450 mg) were administered in a crossover manner to 16 healthy volunteers in a double-blind, placebo-controlled phase 1A study; a 1- to 2-week washout interval separated the treatments. In the double-blind phase 1B study, 24 healthy subjects were randomized to receive OPT-80 (150, 300, or 450 mg) or placebo for 10 days. In both studies, OPT-80's safety and tolerability were evaluated and the concentrations of OPT-80 and its primary metabolite (OP-1118) in plasma and feces were determined. OPT-80 levels in the urine were also analyzed for the phase 1A study. In both the single-dose and the multiple-dose studies, OPT-80 was well tolerated by all subjects in all dose groups. Maximal plasma concentrations were near or below the limit of quantification (5 ng/ml) across the dose range; urine concentrations were below the detection limit. The fecal total recovery of OPT-80 plus its major metabolite, OP-1118, approximated 100%. The tolerability, high fecal concentration, and low systemic exposure data from these studies support the further clinical development of OPT-80 as an oral therapy for CDI.
Role of the AheABC Efflux Pump in
Aeromonas hydrophila
Intrinsic Multidrug Resistance
Authors: Hernould Mathieu , Gagné Séverine , Fournier Michel , Quentin Claudine , Arpin Corinne
Published: February 2008

Gene inactivation and complementation experiments showed that the tripartite AheABC efflux pump of
Aeromonas hydrophila
extruded at least 13 substrates, including nine antibiotics. The use of phenylalanine-arginine-β-naphthylamide (PAβN) revealed an additional system(s) contributing to intrinsic resistance. This is the first analysis of the role of multidrug efflux systems in
Aeromonas
spp.
Recovery of Humoral Immunity Is Critical for Successful Antiviral Therapy in Disseminated Mouse Adenovirus Type 1 Infection
Authors: Lenaerts L. , Kelchtermans H. , Geboes L. , Matthys P. , Verbeken E. , De Clercq E. , Naesens L.
Published: February 2008

Severe adenovirus infections in transplant recipients undergoing immunosuppressive therapy are of increasing concern. Controversy exists on the contribution of antiviral therapy and the host immune response to recovery from these infections. Here, we established a systemic mouse adenovirus type 1 (MAV-1) infection in cyclophosphamide (CyP)-treated BALB/c mice. CyP was administered at 100 mg per kg of body weight every other day for 2, 3, or 4 weeks, thereby inducing general but reversible leukopenia, with a major suppression of the B-cell numbers and functionality that was more pronounced than that seen with T cells. The outcome of MAV-1 infection was dependent on the duration of CyP therapy, as the mice with the most severe immunosuppression were the most vulnerable to MAV-1-induced hemorrhagic enteritis and mortality. The protective effect of concomitant antiviral therapy with cidofovir depended on the level of immunosuppression. The combination of cidofovir treatment with the withdrawal of immunosuppression was the most successful regimen for increasing survival rates. Survival was clearly correlated with the clearance of virus and increased titers of MAV-1-specific antibodies in sera. In addition, the passive transfer of MAV-1-specific immunoglobulin G into MAV-1-infected SCID BALB/c mice caused a marked delay in mortality, the extent of the delay being dependent on the titer of MAV-1-specific antibodies. Based on the critical role of the humoral immune response in the early defense against disseminated adenovirus infection, the concomitant use of adenovirus-specific immunoglobulins and antiviral therapy should be considered for transplant patients at risk for severe adenovirus infections.
Malaria Treatment with Atovaquone-Proguanil in Malaria-Immune Adults: Implications for Malaria Intervention Trials and for Pre-Exposure Prophylaxis of Malaria
Authors: Polhemus Mark E. , Remich Shon , Ogutu Bernhards , Waitumbi John , Lievens Marc , Ballou W. Ripley , Heppner D. Gray
Published: February 2008

Eighty adults in areas of Kenya where malaria is holoendemic received presumptive treatment with atovaquone-proguanil and were followed closely. The time to the first
Plasmodium falciparum
parasitemia was 32 days. This prolonged prophylaxis period has implications for study design when used in malaria intervention trials and cautiously suggests clinical investigation of potential preexposure prophylaxis of malaria.
Iron-Regulated Biofilm Formation inStaphylococcus aureusNewman Requiresicaand the Secreted Protein Emp
Authors: Johnson Miranda , Cockayne Alan , Morrissey Julie A.
Published: February 2008

Staphylococcus aureusbiofilm formation is induced in iron-restricted growth conditions in vitro. In this study, we showed that Emp and Eap play important roles in low-iron-induced biofilm formation ofS. aureusNewman. Eap and Emp are secreted proteins which are non-covalently attached to theS. aureuscell surface and have previously been implicated in a number of aspects ofS. aureuspathogenesis. We showed here that the transcription of these important virulence factors is induced by growth in low-iron medium, reflective of the in vivo environment. Our results show that iron regulation of Eap and Emp is Fur independent. However, Fur is required for full induction ofeapandempexpression in low-iron conditions. In this study, we demonstrated that in addition to Fur, low-iron-induced biofilm formation requires Sae, Agr, and SarA. In iron-restricted growth conditions, Sae and Agr are essential for Emp and Eap expression and hence for biofilm formation, whereas SarA appears to have a less-significant role. We also showed that expression of theicaoperon is required for biofilm formation in iron-restricted growth conditions. We demonstrated that in fact,icais required for the expression of the important multifunctional virulence determinantseapandemp.
Undrained triaxial strength and stress–strain characteristics of a glacial till soil
Authors: Atkinson J. H. , Little J. A.
Published: February 2008

Undrained triaxial compression tests were carried out on reconstituted and nominally undisturbed tubed samples of a lodgement till from the Vale of St. Albans in Hertfordshire, England. The soil is a matrix-dominant, chalky boulder clay of Anglian age with little discernable engineering fabric. Electron microscope observations showed the presence of crystalline calcite in tube samples.The test results were examined within the general framework of critical state soil mechanics using normalizing procedures to take account of the different states and stress histories of the samples. These analyses demonstrate the practical importance of accounting for the current state and stress history in the interpretation of soil test data.The present results form a self-consistent pattern of behaviour. Differences between reconstituted and tubed samples were found only at small strain and may be attributed to cementing in tubed samples, which is broken down during reconstitution and during relatively large straining in recompression and shearing. Key words: boulder clay, cemented soil, critical state, shear strength, soil mechanics, stiffness, till, triaxial test.