bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical electrophysiological characterization of the acquired neuromyotonia phenotype of autoimmune peripheral nerve hyperexcitability
Authors: Maddison Paul , Mills Kerry R. , Newsom‐Davis John
Published: March 2006

Acquired autoimmune neuromyotonia is regarded as part of the spectrum of peripheral nerve hyperexcitability disorders. We aimed to use clinical neurophysiological measurements to study the extent, distribution, and characteristics of spontaneous motor unit potentials in 11 patients with acquired neuromyotonia. Investigations revealed that most spontaneous discharges recorded were motor unit, or partial motor unit potentials of normal size. Bursts of motor unit potentials arose more commonly from distal portions of the peripheral nerve and had abnormal absolute and relative refractory periods. Spontaneous discharges in some patients occurred in semirhythmic bursts in certain muscles. No patient had neurophysiological abnormalities detectable in first‐order neurons of the central nervous system when using transcranial magnetic stimulation to estimate the threshold for corticomotor excitation and determine central motor conduction time. Only patients with coexistent myasthenia gravis had neurophysiologically detectable defects in neuromuscular transmission. The pathogenic region of abnormality in peripheral nerve hyperexcitability disorders therefore seems to lie within the terminal branches of peripheral motor nerves. Muscle Nerve, 2006
A misclassification cost‐minimizing evolutionary–neural classification approach
Authors: Pendharkar Parag , Nanda Sudhir
Published: March 2006

Machine learning algorithms that incorporate misclassification costs have recently received considerable attention. In this paper, we use the principles of evolution to develop and test an evolutionary/genetic algorithm (GA)‐based neural approach that incorporates asymmetric Type I and Type II error costs. Using simulated, real‐world medical and financial data sets, we compare the results of the proposed approach with other statistical, mathematical, and machine learning approaches, which include statistical linear discriminant analysis, back‐propagation artificial neural network, integrated cost preference‐based linear mathematical programming‐based minimize squared deviations, linear integrated cost preference‐based GA, decision trees (C 5.0, and CART), and inexpensive classification with expensive tests algorithm. Our results indicate that the proposed approach incorporating asymmetric error costs results in equal or lower holdout sample misclassification cost when compared with the other statistical, mathematical, and machine learning misclassification cost‐minimizing approaches. © 2006 Wiley Periodicals, Inc. Naval Research Logistics, 2006.
A case of short‐root anomaly in a female from medieval Istria
Authors: Šikanjić P. Rajić , Meštrović S.
Published: March 2006

Dental examination of a young female skeleton from medieval Istria revealed very short‐roots of both maxillary central incisors. This developmental pathological condition is known in the literature as short‐root anomaly, occurring mostly in maxillary incisors. In affected teeth, the crown:root ratio is 1:1.6. Although the prevalence of this condition has been reported in modern populations, this appears to be the first documented case of the anomaly from the medieval period. Unfortunately, fragmentary preservation of the skeletal material prevents us from making a full diagnosis of possible aetiology. Copyright © 2006 John Wiley & Sons, Ltd.
Insights into the processes behind the contamination of degraded human teeth and bone samples with exogenous sources of DNA
Authors: Gilbert M. T. P. , Hansen A. J. , Willerslev E. , Turner‐Walker G. , Collins M.
Published: March 2006

A principal problem facing human DNA studies that use old and degraded remains is contamination from other sources of human DNA. In this study we have attempted to contaminate deliberately bones and teeth sampled from a medieval collection excavated in Trondheim, Norway, in order to investigate this poorly understood phenomenon. Five pairs of teeth and bone samples were bathed in water containing various concentrations (from 10−9 and 10−21 g/l) of purified ΦX174 DNA. Subsequently the samples were subjected to a routine decontamination protocol involving a bleach bath followed by exposure to λ=254 nm ultraviolet light, prior to DNA extraction and analysis for evidence of the persistence of the contaminant. The results support previous speculation that bone is more susceptible to water‐borne sources of contaminant DNA, although both bone and teeth are readily contaminated and are difficult to decontaminate using the tested protocol. We believe that this is largely due to the porous nature of bone and teeth facilitating the deep penetration of the contaminant DNA. To simulate a more realistic handling situation, 27 further teeth were directly handled and washed, then decontaminated, prior to assaying for the residual presence of the handler's DNA. Surprisingly, although our results suggest that a large proportion of the teeth were contaminated with multiple sources of human DNA prior to our investigation, we were unable to contaminate the samples with further human DNA. One potential explanation may be the deposition of sediment or other structural changes that occur within the samples as they desiccate post‐excavation, which may protect samples from subsequent contamination, but also prevent the efficacy of bleach baths in decontaminating specimens. Copyright © 2006 John Wiley & Sons, Ltd.
Perceptions of fieldwork education in Malta: challenges and opportunities
Authors: Bonello Marjorie
Published: March 2006

Academic upgrading of the occupational therapy programme in Malta has necessitated exploration of current fieldwork practices through a qualitative study. Data were collected through one‐to‐one interviews with 18 recently qualified occupational therapists. The findings showed the multi‐faceted and complex nature of the fieldwork process, confirming the strong influence and relationships between the fieldwork context, the fieldwork supervisor and the different values and attitudes each learner brings to the fieldwork situation. The various practices as voiced by the participants affected the quality of their fieldwork experiences in different ways. Awareness of these key influences will pave the way forward for fieldwork education planners to provide meaningful experiences. Copyright © 2001 Whurr Publishers Ltd.
Multicontextual occupational therapy intervention: a case study of traumatic brain injury
Authors: Landa‐Gonzalez Belkis
Published: March 2006

Cognitive deficits after a traumatic brain injury can result in significant functional limitations in all areas of daily living. An individual's ability to generalize learning may be limited, thus making it harder to live independently in the community. Assessing a client's metacognitive skills and awareness level may help to establish a baseline understanding about the supervision required and the most suitable living arrangements. This study describes a multicontextual, community re‐entry occupational therapy programme directed at awareness training and compensation for cognitive problems in a 34‐year‐old man with traumatic brain injury. Intervention consisted of metacognitive training, exploration and use of effective processing strategies, task gradations and practice of functional activities in multiple environmental contexts. Strategies such as self‐prediction, self‐monitoring, role reversal and the use of checklists were used. Results after six months of intervention show improvements in the client's awareness level, enhancement of his occupational function, increased satisfaction with performance and a decrease in the level of attendant care. Additional studies are recommended to validate the findings. Copyright © 2001 Whurr Publishers Ltd.
Going the distance: developing shared web‐based learning programmes
Authors: Stanton Sue
Published: March 2006

Despite a high demand for continuing professional education, it is becoming more challenging to provide education in a resource‐limited environment that meets the varied needs of learners. The advent of user‐friendly, interactive communication technology led the University of British Columbia in Canada to explore the feasibility of developing a web‐based distance learning programme shared by undergraduate and practising therapists to address this problem. Potential benefits and challenges of distance learning, undergraduate web‐learning, pilot‐test results and an assessment of therapists' interests and needs are profiled. Copyright © 2001 Whurr Publishers Ltd.
European Network of Occupational Therapy in Higher Education: a five‐year review
Authors: Bruggen Hanneke Van
Published: March 2006

In 1995 occupational therapy programmes in Europe founded a network in Aalborg, Denmark, with the aim of advancing the education of occupational therapists and the body of knowledge of the discipline. The European Network of Occupational Therapy in Higher Education (ENOTHE) is one of 43 other academic networks supported by the European Commission. The achievements, impact and obstacles in the work of ENOTHE will be discussed. Copyright © 2001 Whurr Publishers Ltd.
Australian occupational therapy practice in acute care settings
Authors: Griffin Susan D. , McConnell David
Published: March 2006

A national sample of occupational therapists was surveyed to explore the nature of Australian occupational therapy practice in acute care settings. Self‐care was the major client need that therapists reported they addressed, with an initial interview being the most common assessment procedure. Client education was the most frequently used intervention. The most important skills therapists reported for effective practice in acute care were time management, quick clinical reasoning and lateral thinking. Important workplace characteristics included a cooperative health‐care team and early referral. Therapists reported that their most important resources were supportive senior therapists and a well‐resourced equipment pool. Three attitudinal factors emerged. Therapists in interdisciplinary teams and those with more experience had more positive attitudes. Younger therapists experienced more concern about not being able to do more for their patients. Results suggest a need for graduates to be better prepared in some skill areas and to have more realistic expectations of practice in this area. Department managers need to ensure younger therapists receive adequate support from senior therapists. Further research is needed to determine how best to provide this support and to further examine the influence of the education experience on practice expectations. Copyright © 2001 Whurr Publishers Ltd.
Inquiry‐based learning: an instructional alternative for occupational therapy education
Authors: Madill Helen M. , Amort‐Larson Gail , Wilson Sylvia A. , Brintnell Sharon G. , Taylor Elizabeth , Esmail Shaniff
Published: March 2006

An inquiry‐based learning (IBL) approach was used as the model of instruction in one of three sections offered annually to large introductory occupational therapy classes in a Canadian university during 1994/5, 1995/6, 1996/7. Students' final grades in this pre‐entry course form part of the grade point average on which admission to the BSc OT programme is based. The IBL model was employed to (1) increase the amount of student‐directed learning, (2) increase the amount of independent problem‐solving, (3) increase student–instructor interaction within the learning situation, and (4) reduce the number of in‐class hours for students. This study is an evaluation of whether students from the IBL sections would subsequently do as well as those from other sections in selected junior professional courses. Students from the three IBL sections (n=47) were peer matched to students who had completed other sections of the introductory course, but were part of the same admission cohort (n=68). Their grades in three junior professional courses were compared at the end of their first year in the BSc OT programme. Results indicated that students from the IBL sections did at least as well as those from other sections where a different instructional approach was used, and those from the IBL sections in 1994/5 and 1996/7 each did significantly better on two of the junior professional courses used as the outcome measure: therapeutic occupation and assessment and evaluation techniques. Students reported that the IBL experience stimulated them to learn more about the field, helped them develop problem‐solving skills in relation to occupational therapy, and enabled them to learn more about career opportunities in occupational therapy. Mature students were more positive about the IBL approach than students in their first year of university. Copyright © 2001 Whurr Publishers Ltd.
How does work work for people with bipolar affective disorder?
Authors: Tse Samson S. , Walsh Anne E. S.
Published: March 2006

Despite modern treatments, bipolar disorder remains a chronic, relapsing disorder that leads to long‐term psychosocial disability. A review of the literature suggests that while employment rates amongst individuals with bipolar disorder may improve over time, and are relatively better compared to some other chronic mental disorders, employment prospects do not match the high scholastic achievements seen amongst this group of people before the onset of their illness. For those with bipolar disorder, clinical recovery does not necessarily mean functional recovery, and the usual early age of onset may further reduce an individual's preparedness for employment. Two brief vignettes are used to discuss how occupational therapists can help their clients maintain their sense of hope in vocational recovery, gain better self‐awareness and work with clients at various stages of recovery rather than waiting for full functional recovery. Further research is required to help identify specific factors that contribute to the success of employment integration amongst people with bipolar disorder. Copyright © 2001 Whurr Publishers Ltd.
Reliability and validity of the Leisure Satisfaction Scale (LSS – short form) and the Adolescent Leisure Interest Profile (ALIP)
Authors: Trottier Angela N. , Brown G. Ted , Hobson Sandra J.G. , Miller William
Published: March 2006

This study aimed to evaluate the reliability and validity of the Leisure Satisfaction Scale (LSS – short form) and the Adolescent Leisure Interest Profile (ALIP). The LSS and the ALIP are instruments that occupational therapists can use to evaluate the leisure activities that clients enjoy. Evaluation of leisure interest and participation will assist in creating goals for therapy to maximize a client's ability to participate in leisure activities. This study examined the test–retest reliability and concurrent validity of the LSS and the ALIP using a sample of 37 adolescents between the ages of 13 and 17 with no known impairments. The assessments were administered individually or in small groups 7 to 17 days apart. Cronbach's alpha was used to determine the internal consistency. Pearson product moment correlations were calculated to examine the test–retest reliability of the 60 subscales and the six question totals of the ALIP, as well as for the 6 subscales and total score of the LSS. Concurrent validity was evaluated between the ‘How often?’ question of the ALIP and the LSS (short form). Based on the study results, the ALIP and the LSS seem to have good test–retest reliability levels when used with adolescents with no known physical or mental impairments. The concurrent validity between the two instruments was not supported, with many of the scores indicating only weak or no association to each of the subscales, suggesting that the assessments differ in some fundamental way. However, the evidence of some relationships between subscales may indicate some areas where the ALIP and the LSS are similar. Copyright © 2002 Whurr Publishers Ltd.
Clinical outcomes research from the occupational therapist's perspective
Authors: Bowman Julia , Llewellyn Gwynnyth
Published: March 2006

With increasing costs and scarcity of resources, occupational therapists need to embrace outcomes research to demonstrate the effectiveness of its clinical interventions. To explore clinicians' perspectives on clinical outcomes research a qualitative study was undertaken involving three in‐depth group interviews with 15 occupational therapists from the South Western Sydney Area Health Service. Five broad themes permeated participants' perception: (a) defining the process, (b) factors that impact on participation in clinical outcomes research, (c) organizational influences, (d) the value of clinical outcomes research, and (e) potential partnerships with academics. Three conceptual categories are identified: knowledge and understanding about clinical outcomes research, clinicians' experience conducting or participating in clinical outcomes research and the relevance of clinical outcomes research to occupational therapy clinical practice. Similarity to findings in the international literature on occupational therapists' engagement in clinical research suggests that the findings from this small sample of Australian therapists are robust. The implications of the findings for continuing professional education programmes and clinical supervision are presented. Copyright © 2002 Whurr Publishers Ltd.
Practical strategies for working with indigenous people living in Queensland, Australia
Authors: Watts Elizabeth , Carlson Glenys
Published: March 2006

Internationally, occupational therapists have recognized the need to provide culturally appropriate services for indigenous people. This study explored experiences, perspectives and practical strategies of occupational therapists working with Aboriginal and Torres Strait Islander people living in rural and remote areas of Queensland, Australia. Semi‐structured interviews were conducted with eight occupational therapists who had at least 12 months' experience providing services to Aboriginal and Torres Strait Islander people in health, rehabilitation or education services. Key themes identified in the data focused on strategies for facilitating effective communication with individuals and families, and collaborating with other service providers. The role of Aboriginal Liaison Officers or Indigenous Health Workers was emphasized by participating therapists. Participants identified resources that they perceived as useful in their practice, such as cross‐cultural training and access to indigenous health workers. Other resources suggested for further development included information about learning styles of indigenous people and information about cultural variations between specific Aboriginal and Torres Strait Islander communities. The small number of participants limits generalizability of the findings. However, therapists can decide on the relevance of strategies to their own workplaces. Suggestions for further research focused on improving occupational therapy services for indigenous people in Australia. These include an investigation of therapy goals with indigenous people, and interviews with indigenous Australians and indigenous health workers about their experiences and perceptions of occupational therapy. Copyright © 2002 Whurr Publishers Ltd.
A survey of paediatric occupational therapists in the United Kingdom
Authors: Howard Lynne
Published: March 2006

The purpose of this study was to examine the work of paediatric occupational therapists in the UK, and to compare the results with similar surveys carried out in the US, Australia and Canada. A postal questionnaire survey was sent to 212 members of the National Association of Paediatric Occupational Therapists. Questions were asked about a wide range of issues pertinent to paediatric practice. The results showed that data collected in the UK are similar to those from the three other countries – for example, in the unique areas of work, such as assessment for adaptive equipment, training in activities of daily living and fine motor skills training, and that there is also some overlap with other disciplines. The study had some limitations in terms of respondents accessed and scope of questions asked. It highlighted a number of areas for further research, one being to identify what undergraduate teaching needs to be made available to students who want to work with children. Several conclusions are drawn, principally that children's occupational therapists tend to remain in the specialization for several years and make good use of postgraduate courses to enhance their practice. Copyright © 2002 Whurr Publishers Ltd.
Identifying occupational therapists' referral priorities in community health
Authors: Harries Priscilla , Gilhooly Ken
Published: March 2006

Occupational therapists in British community mental health teams have been debating how the most effective services can be targeted at the most needy clients. This paper presents the results of a quantitative study that examined 40 British occupational therapists' referral prioritization policies. Results showed half of the participants felt their generic responsibilities, which involved having care coordination responsibilities, were too large. Only 25% of participants co‐ordinated care for clients whose needs were related to occupational dysfunction. Judgement analysis, that involved regressing the 40 individuals' prioritization decisions onto the 90 respective referral scenarios, was used to statistically model how referral information had been weighted. Group agreement of prioritization was moderate with the reason for referral, history of violence and diagnosis being given the most weighting. Consistency in policy application, as measured by examining prioritization decisions on identical referrals, showed wide variability. Further research is required to identify the optimal and most stable policies within this group. Copyright © 2003 Whurr Publishers Ltd.
Rest: a qualitative exploration of the phenomenon
Authors: Nurit Weinblatt , Michal Avrech‐Bar
Published: March 2006

The founders of occupational therapy perceived rest as one of the performance areas of the profession. They believed that an optimal balance between work, play and rest was crucial in obtaining maximal function and health. However, few occupational therapy theorists or researchers have explored the phenomenon. The authors explored the phenomenon of rest as reported in the literature and through a qualitative study. The results of the literature review showed that rest is differentiated from sleep; rest is equated with interrupting physical and mental activity resulting in a relaxed state. Rest can be achieved by listening to music, hypnosis, reading, walking and sitting quietly. In this exploratory study, seven individuals working at Tel Aviv University were interviewed regarding their definitions of rest. The results indicated that rest was defined as an activity that was personal, quiet and effortless, experienced alone or with friends, and helped in doing daily activities. It is concluded that there is a need for occupational therapists to explore further the phenomenon of rest as it relates to occupational performance, ergonomics and health maintenance. Examining the concept of rest is a challenge that involves returning to the theoretical origins of the profession. Copyright © 2003 Whurr Publishers Ltd.
Concepts in occupational therapy in relation to the ICF
Authors: Haglund Lena , Henriksson Chris
Published: March 2006

Occupational therapists need an acceptable terminology to describe a client's clinical performance. The language or terminology must be in harmony with common language in the health care system but also reflect occupational therapists' professional responsibility. The aim of this paper is to help clarify similarities and differences between concepts in occupational therapy and the International Classification of Functioning, Disability and Health (ICF). Two studies were completed in which items in the International Classification of Impairments, Disabilities and Handicaps (ICIDH‐2) were compared with concepts from the Swedish version of the assessment of Motor and Process Skills (AMPS) and the Assessment of Communication and Interaction Skills (ACIS‐S). An expert panel of occupational therapists served as raters and 33 clients with learning disabilities and mental health problems were assessed. The result showed that 12 (60%) of the skills items from the ACIS‐S were found to be equivalent to items in then ICIDH‐2. In total, 41% (n=23) of the items in the AMPS or ACIS‐S have a correlation higher then 0.60 with the ICIDH‐2. The classification can serve as a useful tool for occupational therapists and supports communication between professions, but is not sufficient as a professional language for occupational therapists. Further research is indicated to examine how the ICF can be applied in occupational therapy and its implications on clinical practice. Copyright © 2003 Whurr Publishers Ltd.
Changing practice patterns of school‐based occupational therapists in Israel
Authors: Weintraub Naomi , Kovshi Moriah
Published: March 2006

Following the enactment of the Special Education Law in Israel in 1988, school‐based occupational therapists (OTs) were expected to modify their practice patterns by, providing services within the classroom or other educational settings, increasing collaboration with other team members, and implementing indirect intervention models such as monitoring and consultation. The purpose of this study was to examine the intervention patterns of school‐based OTs in Israel. The study sample included 77 school‐based OTs. The survey was carried out through a questionnaire which included: (1) background information, (2) implementation and perceptions towards intervention models, and (3) team‐work practices of the OTs. The findings indicated that most of the time (76.9%) OTs still implement the ‘direct therapy’ model, working outside the classroom and focusing on improving performance components. These findings imply that school‐based OTs in Israel are still in the process of changing their practice patterns, and are mostly applying the medical model. However, due to the relatively small sample, it is important to repeat this survey using a larger sample of OTs who work in different settings and with various age groups. Copyright © 2004 Whurr Publishers Ltd.
The influence of virtual reality on playfulness in children with cerebral palsy: a pilot study
Authors: Reid Denise
Published: March 2006

The purpose of this paper was to examine the effects of virtual play intervention on the level of playfulness of children with cerebral palsy. Thirteen children aged 8–13 years comprised the study group. Children attended eight one‐hour virtual reality play sessions in which they were immersed and interacted with virtual reality. The Test of Playfulness (TOP) was used as the measure to assess playfulness. Participants were videotaped while they played during 12 different environments over the course of their intervention time. Three randomly selected virtual reality play sessions were chosen to score three different virtual reality environments within each session yielding a total of nine trials (environments) for each participant. The types of virtual environments varied across participants. Overall, the different virtual reality play environments produced varying levels of playfulness according to the TOP's four different subscale scores. Motivation ranged from 1.50 to 2.25, internal control ranged from 1.00 to 1.88, suspension of reality ranged from 0 to 0.26, and framing ranged from 1.33 to 1.78. The three environments producing the highest playfulness ratings were called Paint, Trip and Island Sounds. These environments allowed creativity, persistence with the task, pleasure, and a certain degree of control. Two environments did not appear to foster playfulness. A possible reason was that these environments were too unpredictable and frustrating for participants. These results will be useful for creating new virtual reality software applications that will encourage playfulness in children with disabilities. Copyright © 2004 Whurr Publishers Ltd.
The effects of guided imagery relaxation in people with COPD
Authors: Louie Stephanie Wai‐Shan
Published: March 2006

The aim of this study was to explore the effects of guided imagery relaxation in people with chronic obstructive pulmonary disease (COPD) using a randomized controlled design. Half of 26 participants were allocated to the treatment group in which six practice sessions on guided imagery were conducted, while the control group was instructed to take rest quietly during the six sessions. At the seventh session, physiological changes: partial percentage of oxygen saturation; heart rate; upper thoracic surface electromyography; skin conductance; and peripheral skin temperature were recorded during a 30‐minute session with a sampling frequency of one minute. Repeated measures analysis of variance was used to explore the changes of the parameters between the groups. Mann‐Whitney U test was used to compare the change of perceived dyspnoea between the groups. Results showed there was a statistically significant (p<0.05) increase in partial percentage of oxygen saturation in the treatment group, but no significant effects on the other physiological parameters. Further study exploring the psychological effects of guided imagery is suggested. Copyright © 2004 Whurr Publishers Ltd.
Attitudes and practices of pediatric oncology providers regarding fertility issues
Authors: Goodwin Tress , Elizabeth Oosterhuis B. , Kiernan Michaela , Hudson Melissa M. , Dahl Gary V.
Published: March 2006

Purpose

Given the higher survival rates of childhood cancer, health care providers must be aware of the side effects of cancer therapies to educate patients and provide appropriate interventions to reduce cancer‐related morbidity. To understand the current practices and attitudes in a pediatric hematology/oncology clinic, health care providers were surveyed regarding fertility issues pertinent to their patient care.

Participants and Instruments

In this study, 93.8% (30/32) health care providers in one pediatric hematology/oncology department completed a 44‐item survey assessing knowledge, current practices, obstacles to current practices, perceptions of patient differences, and improvements to future practice.

Results

The majority of health care providers were aware of the adverse effects of alkylating agents (90.7%) and of abdominal and pelvic radiation (100.0%) on fertility. However, only half were aware of gender differences in gonadotoxicity (50.0%) or knowledgeable of current research and technology in fertility preservation (53.3%). While only 34.6% of providers currently consulted with specialists, nearly all (92.8%) indicated a desire to do so in the future, but 64.3% indicated difficulties in finding proper facilities and specialists for their patients. Almost all (96.6%) agreed that providers and patient families need more information regarding the effects of cancer therapy on fertility.

Conclusions

Surveyed pediatric oncology providers considered fertility to be an important issue for childhood cancer patients and desired more resources regarding effects on fertility and fertility preservation. Greater communication needs to be established between pediatric oncology providers and specialists in reproductive medicine and endocrinology to ensure adequate professional collaboration and patient referrals. Pediatr Blood Cancer 2007;48:80–85. © 2006 Wiley‐Liss, Inc.
Safety assessment of intensive induction with vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) in the treatment of Ewing tumors in the EURO‐E.W.I.N.G. 99 clinical trial
Authors: Juergens Christine , Weston Claire , Lewis Ian , Whelan Jeremy , Paulussen Michael , Oberlin Odile , Michon Jean , Zoubek Andreas , Juergens Herbert , Craft Alan
Published: March 2006

Background

The EUROpean Ewing tumour Working Initiative of National Groups 1999 (EURO‐E.W.I.N.G. 99) protocol prescribes six courses of vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) as intensive induction chemotherapy for Ewing tumors (ET). Granulocyte‐colony stimulating factor (G‐CSF) is recommended. Adverse reactions (AR) were evaluated; quality assurance of data collection reviewed.

Procedure

Safety data from 4,746 courses of VIDE in 851 patients less than 50 years with ET were collected using a checklist and evaluated using descriptive statistics with sub‐groups including gender, age, and tumor volume, analyzed by Wilcoxon and Kruskal–Wallis tests.

Results

Myelosuppression and infections were the major AR but with appropriate supportive therapy targeted dose intensity was maintained. Five VIDE‐related deaths with three due to sepsis were reported. Renal and cardiac toxicity were reflected by glomerular filtration rate (GFR) <39 ml/min/1.73m2 in 0.1%, tubular phosphate reabsorption ≤0.80 in 1.9%, and left ventricular shortening fracture <28% in 2.5% VIDE courses. Statistically significant gender‐associated AR concerning hemoglobin and platelets were observed with females > males as were age‐associated AR concerning hemoglobin, WBC, platelets, stomatitis, and vomiting with AR decreasing with age, that is, children > adolescents > adults. No association of AR to tumor volume was found. In VIDE courses with and without G‐CSF, neutropenia‐related fever in 60.8% and 65.8%, and infection in 54.7% and 61.0% courses, respectively, were recorded.

Conclusions

AR under VIDE remained within the expected range. Some AR, for example, hematotoxicity were significantly influenced by age and gender but not by tumor volume. G‐CSF did not significantly influence neutropenia‐related fever and infection. Solicited safety collection with checklists adequately reflects the burden per course. Pediatr Blood Cancer © 2006 Wiley‐Liss, Inc.
Polystyrene–organoclay nanocomposites prepared by melt intercalation, in situ, and masterbatch methods
Authors: Yilmazer Ulku , Ozden Gulsum
Published: March 2006

In this study, polystyrene (PS)/montmorillonite nanocomposites were prepared by melt intercalation, in situ polymerization, and masterbatch methods. In the masterbatch method, as the first step, a high clay content composite of PS–organoclay (masterbatch) was prepared by in situ polymerization, and then the prepared masterbatch was diluted to desired compositions with commercial PS in a twin‐screw extruder. The structure and mechanical properties of the nanocomposites were examined. X‐ray diffraction (XRD) analysis showed that the d‐spacing of the in situ formed nanocomposites increased from 32.9 Å for the organoclay powder to 36.3 and 36.8 Å respectively in nanocomposites containing 0.73 and 1.6 wt% organoclay, indicating intercalation. However, the d‐spacing of the other prepared materials remained nearly unchanged when compared with pure organoclay powder. Thus, at these low clay contents, in situ formed nanocomposites showed the best improvement in mechanical properties including tensile, impact strength, and Young's modulus. In situ polymerization method did not prove to be efficient at high clay loadings in terms of intercalation and mechanical properties. At high clay loadings, the effects of the three methods in promoting mechanical properties were not significantly different from each other. POLYM. COMPOS., 27:249–255, 2006. © 2006 Society of Plastics Engineers
Does experience equate with learning in critical care nurses?
Authors: Douglas Margaret , Gibson Vanessa , Gregg Alan
Published: March 2006

Schemes that aim to provide some form of academic accreditation in recognition of work‐based learning are not a new concept. Work‐based learning is seen as one of many ways to help to build a modern workforce that is fit for practice (DoH 2000a). Northumbria University has developed a BSc (Hons) and a higher education diploma in critical care practice pathway that is open to all practitioners in critical care. One of the core modules of this is ‘Foundations in Critical Care’. However, it was recognized that not all practitioners would need to complete a foundation‐level module to access the pathway and an Accreditation of Experiential Learning (APEL) scheme was developed in order to accredit experienced practitioners with academic points for learning gained from practice. What is new about the Northumbria University APEL process is the abandonment of the usual portfolio approach and the adoption of an annotated CV that outlines students' experience and a viva voce assessment. At their vivas students are asked a number of questions pertaining to the learning outcomes of the module. The assessment panel members comprises one academic and one expert practitioner, who then make a judgement on whether or not the knowledge gained through students' experience equates with the learning outcomes of the module. This has been an interesting and enlightening experience: most students who have been through the process have been successful. However, the process has made a number of students think very carefully about whether or not they need to undertake a foundation module and a number have opted to do just that. The advantages over portfolio submission are numerous, the most obvious being that during the viva the only knowledge that students can demonstrate is their own. Copyright © 2003 Whurr Publishers Ltd.
Improving communication between service users and professionals via the internet
Authors: Hughes Rhidian , Higginson Irene , Sinha Anu , Down Keren , Leigh Nigel
Published: March 2006

A virtual forum—referring to an internet website that allows people with motor neurone disease (MND), their families and healthcare professionals to communicate—has been developed. We demonstrate ways in which communication was enhanced between those affected by MND and healthcare professionals, notably by debate and campaigning, asking questions and seeking advice, and contributing to the ongoing development of the website. Future development of the forum will involve: refocusing the website to include all neurological illnesses; professional re‐design of the website: improved site hosting; publicizing the website; and undertaking detailed research on its role and operation. The issues raised in the development of a virtual forum for people with MND have wider resonance for practice development in healthcare. Copyright © 2004 Whurr Publishers Ltd.
Implementing sustainable foundations for practice and service development
Authors: Eve Julian
Published: March 2006

This article is about the development of a small 12‐bedded residential unit, Broomhill House, into a residential and community base for more than 30 clients with long‐term complex mental health needs. The organizational journey and the changes to clinical process that have contributed to Broomhill House becoming an established mental health recovery service, highly regarded by its clients, their carers and members of the multidisciplinary team are described. Copyright © 2004 Whurr Publishers Ltd.
Public health nursing: developing practice
Authors: Carr Susan , Davidson Alison
Published: March 2006

The present paper addresses the issue of practice development in a public health nursing context. It explores two levels of practice development: the development of a new and innovative public health nurse role within a primary care trust and the development of community nursing practice facilitated by the post‐holder. To date much of the knowledge about practice development in nursing has been located in specific clinical settings, often in relation to specific client groups. In this development the client group is the community within the area and the specific needs of the clients relate principally to health inequalities. The present position of public health nursing is summarized and the process and concept of practice development is discussed. Key elements of practice development are outlined from the literature, using the public health nurse role to illustrate their relevance in this context. An evaluation study was also undertaken, which served to inform the process. The evaluation study is outlined and some of the research data are presented to facilitate discussion of the perceptions of community nurses and other stakeholders involved in the process of public health practice development. The discussion concludes with key issues that must be taken into account if the process is to be successful. Copyright © 2004 Whurr Publishers Ltd.
An account of 360° review as part of a practice development strategy
Authors: Dewing Jan , Hancock Sarah , Brooks Jenny , Pedder Lesley , Adams Liz , Riddaway Lisa , Uglow Julie , O'Connor Pauline
Published: March 2006

The purpose of this paper is to describe the experiences and learning of a group of practitioners, who, while engaged with a systematic emancipatory practice development strategy, undertook a 360° review of their leadership. The purpose of the review was two‐fold: first, to compare their leadership self‐assessment with perceptions of those people they worked with who were affected by their style of leadership; and second, to enable the group members to develop leadership action plans that would facilitate implementation of the practice development strategy. The article shows how the group were moving along a path of enlightenment and empowerment in relation to one style of leadership called transformational leadership. Copyright © 2004 Whurr Publishers Ltd.
Therapeutic and ethical practice: a participatory action research project in old age mental health
Authors: Clarke Charlotte , Gardner Andrew
Published: March 2006

Despite the contemporary emphasis on evidence‐based practice, there remains a dearth of knowledge about how professional philosophy and expertise influence clinical practice. These issues are magnified when caring for people for whom ‘good’ care is hard to define (for example, older people with mental health needs) owing to the dual demands of physical care (in this study for example, continence care) and psychological care (for example, patient autonomy). The aim of the present study was to analyse ethical tensions of developing and managing continence care in an assessment unit for older people with mental health needs. A participatory action research approach was used, seeking to engage the unit staff in developing their practice. Data were collected by focus group and individual interview, observation and secondary data analysis. The study demonstrated the complexity of decision‐making in this field, not least when there was tension between the duty to provide good clinical care and the duty to respect the autonomy of the patient. Despite the relative stability of the external evidence base in continence care, the clinical decisions fluctuated in time, place and person (situated decision‐making). Copyright © 2002 Whurr Publishers Ltd.
Guiding small‐scale evaluation: a critical step in developing practice
Authors: Carr Susan , Clarke Charlotte
Published: March 2006

Evaluation is an essential and important aspect of all health and social care practice. This paper describes an evaluation framework developed as part of the evaluation of a health action zone. Complex community initiatives, such as health action zones, often include multiple small‐scale projects. The evaluation work of such projects is often restricted by lack of time, finance and supportive guidance. These issues are exacerbated by the dearth of user‐friendly literature on the subject of small‐scale evaluation. The framework and process reported here explore a range of evaluation designs and provide a flexible format to support evaluation in practice. It is hoped that these will be useful to both practitioners engaged in evaluating their practice and to those supporting others in this endeavour. Copyright © 2002 Whurr Publishers Ltd.
Child and adolescent mental health: a new pathway of care to improve access to services
Authors: Hewson Lesley , Chennells Liz , Worrall‐Davies Anne
Published: March 2006

The present paper considers the development of a new integrated model of care to improve services aimed at addressing the mental health needs of children and young people after increased staffing levels and other initiatives had failed to bring about the necessary improvements in the service. A different approach, focused on a radical redesign of the pathway for referral and treatment, appears to have been successful in ensuring that children and young people receive a more timely and acceptable service. Copyright © 2003 Whurr Publishers Ltd.
Effect of triage on patient outcomes
Authors: Horsey Madeleine , Thomas Peter , Adlem Linda
Published: March 2006

Both staff and patients at the Blandford Community Hospital Physiotherapy Department were unhappy that sometimes it took as long as 12 weeks for general practice patients to receive their initial appointments. A triage system was introduced and an audit undertaken to compare outcomes before and after triage to see if, after undertaking triage, patients needed fewer treatments or were discharged sooner. Copyright © 2003 Whurr Publishers Ltd.
Reciprocal support provision: personality as a moderator?
Authors: Knoll Nina , Burkert Silke , Schwarzer Ralf
Published: March 2006

In some cases, support provision can be predicted by the history of prior social exchange. Receiving may encourage providing. Moreover, personality dispositions may moderate the degree to which persons reciprocate support. Co‐student dyads (N = 43) facing an exam repeatedly reported their levels of received and provided support. Data revealed both direct and moderated reciprocal support provision. Actors' receipt of emotional support predicted the subsequent change in actors' provision of emotional support, indicating reciprocity. Also, more reciprocal emotional support provision was found in introverted and open individuals, whereas more reciprocal instrumental support provision was observed in introverts and less open individuals. Findings were partially validated when partner‐provided support instead of actor‐received support served as the predictor of later support provision. Copyright © 2006 John Wiley & Sons, Ltd.
Extremely regio‐regular poly (3‐alkylthiophene)s from simplified chain‐growth Grignard metathesis polymerisations and the modification of their chain‐ends
Authors: Hiorns Roger C , Khoukh Abdel , Gourdet Benoit , Dagron‐Lartigau Christine
Published: March 2006

A simplified route to regio‐regular poly(3‐alkylthiophene)s (P3AT) with predetermined molecular weights and low molecular weight distributions based on the chain‐growth GRIM polymerisation of 2,5‐dibromo‐3‐alkylthiophenes is detailed. It is proposed by way of in‐depth 13C‐, 1H‐ and two‐dimensional NMR characterisations that the resulting P3ATs are quasi‐100% regio‐regular except for one regio‐irregular pair at one chain‐end. It is probable that chain‐end groups exhibit reduced conjugation with the rest of the polymer. A comparison of the preparation of poly(3‐hexylthiophene) and poly(3‐butylthiophene) (P3BT) is presented. New methods required for the hydrogenation, formylation and bromomethylation of the chain‐ends of P3BT, necessary to overcome its poor solubility and low reactivity, are described. Copyright © 2006 Society of Chemical Industry
Hydrophobic and superhydrophobic surfaces from polyphosphazenes
Authors: Allcock Harry R , Steely Lee B , Singh Anurima
Published: March 2006

Hydrophobic polymers play a crucial role in many biomedical and commercial applications. Hydrophobic polyphosphazenes offer opportunities for the tuning of surface properties that are not found for many conventional hydrophobic materials. Thus, changes in the side groups linked to the polyphosphazene skeleton allow the surface character to be changed from highly hydrophilic to hydrophobic. The hydrophobic side groups range from fluoroalkoxy groups to aryloxy and organosilicon units. Moreover, the polymer architectures can be varied from single‐substituent species to mixed substituent polymers or to block or comb copolymer structures. Superhydrophobicity, with contact angles to water as high as 159°, has been achieved by electrospinning a fluoroalkoxy derivative to nanofiber mats. Copyright © 2006 Society of Chemical Industry