bluuebunny/crossref_metadata_2025 huggingface dataset:
Preclinical studies of fibroblast growth factor receptor 3 as a therapeutic target in multiple myeloma
Authors: Paterson Joshua L. , Li Zhihua , Wen Xiao‐Yan , Masih‐Khan Esther , Chang Hong , Pollett Jonathan B. , Trudel Suzanne , Stewart A. Keith
Published: December 2004

Dysregulation of fibroblast growth factor receptor 3 (FGFR3) by the translocation t(4;14)(p16;q32) occurs in 15% of multiple myeloma (MM) patients and confers a growth and survival advantage to malignant plasma cells. As FGFR3 is a molecular target, we assessed the therapeutic potential of the FGFR‐specific tyrosine kinase inhibitors SU5402 and SU10991 in MM. SU5402 inhibited FGFR3 phosphorylation in vitro and in murine MM tumour models. B cells dependent on FGFR3 for survival were specifically sensitive to SU5402. A panel of 11 human myeloma cell lines was studied, five bearing the t(4;14) translocation. The KMS11 human myeloma cell line, which expresses constitutively active mutant FGFR3, displayed an 85% decrease in S‐phase cells, a 95% increase in G0/G1 cells, and 4·5‐fold increase in apoptotic cells after 72 h treatment with 10 μmol/l SU5402. Activated extracellular signal‐regulated kinases  1 and 2 and signal transducer and activator of transcription 3 were rapidly down‐regulated after SU5402 treatment. In human myeloma cell lines expressing wild‐type FGFR3 the stimulating effect of aFGF ligand was abrogated by SU5402 treatment. Myeloma cells lacking the t(4;14) or with the t(4;14) and a secondary RAS mutation did not respond to therapy. These findings support the development of clinical trials of early intervention with FGFR3 inhibitors in t(4;14) myeloma.
Clinical relevance of a newly identified HLA‐A24‐restricted minor histocompatibility antigen epitope derived from BCL2A1, ACC‐1, in patients receiving HLA genotypically matched unrelated bone marrow transplant
Authors: Nishida Tetsuya , Akatsuka Yoshiki , Morishima Yasuo , Hamajima Nobuyuki , Tsujimura Kunio , Kuzushima Kiyotaka , Kodera Yoshihisa , Takahashi Toshitada
Published: December 2004

Minor histocompatibility antigens (mHAs) are major histocompatibility complex (MHC)‐associated peptides, which trigger T‐cell responses that mediate graft versus host disease (GVHD) and graft versus leukaemia effects. We recently identified a new mHA epitope, termed ACC‐1, which is presented by HLA‐A*2402 and encoded by BCL2A1, whose expression is restricted to haematopoietic cells including leukaemic cells. HLA‐A24/ACC‐1 tetramer detected the presence of ACC‐1‐specific CD8+ cells in the peripheral blood of a patient up to 7 months following transplantation, and these tetramer‐positive cells were expandable in vitro by ACC‐1 peptide stimulation. A retrospective analysis of 320 patients with HLA‐A*2402 who had received a human leucocyte antigen (HLA) genotypically matched unrelated donor through the Japan Marrow Donor Programme was conducted to determine whether ACC‐1 disparity is associated with adverse clinical outcomes such as GVHD. Among these patients, ACC‐1 disparity was detected in 55 (17·2%) donor/recipient pairs. After adjusting for known risk factors, the hazard ratios or odds ratios of acute and chronic GVHD, relapse and disease‐free survival were not statistically different between patients receiving ACC‐1 compatible and incompatible transplantation. These data suggest that disparity of haematopoietic cell‐specific mHA, ACC‐1, is unlikely at least to augment GVHD, and that T cells specific for ACC‐1 may also be used for immunotherapy of recurring leukaemia without GVHD.
Association between thrombin activatable fibrinolysis inhibitor genotype and levels in plasma: comparison of different assays
Authors: Guimarães A. H. C. , van Tilburg N. H. , Vos H. L. , Bertina R. M. , Rijken D. C.
Published: December 2004

Thrombin activatable fibrinolysis inhibitor (TAFI) antigen levels exhibit a large interindividual variability in which genetic control seems to play a major role. However, recent reports have questioned the association between TAFI concentration and genotype, suggesting that variable antibody reactivity towards TAFI isoforms, particularly the Thr325Ile polymorphism (1040C/T), may lead to artefacts in TAFI antigen levels. In order to compare assay outcome we determined plasma TAFI levels in 92 healthy individuals, using an enzyme‐linked immunosorbent assay (ELISA) (commercial antibodies), an electroimmunoassay (in‐house antibodies) and a commercial chromogenic assay (Actichrome® TAFI). Each individual was genotyped for the −438A/G and 1040C/T polymorphisms in the TAFI gene. TAFI levels were significantly associated with genotype in both antigen and chromogenic assays. All assays displayed significant correlations with each other. Linear regression and Bland–Altman agreement analysis in the genotype subgroups showed that neither the genotype nor the concentration affected the relationship between the Actichrome® TAFI and the electroimmunoassay. In contrast, the ELISA/Actichrome® TAFI and the ELISA/electroimmunoassay relationships were concentration‐ and genotype‐dependent. Our results demonstrate that artefacts may arise when measuring TAFI antigen levels by ELISA. Nevertheless, the electroimmunoassay and the Actichrome® TAFI assay support a genotype‐related variation of TAFI concentration.
Mid‐trimester fetal blood‐derived adherent cells share characteristics similar to mesenchymal stem cells but full‐term umbilical cord blood does not
Authors: Yu Minjun , Xiao Zhifeng , Shen Li , Li Lingsong
Published: December 2004

Stem cell transplantation is a promising treatment for many conditions. Although stem cells can be isolated from many tissues, blood is the ideal source of these cells due to the ease of collection. Mesenchymal stem cells (MSCs) have been paid increased attention because of their powerful proliferation and pluripotent differentiating ability. But whether MSCs reside in blood (newborn umbilical cord blood and fetal or adult peripheral blood) is also debatable. The present study showed that MSC‐like cells could be isolated and expanded from 16–26 weeks fetal blood but were not acquired efficiently from full‐term infants’ umbilical cord blood (UCB). Adherent cells separated from postnatal UCB were heterogeneous in cell morphology. Their proliferation capacity was limited and they were mainly CD45+, which indicated their haematopoietic derivation. On the contrary, MSC‐like cells shared a similar phenotype to bone marrow MSCs. They were CD34− CD45− CD44+ CD71+ CD90+ CD105+. They could be induced to differentiate into osteogenic, adipogenic and neural lineage cells. Single cell clones also showed similar phenotype and differentiation ability. Our results suggest that early fetal blood is rich in MSCs but term UCB is not.
Human haematopoietic stem cells that mediate long‐term in vivo engraftment are not susceptible to infection by human cytomegalovirus
Authors: Crapnell Kirsten B. , Almeida‐Porada Graca , Khaiboullina Svetlana , St. Jeor Steve C. , Zanjani Esmail D.
Published: December 2004

A human/sheep xenograft model was used to evaluate whether long‐term engrafting haematopoietic stem cells (HSC) are susceptible to human cytomegalovirus (HCMV) infection. CD34+ Lin− HSC were isolated by fluorescence‐activated cell sorting (FACS) from the bone marrow (BM) of HCMV‐positive and HCMV‐negative normal donors. Cells from the latter group were infected in vitro with HCMV. HCMV DNA was detected in both cell populations by nested‐polymerase chain reaction (PCR) and fluorescence in situ hybridization. Cells were transplanted into separate groups of fetal sheep at concentrations of 1·3–5·0 × 105 cells per fetus. Multilineage human haematopoietic cell engraftment, including CD34+ cells, was detected in the BM and peripheral blood of recipients up to 16 months post‐transplant as assessed by FACS analysis and PCR for HLA‐DQα. Levels of engraftment varied (1·2–24·3%) but no sheep exhibited HCMV‐positive cells. To ensure that our inability to detect HCMV‐positive cells was not due to immune‐elimination of HCMV‐infected cells, 3·8–10 × 105 HCMV‐positive uncharacterized BM stromal cells were transplanted into fetal sheep. At 5 weeks post‐transplant several organs were HLA‐DQα‐ and HCMV‐positive, confirming that HCMV was detectable. These results provide evidence that the long‐term engrafting HSC is not a primary target of HCMV and suggest that HCMV infection of human haematopoietic cells is exercised at the level of committed progenitors.
Spleen neoangiogenesis in patients with myelofibrosis with myeloid metaplasia
Authors: Barosi Giovanni , Vittorio Rosti , Margherita Massa , Luca Viarengo G. , Alessandro Pecci , Vittorio Necchi , Isabella Ramaioli , Rita Campanelli , Monia Marchetti , Mario Bazzan , Umberto Magrini
Published: December 2004

Neoangiogenesis is an integral component of bone marrow myeloproliferation in patients with myelofibrosis with myeloid metaplasia (MMM). As extramedullary haematopoiesis is a constitutive feature of MMM, we studied spleen neoangiogenesis by a computerized image analysis in MMM patients. Compared with five normal subjects, spleen CD34‐staining capillary vascular density (CVD) was 2·1–3·03 times higher than the upper range of normal in six of the 15 (40%) MMM patients. CD8‐staining sinusoidal vascular density (SVD) was constantly normal or lesser than normal and was inversely correlated with CVD (R = −0·53; P = 0·04). In MMM patients who did not receive cytoreductive or radiation therapy in the month before splenectomy (n = 9), the CVD was a significant determinant of spleen size (R = 0·88; P = 0·04). In MMM patients, the number of spleen CD34+ haematopoietic stem cells was increased from 1·2 to 98 times the upper limit of normal, and predicted the expansion of CVD (R = 0·57; P = 0·03). A population of cells expressing the CD34+/CD133+/VEGFR‐2+ angiopoietic phenotype was present in the blood and spleen of five of seven patients. These results document that neoangiogenesis is an integral component of spleen re‐localization of haematopoietic stem cells and suggest a cellular mechanism for spleen neoangiogenesis.
Distribution and life history of Euphausia pacifica off northeastern Japan
Authors: TAKI KENJI
Published: December 2004

The abundance, spawning, growth pattern and life span of Euphausia pacifica were examined using widely collected samples off the Japanese coast of the North Pacific. Adults were widely distributed in the Oyashio area [OW; temperature at 100‐m depth (T100) ≤ 5°C] and the transitional area (5°C < T100 ≤ 15°C) throughout the year, but the occurrence of large adults (>15 mm) was limited to OW and the cold waters of the transitional area (CW; 5°C < T100 ≤ 10°C). Spawning occurred in OW and the transitional area throughout the year, especially in CW in spring but rarely in winter. Two modal cohorts of adults were consistently recognized in OW and CW. Cohorts of small males and females (10–11 mm length), which newly appeared in spring, grew remarkably to about 17 mm from the following spring to early summer, followed by a long period of little growth during spring–winter. Then, both male and female cohorts grew slowly and steadily after summer to a maximum of 18–19 mm by the following spring. The cohort of males disappeared after spring, but the females (about 20 mm length) were still being observed up until late summer. If the cohort of small adults is assumed to develop mainly from the spring hatching, the life span of male and female E. pacifica can be estimated to be 24 and 28 months, respectively, off northeastern Japan.
Daily rhythm and seasonal variation of feeding habit of Pacific saury (Cololabis saira) in relation to their migration and oceanographic conditions off Japan
Authors: SUGISAKI HIROYA , KURITA YUTAKA
Published: December 2004

Seasonal and diel variation of feeding activities of Pacific saury (Cololabis saira) were examined following their annual migration cycle in North Pacific waters adjacent to Japan in relation to oceanographic conditions, especially abundance and composition of zooplankton collected in surrounding waters. A high gut fullness and low degree of digestion of the gut contents were frequently observed during the dusk period during the 24‐h cycle for all seasons. In spring and summer saury were distributed in the Kuroshio–Oyashio transitional region and the Oyashio (cold current) area, where they mainly fed on the euphausiid, Euphausia pacifica, and had a higher gut fullness than the other seasons. Their feeding activity decreased in fall, and increased in winter, the spawning season, although they were distributed in an area of poor food conditions in the Kuroshio warm current area. Their distribution in the Kuroshio–Oyashio transitional region and the Oyashio area allow utilization of adult euphausiids, E. pacifica which is a significant food source.
Decadal changes in reproduction of walleye pollock (Theragra chalcogramma) off the Pacific coast of northern Japan
Authors: HAMATSU TOMONORI , YABUKI KEIZOU , WATANABE KAZUTOSHI
Published: December 2004

We examined stock fecundity, abundance of eggs and larvae, and catch per haul of age 0 walleye pollock, Theragra chalcogramma, and considered the relationship between reproduction, recruitment and the ocean environment off the Pacific coast of northern Japan for the period between 1985 and 1996. To calculate stock fecundity, we estimated age at maturity and fecundity, and expanded estimates to the expected age composition of the population as estimated by Virtual Population Analysis. Eggs and larvae were collected by research cruises in the main spawning ground in and around Funka Bay. Catch in number of age 0 per haul were obtained from catch statistics. Annual stock fecundity decreased in the late 1980s, from 97 billion eggs in 1986 to 74 billion in 1990, and increased in the 1990s, to 137 billion in 1995. Abundance of eggs and larvae, and catch of age 0 per haul, were high in the late 1980s; however, they were low or intermediate in the 1990s. The steepness of the spawner recruitment relationship in the 1990s was different from the late 1980s, based on positive relationships between stock fecundity and catch of age 0 per haul in each decade. Sea surface temperature in the main spawning ground around Funka Bay was low in the late 1980s, but high in 1990s. We conclude that the decadal‐scale change in the ocean environment around the main spawning ground between the 1980s and the 1990s caused a change in the reproduction and recruitment of walleye pollock.
Diel changes in vertical distribution patterns of zooplankton and walleye pollock (Theragra chalcogramma) off the Pacific coast of eastern Hokkaido, Japan, estimated by the volume back scattering strength (Sv) difference method
Authors: MIYASHITA KAZUSHI , TETSUMURA KOUTAROU , HONDA SATOSHI , OSHIMA TATSUKI , KAWABE RYO , SASAKI KEI
Published: December 2004

In this study, we tried to accurately discriminate between zooplankton and walleye pollock using a quantitative echosounder at two frequencies (38 and 120 kHz). To estimate the abundance of walleye pollock and zooplankton (mainly Euphausia pacifica), an acoustic and trawling survey with bongo net sampling and CTD (X‐CTD) was conducted during June 2001 off the Pacific coast of eastern Hokkaido, Japan. Neocalanus copepods and E. pacifica were predominant in almost all the net samples. One size class of Neocalanus copepods (mean TL ± SD = 2.0 ± 1.1 mm, N = 1 044 080) and two size classes of E. pacifica (mean TL ± SD = 6.1 ± 2.2 mm, N = 13,099; mean TL ± SD = 15.4 ± 3.6 mm, N = 7628) were collected. The distribution patterns of these two classes and of walleye pollock were identified using the volume back scattering strength (Sv) difference method. On the continental shelf, the walleye pollock schools (small walleye pollock: mainly age 1 and 2) overlapped with almost all zooplankton layers during both day (near the sea bottom and mid‐water) and night (mid‐water and sea surface). Near and offshore of the continental shelf break, during day, the walleye pollock schools (large walleye pollock: mainly older than age 3) overlapped with almost all zooplankton layers near the sea bottom, but during night, the large walleye pollock schools (which were mainly distributed near the sea bottom) showed little overlap with most zooplankton layers (which were mainly distributed between mid‐water and sea surface). This result suggests differences in feeding strategies between small and large walleye.
Modeling the influence of oceanic‐climatic changes on the dynamics of Pacific saury in the northwestern Pacific using a life cycle model
Authors: TIAN YONGJUN , AKAMINE TATSURO , SUDA MAKI
Published: December 2004

A life cycle model for Pacific saury (Cololabis saira) was developed to clarify the possible causes of interannual and decadal variability in its abundance. In the model, the population of saury is composed of two spawning cohorts: one spawned in the Kuroshio region during autumn–winter and the other spawned in the Kuroshio‐Oyashio Transition Zone during winter–spring. The life cycle of saury was divided into six stages: namely egg, larval, juvenile, young, immature and adult stages. The life cycle model combines growth, survival, fishing and reproductive processes, in which the effects of sea surface temperature (SST) in the Kuroshio region and El Niño‐Southern Oscillation (ENSO) events on the winter‐spawning cohorts, the effects of SST in the Oyashio region on the spring‐spawning cohorts, and the effects of fishing on the two spawning cohorts are taken into account. Results of basic modeling, in which environments are assumed stable and the stock is affected by fishing only, shows that the interannual fluctuations in the abundance are small and could hardly explain the observed large annual changes in abundance. On the contrary, results of modeling incorporating the effects of oceanic‐climatic changes corresponded well with actual interannual‐decadal variations in abundance. These results suggest the following environmental effects: (1) SST in the Kuroshio region affects decadal changes in abundance; (2) ENSO events influence the survival of the winter spawning cohort and result in large interannual variations in the abundance. It is concluded that large‐scale climatic and oceanic changes strongly affect the abundance of saury.
Life histories of Eucalanus bungii and Neocalanus cristatus (Copepoda: Calanoida) in the western subarctic Pacific Ocean
Authors: TSUDA ATSUSHI , SAITO HIROAKI , KASAI HIROMI
Published: December 2004

Life cycles of the large suspension‐feeding copepods, Eucalanus bungii and Neocalanus cristatus were investigated by seasonal sampling in the western subarctic Pacific. Eucalanus bungii has a diapause from August to March at copepodite stages between copepodite 3 (C3) and C6 female. We propose that individuals with early birth dates are young of overwintering C5 and C6‐females that develop to C4 in their birth year, while individuals with late birth dates are young of overwintering C4 that develop to C3 in their birth year. Thus, a majority of the population has annual generations alternating with biennial generations. Neocalanus cristatus showed life history almost identical to the population in the Alaskan gyre. Timing of the life cycle in N. cristatus is very close to that in the eastern subarctic gyre, but that of E. bungii is 2 months earlier than in the eastern subarctic. This difference is probably caused by the timing difference in the maximum primary production in the two areas and the plasticity of the life cycle strategy in E. bungii.
Seasonal changes in the reproduction of three oncaeid copepods in the surface layer of the Kuroshio Extension
Authors: NAKATA KAORU , ITOH HIROSHI , ICHIKAWA TADAFUMI , SASAKI KATSUYUKI
Published: December 2004

Seasonal changes in reproduction rates of three dominant oncaeids, Oncaea media, O. venusta f. venella and O. venusta f. –1, and effects of environmental factors on them were examined in the surface layer (0–30 m) in the Kuroshio Extension and adjacent waters off the Pacific coast of central Japan. The biomass of oncaeid copepods peaked in spring, and remained at about 14% of total copepod biomass throughout the year. Monthly mean specific egg production rates of O. media, O. venusta f. –1 and O. venusta f. venella ranged from 0 to 0.038 day−1, from 0.026 to 0.051 day−1 and from 0.022 to 0.049 day−1, respectively, and were relatively higher from winter to spring. Specific egg production rates of both O. media and O. venusta f. venella were positively related to primary production in the euphotic layer. Analysis of temperature effects on reproduction parameters indicated that low temperature was one cause for high specific egg production rates of O. venusta f. –1 in winter, mainly because of an increase in clutch size. Environmental factors thus affect reproduction of the dominant oncaeids in the surface layer of the Kuroshio Extension, and an increase in temperature and decline in primary production would reduce their reproduction.
Environmental factors affecting larval growth of Pacific saury, Cololabis saira, in the northwestern Pacific Ocean
Authors: OOZEKI YOSHIOKI , WATANABE YOSHIRO , KITAGAWA DAIJI
Published: December 2004

Environmental factors affecting larval growth of the Pacific saury, Cololabis saira, were analyzed from specimens sampled in the northwestern Pacific Ocean in winter, spring and autumn, 1992–94. Body length at 5 days before sampling was individually estimated by back‐calculation from otolith increment widths and recent growth rate was determined. Recent growth rates of saury larvae were significantly different among seasons and years. Results of multiple regression analysis between the recent growth rate and environmental factors indicated that sea surface temperature, chlorophyll a concentration and copepodite stage Copepoda concentration were positively correlated with the growth rate of saury larvae. Annual and seasonal variations of larval growth were largely explained by these environmental factors.
Trophodynamic modeling of walleye pollock (Theragra chalcogramma) in the Doto area, northern Japan: model description and baseline simulations
Authors: YAMAMURA ORIO
Published: December 2004

An age‐structured trophodynamic model was constructed to quantitatively analyze factors affecting post‐settlement mortality and growth of walleye pollock (Theragra chalcogramma) in the Doto area, the main nursery ground of the Japan Pacific population. The model included (i) multiple age classes of pollock, (ii) a generic predator, (iii) fisheries, and (iv) major prey of pollock. Major processes considered were (i) recruitment, (ii) bottom‐up control of somatic growth, (iii) mortality because of predation, cannibalism and fishing, (iv) size‐selective prey selection, (v) temperature‐dependent bioenergetics such as conversion efficiency and daily consumption rate, and (vi) production and advective supply of prey. By assuming that pollock select prey based upon both relative abundance and predator–prey size relationships, the model accurately simulated seasonal and ontogenetic variations in the diet. However considering ontogenetic segregation, the model showed that, due to cannibalism, newly recruited fish would be totally consumed within 6 months after settlement. By considering segregation (10% overlap during spring and 0.1% during other seasons), an agreement of diet between the simulation and empirical data averaged 82.7% for the different seasons and fish sizes. Euphausiids, the most important prey of pollock, suffered the highest predation impact (22.2 ± 5.3 WWg m−2 yr−1) exceeding annual production in the model domain (17.2 ± 0.1 WWg m−2 yr−1), indicating that an advective supply of prey is necessary to support the pollock population. The daily ration of pollock during spring and summer averaged at 1.2 and 0.6% BW day−1 for small (≤200 mm) and large (>200 mm) pollock, respectively; this daily ration was reduced by half during autumn and winter.
The meaning of fatigue for women with multiple sclerosis
Authors: Olsson Malin , Lexell Jan , Söderberg Siv
Published: December 2004

Aim. This paper reports the findings of a study that aimed to elucidate the meaning of fatigue for women with multiple sclerosis (MS).

Background. Living with chronic illness can involve giving up usual activities. MS is a chronic autoimmune disease of the central nervous system. Fatigue is a common experience among people with MS; however, little is known about the meaning of fatigue experienced by women with this condition.

Method. Ten women with MS were interviewed about their experience of fatigue. A phenomenological hermeneutic method influenced by Ricoeur was used to interpret the transcribed interviews.

Findings. The findings were presented in two major themes with five subthemes; experiencing the body as a barrier and experiencing a different absence. Fatigue seemed to give rise to an experience of being absent and divided into two parts. This also led to a feeling of not being able to participate in the surrounding world. The feeling of being an outsider and lacking the ability as a healthy person is interpreted as a form of suffering. Although the fatigue had a great impact on the women's daily life, the women still hoped for some relief. Fatigue seemed to imply that instead of working as an implement to manage in the world the body has become an enemy of survival.

Conclusion. This study highlights the importance for nurses of understanding how women with MS experience fatigue, which is a prerequisite for communication based on a shared understanding. This awareness would enhance nurses’ opportunities to alleviate suffering. More research is needed to investigate what kinds of interventions can help these women to manage their everyday lives and to maintain a sense of normality despite their fatigue and illness. Such interventions should be subject to empirical evaluation research.
Predicting pressure ulcers: cases missed using a new clinical prediction rule
Authors: Schoonhoven Lisette , Grobbee Diederick E. , Bousema Mente T. , Buskens Erik ,   the prePURSE study group
Published: December 2004

Aim.  The aim of this paper is to report a study describing patients with pressure ulcers that were incorrectly classified as ‘not at risk’ by the prediction rule and comparing them with patients who were correctly classified as ‘not at risk’.

Background.  Patients admitted to hospital are at risk of developing pressure ulcers. Although the majority of pressure ulcers can be predicted using a recently developed prediction rule, up to 30% of patients with pressure ulcers may still be misclassified.

Methods.  Between January 1999 and June 2000 a prospective cohort study was conducted in two large hospitals in the Netherlands. Patients admitted to neurology, internal, surgical, and elder care wards for more than 5 days were included (n = 1229), and were examined weekly. Information on potential prognostic determinants for pressure ulcers mentioned in the literature was recorded. Outcome was defined as occurrence of a pressure ulcer grade 2 or worse during hospital admission.

Results.  Patients who developed pressure ulcers experienced more problems with ‘friction and shear’ and underwent surgery more often and longer. Also, they were more often admitted because of malignant conditions.

Conclusion.  We found no specific characteristics that clearly distinguished patients with pressure ulcers that were incorrectly classified as ‘not at risk’ by the prediction rule from patients who were correctly classified as ‘not at risk’. It appears difficult to improve further on the prediction of pressure ulcers using available clinical information.
On becoming dependent on home mechanical ventilation
Authors: Lindahl Berit , Sandman Per‐Olof , Rasmussén Birgit H.
Published: December 2004

Aim. The aim of this paper is to illuminate meanings of becoming dependent on home mechanical ventilator treatment.

Background. People suffering from chronic alveolar hypoventilation and requiring home mechanical ventilation represent a small but increasing group in society, and are some of the most vulnerable individuals with chronic disabilities.

Method. Thirteen people about to begin ventilator treatment at home were interviewed. Data were tape‐recorded and analysed according to a phenomenological‐hermeneutic method.

Findings. Findings revealed two contrasting meanings of being in the process of becoming dependent on a ventilator, interpreted as getting breath or holding breath. This interpretation is presented in two composite stories.

Conclusions. The findings imply possibilities and deficiencies in meeting patients’ existential needs, such as helping them to breathe spiritually by supporting them as they get their breath after such a life‐changing event as becoming dependent on a ventilator.
Women's experiences of bulimia nervosa
Authors: Broussard Brenda B.
Published: December 2004

Aim.  This paper reports a study to interpret and understand bulimia nervosa as women experience it.

Background.  Research into bulimia nervosa has focused on prevalence rates, health complications, comorbidity, neurochemical dysregulation, and cultural influences. Despite a multitude of investigations, little published research appraised bulimic women's personal experiences and understanding of this disorder. Such an understanding would assist health care professionals in providing sensitive, empathetic care.

Method.  The principles of Heideggerian phenomenology guided the study. Participants were 13 actively bulimic women, aged 18–36 years, with lengths of illness from 1 to 23 years. Data were obtained through interviews, personal diaries, and demographic questionnaires.

Findings.  Participants’ narratives revealed four themes that characterized the experience of living with bulimia: isolating self, living in fear, being at war with the mind, and pacifying the brain. The practices bulimic women engage in are carried out in secret, and hence participants experienced isolation. Binge eating and self‐induced vomiting are considered abnormal behaviours; therefore, participants believed that they were subjected to negative public perceptions, which led to the experience of living in fear. The women feared being judged if others knew about the disorder. Several feared living without bulimia because it had become a significant part of their identity. In addition, these women were terrified of gaining weight or becoming fat. They experienced an internal struggle with the mind. In order to pacify the inner voice, many fed the compulsion to eat, and this resulted in guilt. The women subsequently balanced the experience by getting rid of fullness and erasing guilt, which was primarily achieved through self‐induced vomiting.

Conclusions.  Understanding the experience of bulimia for women who suffer from this disorder is important. Bulimia often presents as a chronic and potentially lifelong health issue. Awareness of bulimic women's perspectives could promote a comprehensive appreciation of bulimia, its aetiology, and directions for treatment alternatives.
Ostomy patients’ perceptions of quality of care
Authors: Persson Eva , Gustavsson Bengt , Hellström Anna‐Lena , Lappas George , Hultén Leif
Published: December 2004

Aim.  This paper reports a study whose aim was to assess the quality of care in ostomy patients seen from a patient perspective.

Background.  A stoma operation causes profound changes in a patient's life because of resulting physical damage, disfigurement, loss of bodily function, and change in personal hygiene. Such changes are a cause of major concern for patients and raise important issue for the quality of care.

Methods.  The study group comprised patients who had undergone a colostomy for rectal cancer or an ileostomy for ulcerative colitis, all attending a stoma outpatient clinic. Quality of care was assessed using the identity‐oriented dimension of the validated questionnaire ‘Quality of Care from the Patient's Perspective’. Forty‐two ileostomy and 49 colostomy patients completed the questionnaire.

Result.  While the vast majority of patients in both groups thought that most topics in the questionnaire were important, most rated many aspects of their quality of care as unsatisfactory. One‐third of the colostomy patients and one‐half of the ileostomy patients were dissatisfied with the information they received about the results of medical examinations and laboratory tests, and an even higher proportion was dissatisfied with their opportunities to participate in the decision‐making process or to discuss sexual matters. Stoma‐related complications, which occurred in 71% of the ileostomy patients and in 43% of the colostomy patients, had no impact on these results.

Conclusion.  Information and counselling for patients having ostomies, both on the part of specialist nurses and colorectal surgeons, appeared to deficient, suggesting that standards for quality of care require continuous evaluation and revision.
Lived experiences of the time preceding burnout
Authors: Ekstedt Mirjam , Fagerberg Ingegerd
Published: December 2004

Aim. This paper reports a study to illuminate the complex interaction between person and their life world during the burnout development period.

Background. Burnout is a construct describing the psychological state resulting from ineffective strategies for coping with enduring stress in both client and non‐client work. Role conflict and role ambiguity, or long‐term stress and frustration caused by strain in daily life, promote or exacerbate burnout, indicating that the person's entire life world is involved. There is still a lack of description of lived experiences of the time preceding manifest burnout.

Method. Data were collected from interviews with eight people suffering from burnout and analysed using a phenomenological method.

Findings. The essential meaning of the phenomenon of burnout is understood as being trapped with stimulating challenges as a self‐nourishing drive on one side and with responsibilities and demands on the other. This essence can be illuminated by its eight constituents: inner incentive, feeling responsible, threatened self‐image, cutting off, bodily manifestations, psychological manifestations, fatigue and reaching the bottom line.

Conclusions. The lived experiences of the time preceding manifest burnout are an ambiguous struggle. Cutting off is understood as a mean to shelter the threatened self‐image in a state of vulnerability and weakened strength. Accordingly, a better understanding of how to reach behind the defence of ‘cutting off’ and thus help to open up for consolation and self‐acceptance is an essential skill for nurses, health care professionals and others encountering the burnout sufferers. Furthermore this study illuminates early signs of burnout and an important issue is how to strengthen the individuals’ ability to shelter their need for recovery and restitution.
Modelling novice clinical reasoning for a computerized decision support system
Authors: O'Neill Eileen S. , Dluhy Nancy M. , Chin Elizabeth
Published: December 2004

Aim. The aim of this paper is to introduce the theoretical framework that directs the project.

Background. The Novice Computer Decision Support (N‐CODES) Project is developing a point‐of‐care system to assist novice acute care nurses while making clinical judgements. Unlike prior approaches, N‐CODES is guided by a theoretical understanding of nurses’ decision‐making processes, including the manner by which novices develop this skill.

Framework. Assumptions within information processing theory guided the clinical decision‐making framework. The framework is composed of a clinical decision‐making model and a second embedded model depicting the clinical reasoning development of novice nurses.

Models. The model is developed within a pluralistic perspective synthesizing theoretical and empirical knowledge on clinical decision‐making and the development of novice reasoning skills. A visual representation of experienced nurse decision‐making is presented. A central element is the nurse's use of pre‐encounter data and working knowledge. A second model integrates empirical data on the developing clinical reasoning of the novice. This knowledge is loosely scattered through 25 years of literature. The intersection of these models provides a novel perspective on the way novices begin to identify working knowledge patterns and develop a sense of saliency.

Conclusions. Previous attempts to build comprehensive clinical decision support systems have disregarded important theoretical considerations hindering the success of these projects. Grounding a Decision Support System in a theoretical model of novice nurse decision‐making will strengthen the utility and acceptance of the Decision Support System. Additionally, a conceptualization of novice nurse development is an asset to nurse educators, managers and scientists interested in improving clinical decision‐making.
Psychometric evaluation of the Cognitive Appraisal of Health Scale with patients with prostate cancer
Authors: Ahmad Muayyad M.
Published: December 2004

Aim.  This study was designed to investigate the psychometric properties of the Cognitive Appraisal of Health Scale, specifically with prostate cancer patients.

Background.  Measurement of appraisal is considered a relatively new area in the health studies literature. Cognitive appraisal of potentially stressful events becomes important when individuals face a crisis such as a change in their health status. So far, confirmatory factor analysis (CFA) has not been used to study the factor structure of the Cognitive Appraisal of Health Scale.

Methods.  The structure of the questionnaire was analysed by exploratory factor analysis, CFA using structural equation modelling and an Analysis of Moment Structure procedure with a sample of 133 patients with prostate cancer.

Results.  The results support the three‐factor model for the Cognitive Appraisal of Health Scale because it has robust structure and excellent goodness‐of‐fit indices. Several of the 23 items were grouped into different factors from those in Kessler's scale.

Conclusion.  The use of the reduced version of Cognitive Appraisal of Health Scale with men under health stress is recommended.
Nurses’ experiences of distance education programmes
Authors: Hyde Abbey , Murray Maurice
Published: December 2004

Aim.  This paper reports on a study exploring the experiences of nurses undertaking distance education (DE) programmes.

Background.  While DE has many advantages in terms of the flexibility, autonomy and freedom that it affords to learners, the literature reports that students undertaking these programmes can also experience feelings of being disconnected and isolated.

Methods.  A convenience sample of 15 participants was selected, and data were collected using in‐depth interviews. Data were analysed using a qualitative design that drew most heavily on the methodological procedures of grounded theory.

Findings.  Habermas’ theory of communicative action was found to be relevant to the interpretation of data and four categories were constructed to explain participants’ experiences in relation to DE, namely: lifeworld lamented; lifeworld experienced; lifeworld ceded and learning within a bounded system. These categories reflect the manner in which participants experienced the lifeworld component (the interactive and subjective dimensions) and the system component (objective and outcome oriented dimensions) of the educational realm. While data indicated diversity in how the boundedness of the programmes was experienced, overall such standardized, instrumental courses were viewed favourably by participants within the limitations of their own personal circumstances.

Conclusion.  Distance education as a means of disseminating nursing knowledge should be strengthened. The challenge for nurse educators is to develop DE programmes that minimize their limitations and maximize their potential.
Effects of a postqualification course in palliative care
Authors: Adriaansen Marian J.M. , Van Achterberg Theo , Borm George
Published: December 2004

Aim.  This paper reports a study to determine the effectiveness of a postqualification course in palliative care in terms of increased knowledge, insight and self‐efficacy among Registered and Licensed Practical Nurses.

Background.  The importance of measuring the effectiveness of postqualification courses in palliative care for nurses is widely recognized. The benefits of such courses are often merely described in terms of satisfaction of the course participants.

Method.  A convenience sample of nurses was studied. The effect measurement comprised a pretest/post‐test quasi‐experimental design. Two instruments were used: a comprehensive variant of the Palliative Care Quiz for Nurses and an especially developed domain specific self‐efficacy instrument for palliative care. These were used before and after the course.

Findings.  The course had a positive effect on knowledge and insight level as well as on level of self‐efficacy. The main improvements were related to pain and symptom management. Participants seemed to be able to increase the effects of the course by implementing certain products on the wards, such as clinical lessons, a pain assessment scale and relaxation massage.

Conclusions.  Palliative care courses can make a significant contribution to nurses’ knowledge and insight, as well as their self‐efficacy in providing palliative care.
Introducing chemists to food allergy
Authors: Ortolani C. , Ispano M. , Scibilia J. , Pastorello* E. A.
Published: December 2004

Adverse reactions to food may be toxic or non toxic, depending on the susceptibility to a certain food; non toxic reactions that involve immune mechanisms are termed allergy if they are IgE‐mediated. If no immunological mechanism is responsible, it is termed intolerance. The following disorders are considered a consequence of food allergy: gastrointestinal reactions (oral allergy syndrome, vomiting, diarrhea, protein‐induced enterocolitic syndrome, eosinophilic gastroenteritis); respiratory reactions (rhinitis, asthma, laryngeal edema); cutaneous reactions (urticaria‐angioedema, atopic dermatitis); anaphylaxis. There is much recent evidence to consider celiac disease an immunological disorder. Food allergy diagnosis is based on history, SPT, specific IgE, food challenges. DBPCFC is fundamental for diagnosing true food allergy; patients who have had anaphylaxis to food must not undergo DBPCFC. Rapidly progressive respiratory reactions and anaphylactic shock are life‐threatening reactions that can be caused by food allergy. The doses of food inducing anaphylaxis can be very low, therefore commercial cross‐contamination with an unsuspected food during food processing can be risky for the food allergic patient. The prevention of severe anaphylactic food reactions may lie in interdisciplinary collaboration among allergologists, chemists, food technologists, and experts in food industry research.
Oral tolerance to protein antigens
Authors: Mayer Lloyd , Sperber Kirk , Chan Lisa , Child Joseph , Toy Lisa
Published: December 2004

Oral tolerance is an active non‐response to antigens delivered via the oral route. Mechanisms governing tolerance induction have been well characterized in mouse. Similar studies in man are lacking, although there is evidence that tolerance can be induced. In disease states, tolerance is altered and this may account for the presence of mucosal inflammation. In food hypersensitivity there is evidence that allergens may be handled differently and this may play a role in disease expression.
Impact of (bio)chemical and physical procedures on food allergen stability
Authors: Soler‐Rivas Cristina , Wichers Harry J.
Published: December 2004

A variety of methods have been used to attempt to decrease the allergenicity of food products, with highly variable success. Limited knowledge of allergen and epitope structures and the factors governing their stability may explain this, and the ensuing need for an empirical approach. A combined effort from a processing and genomics‐based approach may open up new ways to improve the quality of foods from an allergenic perspective. Based on structural knowledge, a suitable approach can be chosen that is, for instance, heat stable but protease sensitive; protease resistant but not heat stable; easy to extract; easy to mask because the epitope is exactly on a crosslink site; a molecular probe design that allows screening of germplasm collections.
Standardization ofin vitromethods
Authors: Yman Lars
Published: December 2004

IgE‐antibody analysis is a major diagnostic procedure and a primary tool in allergological research. The determination of sensitization frequencies and antibody concentrations against allergens of defined sources provides critical information for the estimation of the relative importance of food and environment in clinical allergy. True quantitation is essential and requires assay designs providing allergen excess and mass unit calibration. Standardized and reproducible methods show geographic and culture dependent differences between patient populations and contribute to the quality of diagnosis and treatment of allergic disease.
Standardization of double‐blind, placebo‐controlled food challenges
Authors: Bindslev‐Jensen Carsten
Published: December 2004

At present, no international agreement on standardized protocols for use in double‐blind placebo‐controlled food challenge exists. There is a great need for such standardization, both for clinical and for scientific reasons.
In vitro activity of telithromycin against mefA and ermB erythromycin‐resistant viridans streptococci isolated from bacteremia of oral origin in Spain
Authors: Tomás I. , Alvarez M. , López‐Meléndez C. , Limeres J. , Tomás M. , Diz P.
Published: December 2004

Erythromycin‐resistant viridans streptococci are often responsible of bacteremias following dental manipulations. The aim of this study was to evaluate the in vitro activity of telithromycin against erythromycin‐susceptible and erythromycin‐resistant viridans streptococci. Venous blood samples were collected from 84 patients, 30 s after dental extractions. Viridans streptococci were identified by conventional microbiological techniques. A set of 36 viridans streptococci were selected to investigate the in vitro activity of telithromycin by the agar dilution method. Macrolide resistance genes were amplified with specific primers for the mefA and ermB genes and visualized by electrophoresis.

For erythromycin‐susceptible viridans streptococci, telithromycin minimal inhibitory concentration90 (MIC90) was <0.008 μg/ml. For erythromycin‐resistant viridans streptococci, telithromycin MIC90 was 1 μg/ml. The MIC90 to telithromycin of the mefA‐positive and ermB‐negative viridans streptococci was lower than that of the mefA‐negative and ermB‐positive viridans streptococci (0.128 μg/ml versus 1 μg/ml).

The in vitro activity of telithromycin was high, irrespective of the erythromycin susceptibility and the mechanism of erythromycin resistance identified.