bluuebunny/crossref_metadata_2025 huggingface dataset:
The metazoan parasites of swordfish from Atlantic tropical–equatorial waters
Authors: Garcia A. , Santos M. N. , Damiano S. , Nascetti G. , Mattiucci S.
Published: December 2008

The metazoan parasite fauna composition of the swordfish Xiphias gladius is reported from 145 (72 females and 73 males) specimens caught in Atlantic tropical–equatorial waters during June to July 2006 and August 2007. Seventeen metazoan taxa (two monogeneans, two digeneans, one acanthocephalan, four cestodes, seven nematodes and one copepod) were identified by morphological and genetic methodologies. Among those identified, Anisakis brevispiculata, Anisakis paggiae and the acanthocephalan Bolbosoma vasculosum are new host records. Dominant species were: the anisakid nematode larvae Anisakis physeteris, Anisakis brevispiculata, Hysterothylacium incurvum and Hysterothylacium corrugatum (s.l.), the adult cestode Fistulicola plicatus, the plerocercoid Hepatoxylon squali and the monogeneans Tristoma integrum and Tristoma coccineum, which showed high prevalences and intensities. The relationship between metazoan parasites and host size and sex was investigated for the first time. No statistically significant correlation was found between host sex and parasite burden. Infection levels with T. integrum and T. coccineum were observed to be significantly negatively correlated to host size. Infection levels by endoparasites observed in X.gladius from Atlantic tropical‐equatorial area may be related to host feeding behaviour and the availability of the parasites’ intermediate and final hosts in the area studied. Anisakids of the genus Anisakis, were identified genetically to species level, and were considered to be promising biological tags for the characterization of X.gladius stocks.
Interactions between gnathiid isopods, cleaner fish and other fishes on Lizard Island, Great Barrier Reef
Authors: Grutter A. S.
Published: December 2008

The rate of emergence of micropredatory gnathiid isopods from the benthos, the proportion of emerging gnathiids potentially eaten by Labroides dimidiatus, and the volume of blood that gnathiids potentially remove from fishes (using gnathiid gut volume) were determined. The abundance (mean ±s.e.) of emerging gnathiids was 41·7 ± 6·9 m−2 day−1 and 4552 ± 2632 reef−1 day−1 (reefs 91–125 m2). The abundance of emerging gnathiids per fish on the reef was 4·9 ± 0·8 day−1; but excluding the rarely infested pomacentrid fishes, it was 20·9 ± 3·8 day−1. The abundance of emerging gnathiids per patch reef was 66 ± 17% of the number of gnathiids that all adult L. dimidiatus per reef eat daily while engaged in cleaning behaviour. If all infesting gnathiids subsequently fed on fish blood, their total gut volume per reef area would be 17·4 ± 5·6 mm3 m−2 day−1; and per fish on the reefs, it would be 2·3 ± 0·5 mm−3 fish−1 day−1 and 10·3 ± 3·1 mm3 fish−1 day−1 (excluding pomacentrids). The total gut volume of gnathiids infesting caged (137 mm standard length, LS) and removed from wild (100–150 mm LS) Hemigymnus melapterus by L. dimidiatus was 26·4 ± 24·6 mm3 day−1 and 53·0 ± 9·6 mm3 day−1, respectively. Using H. melapterus (137 mm LS, 83 g) as a model, gnathiids had the potential to remove, 0·07, 0·32, 0·82 and 1·63% of the total blood volume per day of each fish, excluding pomacentrids, caged H. melapterus and wild H. melapterus, respectively. In contrast, emerging gnathiids had the potential of removing 155% of the total blood volume of Acanthochromis polyacanthus (10·7 mm LS, 0·038 g) juveniles. That L. dimidiatus eat more gnathiids per reef daily than were sampled with emergence traps suggests that cleaner fishes are an important source of mortality for gnathiids. Although the proportion of the total blood volume of fishes potentially removed by blood‐feeding gnathiids on a daily basis appeared to be low for fishes weighing 83 g, the cumulative effects of repeated infections on the health of such fish remains unknown; attacks on small juvenile fishes, may result in possibly lethal levels of blood loss.
Survival of male breast cancer patients: Population‐based cohort study
Authors: Thalib Lukman , Hall Per
Published: December 2008

Little information is available on the survival of male breast cancer patients because the disease is extremely rare in men. Moreover, previous reports on the prognosis of male breast cancer have been conflicting. We took advantage of a number of large, nationwide registries in Sweden to evaluate the prognostic value of sex in breast cancer patients. A population‐based cohort of 269 male and 30 011 female breast cancer patients born after 1935 and diagnosed with primary breast cancer between 1970 and 1997 was generated by linking a number of Swedish registries, including the Swedish Cancer Registry, the Cause of Death Registry, the Swedish Generation Registry, and the Registry of Population and Population Changes. We used this cohort to quantify the association between the sex of the patient and breast cancer‐specific mortality, using the Cox proportional hazards. The sex of the patient did not significantly influence the prognosis of breast cancer. Adjusting for age at diagnosis and calendar period did not alter the results. Nor did the results change when the analyses were repeated for all causes of morality. Our study, one of the largest to date, failed to find evidence to support the proposed association between the sex of breast cancer patients and survival. Given the previous reports, which advocated that male breast cancer patients have poorer survival and need aggressive treatment strategies, our findings are reassuring and clinically very important. (Cancer Sci 2009; 100: 292–295)
The combined effect of SNP‐marker and phenotype attributes in genome‐wide association studies
Authors: Chan E. K. F. , Hawken R. , Reverter A.
Published: December 2008

The last decade has seen rapid improvements in high‐throughput single nucleotide polymorphism (SNP) genotyping technologies that have consequently made genome‐wide association studies (GWAS) possible. With tens to hundreds of thousands of SNP markers being tested simultaneously in GWAS, it is imperative to appropriately pre‐process, or filter out, those SNPs that may lead to false associations. This paper explores the relationships between various SNP genotype and phenotype attributes and their effects on false associations. We show that (i) uniformly distributed ordinal data as well as binary data are more easily influenced, though not necessarily negatively, by differences in various SNP attributes compared with normally distributed data; (ii) filtering SNPs on minor allele frequency (MAF) and extent of Hardy–Weinberg equilibrium (HWE) deviation has little effect on the overall false positive rate; (iii) in some cases, filtering on MAF only serves to exclude SNPs from the analysis without reduction of the overall proportion of false associations; and (iv) HWE, MAF and heterozygosity are all dependent on minor genotype frequency, a newly proposed measure for genotype integrity.
Statin treatment in a cohort of 20 212 men and women in Norway according to cardiovascular risk factors and level of education
Authors: Selmer Randi , Sakshaug Solveig , Skurtveit Svetlana , Furu Kari , Tverdal Aage
Published: December 2008

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Use of statins reduces cardiovascular morbidity and mortality.

• Little is known about educational inequalities in use of statins.

WHAT THIS STUDY ADDS

• In Norway in patients with no history of cardiovascular disease or diabetes, start of statin treatment was not associated with educational level after adjustment for cardiovascular risk factors.

• In patients with a history of cardiovascular disease or diabetes, especially highly educated women tended to start statin treatment more often than women of low educational level.

• Persistence of statin treatment did not vary by educational level.

AIMS To study the influence of patients' education and cardiovascular risk factors on the probability of statin treatment.

METHODS A prospective cohort study of participants in regional health surveys in Norway 2000–2002 with statin use recorded in the Norwegian Prescription Database 2004–2006 as outcome measure. Information on history of cardiovascular disease (CVD) and diabetes, lipid levels, blood pressure, use of cardiovascular drugs, body mass index, family history, smoking, physical activity, marital status and place of residence was obtained at baseline. A total of 20 212 men and women aged 40–41, 45–46 and 59–61 years who reported never use of statins were included. Educational level was retrieved from Statistics Norway. Adjusted relative risks (RR) were estimated by Poisson regression.

RESULTS Whereas 655 participants reported a history of CVD or diabetes, 19 557 reported no such history. In the non‐CVD/diabetes group 1620 persons (8%) became statin users and 222 persons (34%) in the CVD/diabetes group. RR of becoming a statin user for high vs. low education increased from 0.64 [95% confidence interval (CI) 0.55, 0.73] to 0.91 (95% CI 0.79, 1.05) after adjustment in the non‐CVD/diabetes group and from 0.94 (95% CI 0.70, 1.26) to 1.35 (95% CI 1.00, 1.81) in the CVD/diabetes group.

CONCLUSIONS Patients with no history of CVD/diabetes were prescribed statins according to cardiovascular risk independent of education. There was a tendency to a higher probability of statin treatment among highly educated compared with people of lower educational level in the group with a history of CVD or diabetes, after adjustment for other CVD risk factors, particularly in women.
Clinical Immunology Review Series: An approach to the patient with allergy in childhood
Authors: Sporik R , Henderson J , Hourihane J O'B
Published: December 2008

ARTICLES PUBLISHED IN THIS CLINICAL IMMUNOLOGY REVIEW SERIES

allergy in childhood, allergy diagnosis by use of the clinical immunology laboratory, anaphylaxis, angioedema, management of pulmonary disease in primary antibody deficiency, recurrent infections in childhood, recurrent infections in adulthood, recurrent oro-genital ulceration, recurrent superficial abscesses, SLE and Sjögren's syndrome, urticaria, vasculitis/CTD

Allergic conditions are common, with asthma being the most common chronic illness in childhood in most developed countries. Some 80% of asthmatic children are sensitized to aeroallergens, usually indoor animal dander and house dust mite. Some 80% of asthmatics also have rhinitis. Rhinitis and eczema receive less medical attention than asthma, but they can cause long-term morbidity and have substantial direct and indirect economic costs. Food allergy and anaphylaxis are increasingly recognised and are usually easily diagnosed and managed. Clinicians can use in vivo and in vitro measurements of allergen-specific immunoglobulin E to better time reintroduction of implicated foods. Specific parenteral and sublingual immunotherapy is widely practiced internationally but is uncommon in the UK. It may alter the natural history of aeroallergen reactive diseases in the upper and lower airways. Specific oral tolerance induction represents the current cutting edge in clinical allergy research. It remands resource intensive at present and cannot be adopted into routine clinical practice at this time.
Reduced circulating CD4+CD25+ cell populations in haemorrhagic fever with renal syndrome
Authors: Zhu L Y , Chi L J , Wang X , Zhou H
Published: December 2008

Immunopathological mechanisms are speculated to underlie haemorrhagic fever with renal syndrome (HFRS) caused by Hantaviruses. CD4+CD25+ T regulatory cells (Tregs), a subset of CD4+ T cells, expressed high levels of CD25 and the forkhead box transcription factor P3 (FoxP3), plays an important role in the down-regulation of various immune responses. Therefore, we hypothesized that in patients with HFRS the immunopathology could be, at least in part, the result of an inefficient control of pathogenic effector T cells by Tregs. The number of Tregs was determined by flow cytometry according to their characteristic CD4+CD25high membrane phenotype. The functional characterization of Tregs was analysed by suppression of proliferation and secretion of cytokines by co-cultured effector CD4+CD25- T cells. FoxP3 mRNA level was assessed by quantitative real-time polymerase chain reaction. We observed that CD4+CD25high cells of patients with HFRS showed a conventional phenotype. Furthermore, acute-stage patients with HFRS exhibited significantly reduced numbers of peripheral Tregs compared with healthy donors, and marked improvement was observed in convalescent-phase patients. The frequency of Tregs was correlated positively with platelet count, and was correlated negatively with blood urea nitrogen, serum creatinine and serum aspartate aminotransferase. On the other hand, Tregs from both healthy individuals and patients with HFRS exhibited equal FoxP3 expression of mRNA, and their ability to suppress the proliferation and cytokine secretion of CD4+ effector T cells was unimpaired in HFRS patients.
Accumulation of DNA damage in Antarctic mosses: correlations with ultraviolet‐B radiation, temperature and turf water content vary among species
Authors: TURNBULL JOHANNA D. , ROBINSON SHARON A.
Published: December 2008

The susceptibility of three East Antarctic moss species to UV‐B radiation was examined by measuring accumulation of cyclobutane pyrimidine dimers under natural sunlight during the austral summer season of 2002/03. The 2002/03 season was characterized by unusually low springtime ozone depletion and as such our results likely underestimate the DNA damage possible in a more typical UV‐B radiation season. Despite this all three species accumulated significant DNA photoproducts. We also found a positive association between photoproduct accumulation and incident UV‐B radiation in the two cosmopolitan species, Bryum pseudotriquetrum and Ceratodon purpureus, with more DNA damage in samples collected early in the season compared with later in the summer. For B. pseudotriquetrum, negative associations were also observed between photoproduct accumulation and both turf water content and the 10‐day mean air temperature. Photoproduct accumulation in the endemic species Schistidium antarctici was similarly high across the season and no significant association with environmental variables was found. Our results are consistent with the two cosmopolitan species having somewhat higher UV‐B‐screening capabilities and possibly more efficient mechanisms for repairing DNA damage than the endemic S. antarctici.
Quantitative aspects of heterogeneity in soil organic matter dynamics in a cool‐temperate Japanese beech forest: a radiocarbon‐based approach
Authors: KOARASHI JUN , ATARASHI‐ANDOH MARIKO , ISHIZUKA SHIGEHIRO , MIURA SATORU , SAITO TAKESHI , HIRAI KEIZO
Published: December 2008

Soil is the largest carbon reservoir in terrestrial ecosystems; it stores twice as much carbon as the atmosphere. It is well documented that global warming can lead to accelerated microbial decomposition of soil organic carbon (SOC) and enhance the release of CO2 from the soil to the atmosphere; however, the magnitude and timing of this effect remain highly uncertain due to a lack of quantitative data concerning the heterogeneity of SOC biodegradability. Therefore, we sought to identify SOC pools with respect to their specific mean residence times (MRTs), to use those SOC pools to partition soil respiration sources, and to estimate the potential response of the pools to warming. We collected surface soil and litter samples from a cool‐temperate deciduous forest in Japan, chemically separated the samples into SOC fractions, estimated their MRTs based on radiocarbon (14C) isotope measurements, and used the data to construct a model representing the soil as a complex of six SOC pools with different MRT ranges. We estimate that a minor, fast‐cycling SOC pool with an MRT of less than 10 years (corresponding to the O horizon and recognizable plant leaf fragments in the A1 horizon) is responsible for 73% of annual heterotrophic respiration and 44% of total soil respiration. However, the predicted response of these pools to warming demonstrates that the rate of SOC loss from the fast‐cycling SOC pool diminishes quickly (within several decades) because of limited substrate availability. In contrast, warming will continue to accelerate SOC loss from slow‐cycling pools with MRTs of 20–200 years over the next century. Although using a 14C‐based approach has drawbacks, these estimates provide quantitative insights into the potential importance of slow‐cycling SOC dynamics for the prediction of positive feedback to climate change.
Exceptional carbon uptake in European forests during the warm spring of 2007: a data–model analysis
Authors: DELPIERRE N. , SOUDANI K. , FRANÇOIS C. , KÖSTNER B. , PONTAILLER J.‐Y. , NIKINMAA E. , MISSON L. , AUBINET M. , BERNHOFER C. , GRANIER A. , GRÜNWALD T. , HEINESCH B. , LONGDOZ B. , OURCIVAL J.‐M. , RAMBAL S. , VESALA T. , DUFRÊNE E.
Published: December 2008

Temperate and boreal forests undergo drastic functional changes in the springtime, shifting within a few weeks from net carbon (C) sources to net C sinks. Most of these changes are mediated by temperature. The autumn 2006–winter 2007 record warm period was followed by an exceptionally warm spring in Europe, making spring 2007 a good candidate for advances in the onset of the photosynthetically active period. An analysis of a decade of eddy covariance data from six European forests stands, which encompass a wide range of functional types (broadleaf evergreen, broadleaf deciduous, needleleaf evergreen) and a wide latitudinal band (from 44° to 62°N), revealed exceptional fluxes during spring 2007. Gross primary productivity (GPP) of spring 2007 was the maximum recorded in the decade examined for all sites but a Mediterranean evergreen forest (with a +40 to +130 gC m−2 anomaly compared with the decadal mean over the January–May period). Total ecosystem respiration (TER) was also promoted during spring 2007, though less anomalous than GPP (with a +17 to +93 gC m−2 anomaly over 5 months), leading to higher net uptake than the long‐term mean at all sites (+12 to +79 gC m−2 anomaly over 5 months). A correlative analysis relating springtime C fluxes to simple phenological indices suggested spring C uptake and temperatures to be related. The CASTANEA process‐based model was used to disentangle the seasonality of climatic drivers (incoming radiation, air and soil temperatures) and biological drivers (canopy dynamics, thermal acclimation of photosynthesis to low temperatures) on spring C fluxes along the latitudinal gradient. A sensitivity analysis of model simulations evidenced the roles of (i) an exceptional early budburst combined with elevated air temperature in deciduous sites, and (ii) an early relief of winter thermal acclimation in coniferous sites for the promotion of 2007 spring assimilation.
Global warming tugs at trophic interactions
Authors: BROOK BARRY W.
Published: December 2008

Climate change impacts are becoming increasingly evident as 1 °C warming above pre‐industrial temperatures is approached. One of the signature biological effects is a shift towards earlier‐timed reproduction. If individual species lack sufficient adaptive plasticity to alter phenology, they will have reduced fitness in a hotter world. Yet, a long‐term study of an oak–caterpillar–songbird–sparrowhawk food web reveals that what could matter as much is if trophic interactions are disrupted. Multiple selective pressures may be triggered by climate change, leading to a tug‐of‐war between the need to stay in synchrony with the timing of maximum food, and the benefits of minimizing predation.
Southeast Alaska: oceanographic habitats and linkages
Authors: Weingartner Thomas , Eisner Lisa , Eckert Ginny L. , Danielson Seth
Published: December 2008

We provide an overview of the physical oceanographic and geological processes that affect marine biological habitats and production in the marine waters throughout the archipelago and continental shelf of Southeast Alaska. Given the paucity of regional data, our overview summarizes work done in adjacent regions of the Gulf of Alaska shelf and basin, and draws on research carried out in similar settings elsewhere. The geological setting, which critically influences the regional meteorology and oceanography, includes a narrow continental shelf, deep channels that permeate the archipelago, fjords, glaciers and a rugged, mountainous coast. The large‐scale meteorology is influenced primarily by seasonal variations in the intensity and position of the Aleutian Low. Winds, freshwater runoff, tides and cross‐shelf exchange control the regional oceanography. The large‐scale flow field advects mass, heat, salt, nutrients and planktonic organisms northward from British Columbia (and even further south) to the northern Gulf of Alaska along the slope, shelf, and within the channels of Southeast Alaska. The deep channels permeating the island archipelago and narrow continental shelf facilitate communication between basin and interior waters. Water properties and flow fields are subject to large annual variations in response to similarly large variations in winds and coastal freshwater discharge. The complex geological setting leads to large spatial heterogeneity in the physical processes controlling the local circulation fields and mixing, thereby creating numerous and diverse marine biological habitats. These various circulation and mixing processes modify substantially Southeast Alaska water masses and thus influence marine ecosystem processes downstream over the northern and western Gulf of Alaska shelf.
Genetic population structure and distribution of a fungal polypore,Datronia caperata(Polyporaceae), in mangrove forests of Central America
Authors: Bergemann Sarah E. , Smith M. A. , Parrent Jeri L. , Gilbert Gregory S. , Garbelotto Matteo
Published: December 2008

Aim We examine the genetic structure of a fungal polypore,Datronia caperata(Berk.) Ryvarden (Polyporaceae), colonizing white mangrove,Laguncularia racemosa(L.) Gaertn. f. (Combretaceae), of Central America.

Location Mangrove forests of Costa Rica and Panama.

Methods Sequences of elongation factor alpha (EFA), beta tubulin (BTUB) and nuclear ribosomal internal transcribed spacer (ITS) regions were obtained from 54 collections ofD.caperatacollected from Caribbean and PacificL. racemosaforests in Central America. Measures of haplotype and nucleotide diversity, nested clade analyses and coalescent analyses were used to estimate the direction and extent of migration of the fungus, and the factors promoting population divergence. We also conducted phylogenetic analyses using Bayesian estimation to test whether putativeD. caperatacollected fromL. racemosawas conspecific withD. caperatacolonizing other hosts from diverse Neotropical forests.

Results Our results demonstrate that there is genetic isolation betweenD. caperatapopulations from Caribbean mangroves and those from Pacific mangroves. Our data suggest that the best explanation for the observed haplotype distribution is a recent range expansion from the Caribbean to the Pacific coasts, with subsequent isolation. This is supported by the infrequent overlap of haplotypes, unidirectional migration estimates from the Caribbean to the Pacific and the older estimated age of mutations in the Caribbean low‐copy BTUB and EFA loci. In addition, our data suggest thatD. caperatafrom mangroves are not conspecific with collections from other hosts found in diverse Neotropical forests.

Main conclusions The low frequency of shared haplotypes between coasts, coupled with the incomplete lineage sorting after cessation of gene flow, is consistent with isolation during the last Pleistocene glaciation. We hypothesize that the greater haplotype and nucleotide diversity in the Pacific occurs either because larger effective population sizes ofD. caperataare maintained in Pacific mangroves or becauseD. caperatapopulations underwent a significant bottleneck as a result of local extinction followed by recolonization. In addition, we found thatD. caperatafound onL. racemosawas not conspecific withD. caperatafrom non‐mangrove hosts and suggest thatD. caperatafound onL. racemosamay be a host specialist.
Understanding inadequate pain management in the clinical setting: the value of the sequential explanatory mixed method study
Authors: Carr Eloise CJ
Published: December 2008

Aim.  The purpose of this paper is to critically explore the sequential explanatory mixed method research design and how it can enhance our understanding of pain management.

Background.  The general prevalence of pain after surgery has not changed significantly over several decades despite the widespread introduction of new pain relieving technologies. The majority of postoperative pain studies use quantitative methods which offer little understanding of the underlying processes of care. Understanding can be illuminated by using an explanatory mixed method research design.

Design.  Discursive paper.

Method.  This paper focuses on the methodological considerations when using a mixed method design. Two previously published mixed methods studies illustrate how findings can inform practice. In the first, 85 women undergoing surgery completed questionnaires to measure pain, anxiety and depression. Telephone interviews explored their pain experiences. The second study considered frequency and patterns of anxiety in the immediate pre and postoperative period. Semi‐structured telephone interviews, identified contributing events/situations amenable to nursing intervention.

Discussion.  Reasons for growing popularity, criticisms, paradigmatic considerations and epistemological roots of pragmatism are explored. The two explanatory mixed method studies provide examples of these studies and how ‘inferences’ from quantitative and qualitative data can inform practice.

Conclusion.  This paper connects quantitative and qualitative data, drawing on two research studies, to give greater understanding to the management of pain. Knowledge of the processes responsible for inadequate pain management can be illuminated by using explanatory mixed methods research designs.

Relevance to clinical practice.  Nursing requires knowledge which reflects the complexity of human health. The explanatory mixed method study can elucidate the problem under scrutiny, e.g. prevalence of pain or anxiety. The qualitative phase can generates an understanding of contributing factors and insights for care delivery. The implicit desire to change and influence practice makes it relevant for those closely aligned to practice.
Qualitative analysis of patients’ intensive care experience during mechanical ventilation
Authors: Wang Kefang , Zhang Bing , Li Chunyan , Wang Chen
Published: December 2008

Aim.  To understand patients’ intensive care experience while receiving mechanical ventilation in intensive care units.

Background.  The mechanically ventilated patient’s experience in the intensive care unit is unique. Notably lacking are international studies on patients’ experience, particularly those living in Asia. A better understanding of patients’ experience is needed for nurses to develop approaches to take care of these patients.

Design.  A phenomenological approach formed by the ideas of Heidegger was used.

Methods.  Eleven participants surviving from mechanical ventilation were interviewed in‐depth. Patients were asked to describe their experience by responding to the question ‘what is it like to experience mechanical ventilation treatment at an ICU?’. Giorgi’s phenomenological analysis procedure was used to analyse the data.

Results.  Five mutually exclusive themes emerged, which were: ‘being in an unconventional environment’, ‘physical suffering’, ‘psychological suffering’, ‘self‐encouragement’ and ‘self‐reflection’. ‘Self‐encouragement’ and ‘self‐reflection’ enhanced patients’ self‐confidence, which was beneficial to recovering.

Conclusion.  Patient’s experiences while receiving mechanical ventilation in the intensive unit were poignant and frightening.

Relevance to clinical practice.  Critical care nurses should place the highest priority on recognising and meeting the needs of ventilated patients in intensive care units. An intensive care unit should be a place for the patient to live as a human being; not just a place to survive.
Understanding the practical and theoretical development of social rehabilitation through action research
Authors: Portillo Mari Carmen
Published: December 2008

Aim.  This paper aims to present and reflect on the process of practical and theoretical change in an action research project in which the issue of social rehabilitation was developed.

Background.  Action research is a useful method to change and advance practice. Consequently, grounded knowledge, which forms the basis of the practical change, is developed. ‘Social rehabilitation’ was the field of clinical practice which needed enhancement as the literature lacked nurse‐led social rehabilitation programmes in the neurology field.

Design.  This was a cyclic action research project.

Methods.  The project took place in a highly specialised hospital in Spain and aimed to promote social life of neurological patients and relatives through the planning, implementation and evaluation of a nurse‐led social rehabilitation programme based on individual needs. In this project, which lasted 30 months, multiple triangulation of sources and methods was applied. Thirty‐seven nurses participated and 22 and 18 patients and their relatives constituted a baseline and an intervention group, respectively.

Results.  Several issues were carefully treated in this action research project to develop practical and theoretical knowledge about social rehabilitation: the validity and reliability of the project, the work organisation of the wards, the nurses’ attitudes towards new care, the researcher–participant relationship and the controversial role of professionals in social rehabilitation.

Conclusion.  The nurses’ emancipation in the process of practice change led to practical and theoretical assimilation of social rehabilitation. Intensive work on practitioners’ attitudes and the provision of empirical evidence were key interventions to foster controversial roles and enhance services.

Relevance to clinical practice.

Details about the process of change of nursing practice in response to clients’ needs have been provided.

Some reflections about how to integrate social care and knowledge about social rehabilitation in clinical daily practice are made.
Nurse prescribers’ interactions with and perceptions of pharmaceutical sales representatives
Authors: Clauson Kevin A , Khanfar Nile M , Polen Hyla H , Gibson Florencetta
Published: December 2008

Aims and objectives.  The aim of our study was to investigate the perceptions of pharmaceutical sales representatives by nurse prescribers.

Background.  Nurses with advanced training have earned prescriptive authority in North America, Europe and other parts of the world. These nurses are being increasingly targeted by pharmaceutical sales representatives. There is a paucity of data regarding nurses’ perceptions of pharmaceutical sales representatives.

Design.  Survey.

Methods.  A convenience sample of nurse prescribers was recruited to complete an Internet questionnaire about their interactions with and perceptions of sales representatives. The data were collected over one month ending in January 2007. There were 39 survey items ranging from perception‐based items assessed by Likert‐type scale to open‐ended queries. Descriptive statistics were used to summarise the results.

Results.  Ninety‐two nurses completed this survey, which demonstrated good internal consistency yielding a Cronbach’s alpha coefficient of 0·83. Positive perceptions of pharmaceutical representatives included: explaining their products clearly (80·4%) and knowledge about their medications (88·0%). Negative aspects included: lack of consideration of nurses’ time (50%) and failure to equally discuss medication strengths and weaknesses (21·8%). Perhaps the most alarming finding was that 35·9% of respondents indicated that sales representatives suggested paybacks for promoting their drugs.

Conclusions.  Nurses with prescriptive authority generally perceive interactions with pharmaceutical sales representatives as positive. However, they also have concerns about the nature and methods of some of their activities. Nations that have nurses with prescribing authority can benefit from observing both the mis‐steps and the positive inroads that have already been made by the profession in the USA and other countries.

Relevance to clinical practice.  Appropriate use of pharmaceutical sales representatives’ services may enhance the ability of nurse prescribers to deliver optimal nursing care. Methods, such as counter‐detailing may be necessary to maintain an evidence‐based approach as the controlling factor.
A systematic review of prophylactic antimicrobials in PEG placement
Authors: Lipp Allyson , Lusardi Gail
Published: December 2008

Aim.  To establish whether prophylactic systemic antimicrobials reduce the risk of peristomal infection in placement of percutaneous endoscopic gastrostomies.

Background.  Percutaneous endoscopic gastrostomies, placed surgically through the anterior abdominal wall, maintain nutrition in the short or long term. Those undergoing percutaneous endoscopic gastrostomy placement are often vulnerable to infection. The increasing incidence of methicillin‐resistant Staphylococcus aureus contributes an additional risk to the debate surrounding antibiotic prophylaxis. The aim of antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient, during placement.

Design.  Systematic review.

Methods.  We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals, relevant conference proceedings and bibliographies of publications identified, and contacted manufacturers and distributors of percutaneous endoscopic gastrostomy products. Randomised controlled trials were selected evaluating the use of prophylactic antimicrobials for percutaneous endoscopic gastrostomy placement, with no restrictions for language, date or publication status. Both authors performed data extraction and assessment of study quality. Meta‐analysis was performed where appropriate.

Results.  Ten eligible randomised controlled trials were identified evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0·31, 95% CI 0·22–0·44). The relative reduction in risk of infection for those given antibiotics was 19% with the need to treat 5·8 patients to prevent one infection – NNT.

Conclusions.  Administration of systemic prophylactic antibiotics for percutaneous endoscopic gastrostomy placement reduces peristomal infection.

Relevance to clinical practice.  The nurse’s role in endoscopy is expanding rapidly and demands that practice is based on the best available evidence. This systematic review seeks to make a contribution to best practice in percutaneous endoscopic gastrostomy placement.
Protein–protein interactions between CbbR and RegA (PrrA), transcriptional regulators of the cbb operons of Rhodobacter sphaeroides
Authors: Dangel Andrew W. , Tabita F. Robert
Published: December 2008

CbbR and RegA (PrrA) are transcriptional regulators of the cbbI and cbbII (Calvin–Benson–Bassham CO2 fixation pathway) operons of Rhodobacter sphaeroides. Both proteins interact specifically with promoter sequences of the cbb operons. RegA has four DNA binding sites within the cbbI promoter region, with the CbbR binding site and RegA binding site 1 overlapping each other. This study demonstrated that CbbR and RegA interact and form a discrete complex in vitro, as illustrated by gel mobility shift experiments, direct isolation of the proteins from DNA complexes, and chemical cross‐linking analyses. For CbbR/RegA interactions to occur, CbbR must be bound to the DNA, with the ability of CbbR to bind the cbbI promoter enhanced by RegA. Conversely, interactions with CbbR did not require RegA to bind the cbbI promoter. RegA itself formed incrementally larger multimeric complexes with DNA as the concentration of RegA increased. The presence of RegA binding sites 1, 2 and 3 promoted RegA/DNA binding at significantly lower concentrations of RegA than when RegA binding site 3 was not present in the cbbI promoter. These studies support the premise that both CbbR and RegA are necessary for optimal transcription of the cbbI operon genes of R. sphaeroides.
Afferent nerve sensitivity is decreased by an iNOS‐dependent mechanism during indomethacin‐induced inflammation in the murine jejunum in vitro
Authors: Xue B. , Hausmann M. , Müller M. H. , Pesch T. , Karpitschka M. , Kasparek M. S. , Hu W. C. , Sibaev A. , Rogler G. , Kreis M. E.
Published: December 2008

Abstract  Evidence exists that visceral afferent sensitivity is subject to regulatory mechanisms. We hypothesized that afferent sensitivity is decreased in the small intestine during intestinal inflammation by an inducible nitric oxide synthase (iNOS)‐dependent mechanism. C57BL/6 mice were injected twice with vehicle or 60 mg kg−1 indomethacin subcutaneously to induce intestinal inflammation. Afferent sensitivity was recorded on day 3 from a 2‐cm segment of jejunum in vitro by extracellular multi‐unit afferent recordings from the mesenteric nerve bundle. In subgroups (n = 6), iNOS was inhibited selectively by L‐N6‐(1‐iminoethyl)‐lysine (L‐NIL) given either chronically from day 1–3 (3 mg kg−1 twice daily i.p.) or acutely into the organ bath (30 μmol L−1). The indomethacin‐induced increase of macroscopic and microscopic scores of intestinal inflammation (both P < 0.05) were unchanged after pretreatment with L‐NIL. Peak afferent firing following bradykinin (0.5 μmol L−1) was 55 ± 8 impulse s−1 during inflammation vs 97 ± 7 impulse s−1 in controls (P < 0.05). Normal firing rate was preserved following L‐NIL pretreatment (112 ± 16 impulse s−1) or acute administration of L‐NIL (108 ± 14 impulse s−1). A similar L‐NIL dependent reduction was observed for 5‐HT (250 μmol L−1) and mechanical ramp distension from 20 to 60 cmH2O (both P < 0.05). Intraluminal pressure peaks were decreased to 0.66 ± 0.1 cmH2O during inflammation compared to 2.51 ± 0.3 in controls (P < 0.01). Afferent sensitivity is decreased by an iNOS‐dependent mechanism during intestinal inflammation which appears to be independent of the inflammatory response. This suggests that iNOS‐dependent nitric oxide production alters afferent sensitivity during inflammation by interfering with signal transduction to afferent nerves rather than by attenuating intestinal inflammation.
Expression of intracellular calcium signalling genes in cattle skin during tick infestation
Authors: BAGNALL N. , GOUGH J. , CADOGAN L. , BURNS B. , KONGSUWAN K.
Published: December 2008

It is widely acknowledged that changes in intracellular calcium ion (Ca2+) concentration provide dynamic signals that control a plethora of cellular processes, including triggering and mediating host defence mechanisms. In this study, quantitative real‐time PCR was used to analyse gene expression of 14 Ca2+ signalling proteins in skin obtained from high tick‐resistant (HR) and low tick‐resistant (LR) cattle following artificial challenge with cattle tick
(Rhipicephalus (Boophilus) microplus). Up‐regulation of numerous genes was observed in both HR and LR skin following tick challenge, however substantially higher transcription activation was found in HR tissue. The elevated expression in HR skin of specific Ca2+ signalling genes such as AHNAK, CASQ, IL2, NFAT2CIP and PLCG1 may be related to host resistance. Our data suggest that Ca2+ and its associated proteins might play an important role in host response to ticks and that further investigation is warranted.
Agreement of efficacy assessments for five‐grass pollen sublingual tablet immunotherapy
Authors: Didier A. , Melac M. , Montagut A. , Lhéritier‐Barrand M. , Tabar A. , Worm M.
Published: December 2008

Background:  The optimal dose of five‐grass pollen sublingual tablet immunotherapy (SLIT) was established recently by the primary criteria Rhinoconjunctivitis Total Symptom Score (RTSS) from the first treatment season. Secondary and exploratory criteria, such as RTSS at peak pollen season, exploratory combined symptom and rescue medication use score, quality of life and immunological markers are calculated and described in this analysis.

Methods:  Six hundred and twenty‐eight patients with grass pollen rhinoconjunctivitis (≥2 years duration) were randomized in a double‐blind, placebo‐controlled trial conducted in Europe. Patients received once‐daily SLIT (Stallergenes, Antony, France) of 100IR, 300IR, 500IR or placebo, starting 4 months before grass pollen season and throughout the 2005 season. Patients were instructed to take rescue medication only if symptoms were severe and record symptom severity on using the RTSS.

Results:  Both 300IR and 500IR doses significantly reduced mean RTSS at pollen peak (P = 0.0005 and P = 0.0014, respectively) and the exploratory combined score (P = 0.0001 and P = 0.0026, respectively) compared with placebo. Compared with patients in the placebo group, those who were taking the 300IR and 500IR doses reported significantly improved quality of life using the mean Rhinoconjunctivitis Quality of Life Questionnaire scores during the peak of the pollen season (P < 0.0001) and at the end of the pollen season (P = 0.0031 and P ≤ 0.0001, respectively). Specific immunoglobulin G4 increased significantly depending on the SLIT dose (P < 0.0001).

Conclusions:  All secondary efficacy criteria, including efficacy at pollen peak, combined score, quality of life and immunological changes, indicate that 300IR tablets represent the optimal dose and suggest it is appropriate for use in clinical practice.
Efficacy of grass pollen sublingual immunotherapy for three consecutive seasons and after cessation of treatment: the ECRIT study
Authors: Ott H. , Sieber J. , Brehler R. , Fölster‐Holst R. , Kapp A. , Klimek L. , Pfaar O. , Merk H.
Published: December 2008

Background:  Data supporting a carry‐over effect with sublingual immunotherapy (SLIT) are scarce. This randomized, double‐blind, placebo‐controlled study evaluated the efficacy, carry‐over effect and safety of grass pollen SLIT using co‐seasonal treatment.

Methods:  Patients (7.9–64.7 years) with grass pollen allergy received ultra‐rush titration with increasing doses (30, 90, 150 and 300 IR) of a 5‐grass pollen mixture every 20 min at the start of the pollen seasons, followed by 300 IR daily until the end of the pollen seasons. A baseline season (no SLIT) was followed by three consecutive treatment seasons and one follow‐up season. Symptoms, medication and adverse events were documented and specific immunoglobulin (Ig)E and IgG4 measured.

Results:  Data were analysed for 183 of the 213 randomized patients. Mean treatment duration varied between seasons (81.8−92.7 days). Combined scores (symptoms and medication) improved progressively across treatment seasons (up to 44.7% improvement for SLIT compared with baseline) and fluctuated between −11.3% and −14.8% for placebo (P < 0.05). Similar changes were observed for symptom scores, with a successive decrease of 39.7% (SLIT) and fluctuations between +13.6% and −1.51% for placebo (P < 0.05). Combined score (P = 0.0508) and symptom score improvements (P = 0.0144) with SLIT continued during follow up. Increases in specific IgG4 observed in the first season were sustained for SLIT vs placebo throughout treatment (P = 0.0001). Titration and daily SLIT were well tolerated. No serious systemic or anaphylactic reactions were reported.

Conclusions:  Seasonal SLIT with ultra‐rush titration is well tolerated and effective from the first treatment season onwards. These data indicate a carry‐over effect of seasonal SLIT.
Association of HLA‐DR antigens with the autologous mixed lymphocyte reaction
Authors: Davey Frederick R. , Kurec Anthony S. , Dock Nancy L. , Hubbell Charlene , Falen Steven W.
Published: December 2008

A study was performed to evaluate the association of HLA‐DR antigens with the proliferative response of T cells in autologous mixed lymphocyte cultures. Peripheral blood mononuclear cells from 100 normal healthy individuals were typed for HLA‐DR antigens and autologous mixed lymphocyte cultures were established. A low proliferative response from autologous cultures was found with individuals bearing HLA‐DR3 antigens and in individuals with only one identifiable HLA‐DR antigen. In contrast, a strong proliferative response was associated with HLA‐DR6 and two identifiable HLA‐DR antigens. These data are consistent with the hypothesis that HLA‐DR3 antigens are associated with a weak immune response gene and HLA‐DR6 antigens are associated with a strong immune response gene.
HLA‐linked SB antigens in Israel
Authors: Cohen N. , Shaw S. , Amar A. , Oksenberg J. , Brautbar C.
Published: December 2008

In the present study we have investigated the HLA‐SB antigen distribution in 65 unrelated Israeli Ashkenazim and non‐Ashkenazim and in a panel of 18 local homozygous typing cells (HTC). Two locally derived SB reagents, anti‐SB2 and SB3, were also studied. The HLA‐SB allele frequencies in the Israeli sample ranged from 0.02 for SB1 to 0.47 for SB4 while SB5 was absent. SB3 had a higher frequency in non‐Ashkenazim (0.11) as compared to Ashkenazim (0.06) but this difference was not significant. On the whole, the allele frequencies for the 5 HLA‐SB antigens studied were in the range observed in non‐Jewish Caucasoid populations with some minor variations. Two of eighteen local HTC's were found heterozygous for SB, demonstrating that homozygosity for HLA‐A, B, C, D and DR does not indicate homozygosity for HLA‐SB. The local anti‐SB2 and SB3 typing reagents gave concordant results when compared with the NIH reference typing cells in population studies.
HLA and susceptibility to multiple sclerosis
Authors: Clerget‐Darpoux F. , Govaerts A. , Feingold N.
Published: December 2008

The study of the joint segregation of multiple sclerosis and HLA, using affected sib pairs as well as whole pedigrees, shows that these two traits are not independently transmitted. The hypothesis of a single susceptibility locus inside HLA region could explain all the observed data, only if a high gene frequency, a very low penetrance, and some environmental correlation between relatives are assumed. Linkage analysis performed on the basis of this hypothesis for 58 multiple sclerosis families concludes to a strict linkage. We obtained a maximum score of 3.11 at = 0.00 for a dominant gene of frequency 0.18 and penetrance of 0.02. This result contrasts with the large recombination fraction obtained by other authors and the discrepancy is explained by the very low gene frequency used in their analysis. Some environmental correlation, in addition to the genetic determinant in HLA region, may explain the overall familial aggregation, but an alternative is the existence of additional genetic determinants.