bluuebunny/crossref_metadata_2025 huggingface dataset:
Dentoalveolar reconstruction of a missing premaxilla using bone graft and endosteal implants
Authors: Fukuda M. , Takahashi T. , Iino M.
Published: March 2003

summary  We report here on a patient with bilateral cleft lip and palate (BCLP) and a missing premaxilla, who underwent dentoalveolar reconstruction of the cleft and premaxillary alveolus using endosteal implants after bone grafting. The patient, whose maxillary incisors and premaxilla were missing, had corticocancellous bone grafting from the iliac crest, followed by excellent bone formation at the anterior alveolus. After the placement of the endosteal implants and the completion of the pre‐surgical orthodontic alignment, orthognathic surgery was performed for the restoration of a Class III open bite. After post‐operative orthodontic preparation, the final fixed prostheses were completed. This treatment procedure offers an option of dentoalveolar reconstruction for BCLP patients with an excised premaxilla.
Self‐assessed bleeding as an indicator of gingival health among 12–14‐year‐old children
Authors: Taani D. Q. , Alhaija E. S. J. A.
Published: March 2003

summary  The aim of this study was to evaluate the relationship between self‐assessed gingival bleeding (GB) and clinically diagnosed gingival health among 12–14‐year‐old school children. A study group (982) comprising of school children aged 12–14 years was chosen by a simple random method from the five geographical areas in Irbid Governate, Jordan. All children completed a questionnaire related to self‐assessment of GB after brushing before they had a clinical examination for oral hygiene and gingival condition using the criteria of Silness & Löe plaque index (1964) and Löe and Silness gingival index (1963). The results showed that the proportions of children who had self‐assessed or clinically assessed GB increased gradually from 12 to 14 years of age with no significant difference (P > 0·05). There were significantly higher proportions of boys than girls who had self‐assessed or were clinically assessed GB (P=0·02, 0·001). The mean plaque (1·83 ± 0·54) and gingival scores (1·90 ± 0·59) of children who reported GB were significantly higher than parallel scores of children without GB (1·27 ± 0·62, 1·23 ± 0·59), respectively (P < 0·001). There was a moderate correlation (r=0·501) between self‐assessed GB and gingival health. In conclusion, there was a positive correlation between self‐assessed GB and gingival health of 12–14‐year‐old children. Therefore, this may be beneficial for monitoring gingival health in children of, at least, developing countries.
Evaluation of alternative intra‐oral repair techniques for fractured ceramic‐fused‐to‐metal restorations
Authors: Özcan M.
Published: March 2003

summary  Ceramic fractures are serious and costly problems in dentistry. Moreover, they pose an aesthetic and functional dilemma both for the patient and the dentist. This problem has created demand for the development of practical repair options which do not necessitate the removal and remake of the entire restoration. Published literature on repair techniques for fractured fixed partial dentures, concentrating on the data obtained both from in vitro and in vivo studies, reveals that the repair techniques based on sandblasting and silanization are the most durable in terms of adhesive and cohesive failures compared with those using different etching agents.
The frequency range of TMJ sounds
Authors: Widmalm S. E. , Williams W. J. , Djurdjanovic D. , Mckay D. C.
Published: March 2003

summary  There are conflicting opinions about the frequency range of temporomandibular joint (TMJ) sounds. Some authors claim that the upper limit is about 650 Hz. The aim was to test the hypothesis that TMJ sounds may contain frequencies well above 650 Hz but that significant amounts of their energy are lost if the vibrations are recorded using contact sensors and/or travel far through the head tissues. Time–frequency distributions of 172 TMJ clickings (three subjects) were compared between recordings with one microphone in the ear canal and a skin contact transducer above the clicking joint and between recordings from two microphones, one in each ear canal. The energy peaks of the clickings recorded with a microphone in the ear canal on the clicking side were often well above 650 Hz and always in a significantly higher area (range 117–1922 Hz, P < 0·05 or lower) than in recordings obtained with contact sensors (range 47–375 Hz) or in microphone recordings from the opposite ear canal (range 141–703 Hz). Future studies are required to establish normative frequency range values of TMJ sounds but need methods also capable of recording the high frequency vibrations.
Evaluating learning opportunities offered to mental health nursing students
Authors: NGANASURIAN
Published: March 2003

This article is based upon a thesis submitted in partial fulfilment of the requirements of Anglia Polytechnic University for the degree of Master of Philosophy. The study, completed in 1997, sought to identify factors making a positive contribution to learning within mental health care settings, and, having done this, to develop a means of auditing. Phase One drew on published work; however, it was necessary to determine the contextual validity of factors shown by colleagues to be conducive to learning, since the focus of this earlier work was, in the main, within general adult nursing. Information on the relevance of these factors was obtained from a sample (n = 146) of mental health nursing students, qualified staff, and teachers who responded to a self‐completion postal survey, using a questionnaire as the research instrument. Phase Two drew upon the work completed in Phase One. A Likert‐type scale audit instrument was developed and administered to a sample (n = 51) of mental health nursing students. In order to test the reliability of this instrument, students’verbal ratings of the quality of their learning experience were compared to numerical ratings provided by the audit instrument resultant from this study. Findings suggest that the instrument provides an effective, efficient means of evaluating learning environments from an individual student's perspective, and as a cumulative profile of student, practice setting and supervisors operating within it. This enables educationalists to identify standards which may be incorporated into future education/service provider contracting arrangements.
The effects of spiritual practices on recovery from substance abuse
Authors: Carter
Published: March 2003

Twelve‐step programs have stressed the importance of spiritual practices for over four decades. The spiritual principles embodied in the twelve‐step programs may be key in their success of recovering addicts/alcoholics with an overall recovery rate of 34%. A literature search revealed little available data on spiritual principles and practices and their effects on long‐term recovery from substance abuse. This study compared two groups of recovering addicts, those with one year of recovery and those with less than one year and a history of relapse. Spiritual practices were measured using a five‐point Likert scale questionnaire. The results of the study indicated a relationship between spiritual practices and long‐term recovery from substance abuse.
What are psychiatric nurses needed for? Developing a theory of essential nursing practice
Authors: Barker  , Jackson  , Stevenson
Published: March 2003

Contemporary developments in health care have encouraged a review of the professional status of psychiatric nursing. However, little study has been made, to date, of the discrete ‘need’ for psychiatric nursing within a multidisciplinary service.

Employing an adapted grounded theory methodology, substantive theory was developed concerning the expressed need for psychiatric nursing, by patients, their carers and mental health professionals, based on six sites from England, Eire and Northern Ireland. The study found some consensus across both recipients and providers of mental health care, that the essential feature of nursing (the core category) involved a complex of relationships: ‘knowing you – knowing me’. Within that complex, nurses either elected, or were required, to move – or ‘toggle’– between three discrete domains of relating: the Ordinary Me (OM); the Pseudo‐ordinary or Engineered Me (POEM); and the Professional Me (PM). Four internal dimensions involving the nurses’ depth of knowing, power, use of time and use of translation, distinguished these domains.

The emergent theory is discussed within the context of the emergent growth in user (consumer) influence and health care technology.
Altschul's legacy in mediating British and American psychiatric nursing discourses: common sense and the ‘absence’ of the accountable practitioner
Authors: Tilley
Published: March 2003

This paper contributes to an archaeology of knowledge in the field of psychiatric and mental health nursing. It focuses on a principal concern of contributors to literature on British psychiatric nursing: the problem of defining psychiatric nursing. Early British writers describing psychiatric nursing accomplished the ‘presence’ of psychiatric nursing as a discursive object, by discursively constructing the ‘absence’ of the psychiatric nurse doing, and being accountable for, ‘appropriate’ work.

Altschul's (1972) Patient–nurse Interaction was the key text in this tradition, mediating British and American discourses, setting the methodological and substantive agenda for an important body of subsequent British psychiatric nursing research.

The paper examines a number of topics in the American and British discourses mediated by Altschul: the privileging of nurses' presence and language in communication with patients; lay versus professional knowledge, and interaction as gossip; ‘common sense’ as a topic; common sense as different from ‘identifiable perspective’; the problem of accountability and the hierarchy of credibility; accountability, the ‘absent’ nurse, and issues of method. Altschul's later work keeps in tension two potentially conflicting claims – on the one hand, that the practice of psychiatric nursing depends on the ‘kind of person’ the nurse is, and on the other, that specialist discourses have priority in determining the basis for practice. Altschul played a crucial role in establishing the role of research in British psychiatric nursing discipline: locating the accountable individual practitioner, and devising remedies for ‘absence’.

In doing so, she anticipated current discourses on nurses' accountability, particularly their inability to demonstrate ‘evidence’ of their ‘effectiveness’.
Ten years on: the abiding presence of R.D. Laing
Authors: Clarke
Published: March 2003

The life and work of Ronald David Laing forms the basis for a review of anti‐psychiatry from the late 1960s until about the mid 1970s. That the period concerned was not the jamboree of sex, drugs and anarchy by which it is normally portrayed is evidenced by Laing's ambivalence towards anti‐psychiatry as well as his yearning for academic and medical respectability. Recent biographies of Laing as well as interviews given shortly before his death were scanned in preparation for this paper. However, some new perspectives are supplied. For example, the curious neglect (by scholars) of the conservative psychiatric forces which paralleled the Laingian critique is briefly examined and especially the attitudes of such forces towards Laingian psychiatry. In addition, some connections are made between Laing's upbringing and his work. Such speculations, always risky, seem valid albeit Laing would probably smile. Lastly, whilst a comparable history of seditious thought in nursing remains unwritten, because hidden, such a history will ultimately depend on psychiatric nursing and especially the career of Annie Altschul who, even earlier than Laing, had sought to define psychiatric care as an interactive and humanizing event.
Schizophrenia: orthodoxy and heresies. A review of alternative possibilities
Authors: Keen T. M.
Published: March 2003

Conflicts about the nature, causes and treatment of schizophrenia have never ceased. Recently, however, a particular set of beliefs (‘the Orthodoxy’) has become influential, and dominates political and managerial agenda for controlling clinical practice and educational initiatives. Theories and therapeutic strategies that differ from the particular biological, behavioural, cognitive and family management approaches favoured by orthodox clinicians have been given far less academic and clinical air‐space. This review surveys some alternative ideas and practices (‘the Heresies’) and critically refers to some of the orthodox tenets such as the genetic and biological bases of schizophrenia, the disease model, ‘family blaming’ and drug treatment. Heresies briefly explored include schizophrenia as an evolutionary inevitability, creative sublimation of schizotypal tendencies and systems‐theory‐based family therapies.
Health‐related hardiness and the effect of a psycho‐educational group on clients' symptoms
Authors: Davis Bryn , WEBSTER C. , AUSTIN W.
Published: March 2003

In the health literature, an individual's ability to resist illness when under stress has been referred to as ‘hardiness’. Resources, which may be used to sustain a sense of well being, can be categorized by two broad domains, ‘control’ and ‘commitment and challenge'. In this research, a quasi‐experimental nonequivalent control group design was used to determine the impact of a specific clinical nursing intervention (the Wellness Program) in terms of its usefulness in fostering the development of health‐related hardiness. Findings demonstrated a significant reduction in symptoms related to obsessive compulsiveness, hostility, psychoticism and average level of distress after subjects completed a relatively short psycho‐educational health promotion group. Subjectively, the treatment group subjects also described positive changes in thoughts, feelings and behaviours. This research has implications for clinical interventions using small groups to promote health.
Developing psychosocial care for acute psychiatric wards
Authors: Baker J. A.
Published: March 2003

The author has reviewed current literature which suggests that it is possible to utilize psychosocial interventions within inpatient care. Through discussion of specific interventions including medication, cognitive behavioural therapy, coping strategy enhancement and education, problems are identified which can impede nurses from developing these skills.
Managing protest behaviour: from coercion to compassion
Authors: Mason T.
Published: March 2003

The compulsory detention and involuntary treatment of mentally disordered offenders is fraught with conceptual difficulties relating to liberty and the protection of others from harm. It is often the case in forensic psychiatry that patients consider themselves unjustly treated and unfairly judged, which may result in some engaging in protest behaviour. This paper is concerned with setting out some philosophical positions in relation to such loss of liberty and forced treatment, and views the protest scenario as a form of hostage situation. This perspective shifts the management of protest behaviour from strategies of coercion to those based on negotiation. Finally, four models of management are set out to facilitate the understanding of protest, and these refer to: (a) crisis bargaining by tracking relational paradox; (b) negotiation as psychotherapy; (c) bio‐behavioural dimension; and (d) protest as post‐traumatic stress disorder.
Forensic psychiatric nursing care — nurses apprehension of their responsibility and work content: a Swedish survey
Authors: Rask M. , Hallberg I. Rahm
Published: March 2003

This questionnaire study aimed to investigate nurses’ views regarding the areas of responsibility, work content and the theoretical perspectives found to dominate nursing duties in Swedish forensic care. The sample (n = 350) was chosen randomly from the five forensic units which provide treatment for patients in Sweden and there was a response rate of 70% (n = 246). The role of the nurses consisted mainly of actions related to activities of daily living (ADL)‐activities. It is worth noting that, within the area of ADL‐activities, practical work on the ward was the nurses’ most common responsibility as well as work content. Less dominating aspects, were educating patients’ families, leading group discussions with family or patients, co‐operating with social authorities as well as activities related to life outside the unit. There were no significant differences with regard to gender but several differences between registered nurses (RNs) and licensed mental nurses (LMNs) were noted. There were mostly weak correlations between areas of responsibility or work content and theoretical perspectives. The results thus suggest that nurses in forensic care view their work to be mainly directed at patients’ capacity for ADL‐activities, medical psychiatric actions, informing and educating patients and families and assessing patients. An even greater emphasis on these aspects may be warranted because of the patients’ serious deficits in social and life skills. It may be useful to consider an increased focus on a psycho–educational approach and to develop and test methods focusing on the development of patients’ capacity for activities related to daily living in a broad sense. Further research is needed to investigate whether the aspects that dominate nursing care also coincide with what the patients apprehend as beneficial for their recovery.
Gatekeeping access to services at the primary/secondary care interface
Authors: McEvoy P.
Published: March 2003

This paper examines the role that mental health clinicians play in gatekeeping access to services at the primary/secondary care interface. Layder’s research map is used to explore the factors that influence gatekeeping decisions at four interrelated levels of social organization; self, situated activity, setting and context, plus a historical dimension that permeates each level. The main theme that emerges from the analysis is that the dilemmas that arise from attempting to control the demand for care are difficult to resolve for policy makers, managers or clinicians alike. A combination of factors make it difficult to establish consistent priorities including: the uneven distribution of specialist services, the lack of a consensus definition of severe mental illness and the difficulty of weighing the potential benefits of care for the individual against the need to ensure that resources are distributed fairly. It is suggested that there are no easy answers to these dilemmas because gatekeeping is a socially contested process, in which there will be winners and losers.
The use of outcome measures to evaluate the efficacy and tolerability of antipsychotic medication: a comparison of Thorn graduate and CPN practice
Authors: Gray R. , Wykes T. , Parr A.‐M. , Hails E. , Gournay K.
Published: March 2003

Assessing the tolerability and efficacy of treatment with antipsychotic medication is a vital part of mental health care. Research has suggested that many side‐effects go undetected by clinicians and there is a need to use standardized assessment tools to ensure that treatments are comprehensively evaluated. The training of Community Psychiatric Nurses (CPNs), who provide much of patients’ care, should focus on enhancing skills in using such assessments. This study aimed to examine differences in the use of standardized assessments of antipsychotic side‐effects and psychopathology by CPNs and Thorn graduates who had received additional training in delivering psychosocial interventions. A questionnaire was sent to 240 Thorn graduates and CPNs practising in England, with an overall adjusted response rate of 54%. Thorn graduates reported using significantly more standardized assessments of side‐effects and psychopathology than CPNs. A trend in both groups towards the use of measures that relied on patient self‐report of side‐effects was observed. This study identified important deficiencies in current CPN practice. A programme of targeted training may be a more realistic and efficient method of enhancing medication management practices in large numbers of CPNs compared to the more expensive and time‐consuming Thorn programme.
Evidence‐based care and the case for intuition and tacit knowledge in clinical assessment and decision making in mental health nursing practice: an empirical contribution to the debate
Authors: Welsh I. , Lyons C. M.
Published: March 2003

This paper provides empirical evidence that challenges the view that methods of clinical assessment and decision making should not rely solely on logical positivist approaches. Whilst the National Health Service (NHS) Executive currently takes a hard positivist line on what constitutes evidence‐based practice, data reveal that it is not always appropriate to disregard the tacit knowledge and intuition of experienced practitioners when making assessment decisions in mental health nursing practice. Data support the case for a holistic approach which may draw on intuition and tacit knowledge, as well as traditional approaches, to meet the requirements of clients with complex mental health problems. A model based on Schon's notion of reflection in and reflection on practice is proposed which demonstrates the value of intuition and tacit knowledge. This model allows the generation of insights which may ultimately be demonstrated to be acceptable and empirically testable. It is accepted that an element of risk taking is inevitable, but the inclusion of a formal analytical process into the model reduces the likelihood of inappropriate care interventions. The cognitive processes which experienced nurses use to make clinical decisions and their implications for practice will be explored.
Formal observations and engagement: a discussion paper
Authors: Bowles N. , Dodds P. , Hackney D. , Sunderland C. , Thomas P.
Published: March 2003

Formal observation of patients at risk is extremely common in acute psychiatric facilities. Effectively a form of physical containment, observation is resource‐intensive, makes significant personal demands upon staff and skews the focus of nursing care towards the small group of patients judged to be most at risk. For patients, the experience of being observed is often less than therapeutic and, in some cases, counter productive. In this paper, the authors draw upon a variety of perspectives, including that of a psychiatrist and a service user. It is argued that the practice of formal observation is ineffective and may actually contribute to the poor state of UK acute psychiatric inpatient units, in terms of direct patient care, clinical decision‐making and appropriate risk management. In a recent ‘commentary’ within this journal, the authors offered ‘engagement’ as an alternative to observation. In this paper, the meaning of engagement is refined and presented as a process of emotional and psychological containment of distress. The paper concludes that inappropriate over‐use of formal observation as a custodial and defensive practice can contribute to a sense of dehumanization and isolation within acute psychiatric patients; engagement may provide a genuine (i.e. not just linguistic) alternative.
From compliance to concordance: a review of the literature on interventions to enhance compliance with antipsychotic medication
Authors: Gray R. , Wykes T. , Gournay K.
Published: March 2003

Non‐compliance with antipsychotic medication is observed in around 50% of people with schizophrenia and is a major preventable cause of psychiatric morbidity. A number of factors influence patient’s decisions about taking medication and include awareness of illness, beliefs about treatment and side‐effects of medication. A variety of interventions targeted at improving compliance have been tested. Education increases patients’ understanding of their illness and treatment but does not improve compliance. However, interventions, such as compliance therapy, based on cognitive–behavioural techniques appear to be effective in enhancing compliance and preventing relapse.
A literature review of dementia care mapping: methodological considerations and efficacy
Authors: BEAVIS D. , SIMPSON S. , GRAHAM I.
Published: March 2003

Dementia care mapping (DCM) is a popular method for evaluating the quality of care and well‐being of people with dementia in formal care settings. Keywords and thesaurus searches were conducted between 1992 and June 2001 using a range of bibliographic databases. Studies that had specifically examined the efficacy of DCM or, had used DCM as the main outcome measure, were included in the review. Nine studies met the inclusion criteria and were evaluated in this review. The review highlights some methodological limitations in the DCM studies to date, including sampling bias, inadequate sample size, short evaluation periods and a lack of consideration of the confounding variables commonly associated with dementia. The evidence presented for DCM suggests that it has good face validity and reliability. However, other aspects of validity remain less convincing and it can only be regarded as a moderately valid instrument. Whilst its theoretical background makes DCM particularly appealing to nurses wishing to improve the quality of their care, it is a very time‐consuming method and requires considerable investment in terms of nursing resources. Consequently, it is essential that more scientifically based studies are conducted to enable other aspects of validity to be developed, thus enhancing the value of DCM as an outcome measure of nursing care.
A comparison of therapeutic commitment, role support, role competency and empathy in three cohorts of nursing students
Authors: Lauder W. , Reynolds W. , Smith A. , Sharkey S.
Published: March 2003

This study investigated the perceptions of students regarding their therapeutic commitment, role competency, role support and empathy towards working with people who have mental health problems. These qualities play a key part in the development of therapeutic relationships, an important goal for working with individuals in most nursing situations. The sample comprised of three cohorts of nursing students undertaking the Diploma in Higher Education (Nursing) in Scotland. There were no significant differences in perceptions of empathy and therapeutic commitment among three cohorts of students, but third year students felt they received less role support than other cohorts. The findings also revealed that preregistration nursing students have perceptions of their role competency and empathic skills which are considerably greater than has been previously reported by registered nurses. The implications of these findings for nurse education are discussed.
Tolerance for depression: are there cultural and gender differences?
Authors: LOEWENTHAL K. M. , MACLEOD A. K. , LEE M. , COOK S. , GOLDBLATT V.
Published: March 2003

This study examined tolerance for depression among Jewish and Protestant men and women in the United Kingdom. A measure of tolerance for depression was developed, which examined willingness to admit to and seek help for depression. More specifically, the items in the measure (developed from extended interviews) covered empathy towards sufferers, potential virtues of the illness, hopes for treatment, seeing the illness as ‘normal’, and telling other people about it. Existing evidence suggested that tolerance for depression might be greater amongst Jews compared with Protestants, and women compared with men. Also, Jewish men were expected to be more tolerant than Protestant men, whereas Protestant and Jewish women were not expected to differ from each other. It was found that tolerance for depression was greater amongst Jews than Protestants, and this is consistent with the elevated levels of depression amongst Jewish men as compared with Protestant men. However, findings relating to gender were mixed and were not always consistent with our expectations. The findings suggest that there may be some cultural variations in willingness to admit to and seek help for depression, and this may be worth examining in other cultural‐religious groups. Individual variations in tolerance for depression may be clinically significant.
A field study of age and gender differences in habitual adult sleep
Authors: HUME KENNETH , VAN FIONA , WATSON ALISON
Published: March 2003

The sleep of 52 healthy paid subjects (23 male) divided into three age‐bands (20–34, 35–49 and 50–70 y) were recorded at night in their homes for a total of 190 subject‐nights while following their normal daily activities and habitual sleep‐wake schedule. There was a shortening in both nocturnal total sleep period and total sleep time (TST) with age, the oldest group sleeping 46 min less than the youngest. Also, the mid‐point of sleep occurred 32 min earlier in the oldest group compared with the youngest group. The reduction in TST with age was due, in part, to increased wake periods within sleep. The youngest subjects showed more Movement Time which progressively decreased with age while the amount of stage 1 increased with age. The amount of slow‐wave sleep (SWS, stages 3+4) was reduced, stage 4 was more than halved, while REM was slightly reduced with age. There were far fewer significant gender differences in the sleep variables: males, particularly in the middle and oldest age bands, had more stage 1 than females, while females had more SWS, particularly stage 3, than males. In general, despite relatively limited subject selection criteria, there was good agreement with previous laboratory‐based normative sleep values for the effect of age and gender.
Information processing and coping style during the wake/sleep transition
Authors: VOSS URSULA , HARSH JOHN
Published: March 2003

Information processing of meaningful events (subject's own name, neutral name and tones) was studied during the transition from wakefulness to sleep in two groups of subjects with opposing information processing styles, Monitors and Blunters. In two experimental sets, subjects were instructed to execute a fingerlift response to a predetermined stimulus type. Subject's own name produced the greatest number of K‐complexes and arousals relative to other name and tones. A task relevance effect was found for arousals but not for K‐complexes. The overall P3 amplitude was larger for Monitors than for Blunters, whereas Blunters showed a larger N350 to target stimuli than Monitors. The findings suggest that higher level processing continues during light sleep and that N350 may reflect a process related to sleep maintenance.
Human insulin gene insertion in mice. Effects on the sleep–wake cycle?
Authors: Valatx  , Douhet  , Bucchini
Published: March 2003

Recently, insulin synthesis and the presence of an insulin receptor have been demonstrated in the brain. Intracerebroventricular infusion of insulin causes a selective increase in the amount of slow‐wave sleep. In the present study, the sleep–wake cycle of transgenic mice, with or without habenular neuronal expression of the human insulin gene, was studied to investigate the possible role of brain insulin as a sleep modulator. Slow‐wave sleep duration was increased in those mice expressing human insulin in the habenula. However, it is possible that this effect was not due to expression of the insulin transgene, but to the genetic background of one of the parental strains (CBA) used for insertion of the transgene. Users of transgenic mice should be aware of this possibility and be cautious in interpreting results when hybrid embryos are used as transgene recipients.
Dreaming and waking consciousness: a character recognition study
Authors: Kahn D. , Stickgold R. , Pace‐Schott E. F. , Hobson J. A.
Published: March 2003

The formal features of dream characters were studied in a sample of 320 dream reports submitted by 33 adult subjects (13 male, 20 female) of varying ages in a university extension course. Subjects were queried by questionnaire about dream characters immediately after recording their dreams upon awakening in their normal home setting. It was found that 48% of characters represented a named personage known to the dreamer, 35% were generically identified by their social role (e.g., policeman) or abstract relation to the dreamer (e.g., a friend) while only 16% were wholly novel. Seventy‐seven percent of characters were pseudosensorily present in the dream whereas 23% were present only by mention or thought. Subjects were allowed to endorse one or more of four bases of recognition and, among named characters, 32% were identified by ‘appearance’, 21% by ‘behavior’, 45% by ‘face’, and 44% by ‘just knowing’ (with the respective percentages for generic characters being 39%, 38%, 9% and 40%). Fourteen percent of named and generic characters had associated some element of bizarreness most frequently consisting of an incongruous feature. Comparing the 25 longest and 25 shortest reports, named subjects were significantly more common in the shortest reports whereas generic and unknown characters were more common in the longest reports. Results are interpreted in neurocognitive terms as possibly reflecting a decrease during dreaming relative to waking in the exchange of information between inferotemporal face identification areas and prefrontal areas subserving logic and working memory.
Night‐time sleep and daytime sleepiness in narcolepsy
Authors: Harsh  , Peszka  , Hartwig  , Mitler
Published: March 2003

This report describes night‐time sleep and daytime sleepiness in a large (N=530) sample of patients meeting the International Classification of Sleep Disorders criteria for diagnosis of narcolepsy. Sleep data were obtained from polysomnographic recordings on two consecutive nights. Sleepiness was assessed using the Multiple Sleep Latency Test, the Maintenance of Wakefulness Test and the Epworth Sleepiness Scale. Analysis revealed that sleep was mild to moderately disturbed on both recording nights. A first‐night effect was suggested by decreased REM latency and increased percentage REM and slow‐wave sleep on the second night. Sleepiness and sleep disturbance varied across patient subgroups created based on patient ethnicity and on the presence/absence of cataplexy, sleep apnoea, and periodic limb movements. Covariation of sleep and sleepiness measures across patients was significant but weak. Strong association was found between subgroup means of sleep and sleep disturbance measures. The findings reported here show that sleepiness and sleep disturbance vary across patient subgroups and that sleep disturbance is related to, although unable to account, for the pathological sleepiness of narcolepsy.
The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects
Authors: Onen S. Hakki , Alloui Abdelkrim , Gross Annette , Eschallier Alain , Dubray Claude
Published: March 2003

The aim of this study was to compare the effects of total sleep deprivation (TSD), rapid eye movement (REM) sleep and slow wave sleep (SWS) interruption and sleep recovery on mechanical and thermal pain sensitivity in healthy adults. Nine healthy male volunteers (age 26–43 years) were randomly assigned in this double blind and crossover study to undergo either REM sleep or SWS interruption. Periods of 6 consecutive laboratory nights separated by at least 2 weeks were designed as follows: N1 Adaptation night; N2 Baseline night; N3 Total sleep deprivation (40 h); N4 and N5 SWS or REM sleep interruption; N6 Recovery. Sleep was recorded and scored using standard methods. Tolerance thresholds to mechanical and thermal pain were assessed using an electronic pressure dolorimeter and a thermode operating on a Peltier principle. Relative to baseline levels, TSD decreased significantly mechanical pain thresholds (−8%). Both REM sleep and SWS interruption tended to decrease mechanical pain thresholds. Recovery sleep, after SWS interruption produced a significant increase in mechanical pain thresholds (+ 15%). Recovery sleep after REM sleep interruption did not significantly increase mechanical pain thresholds. No significant differences in thermal pain thresholds were detected between and within periods. In conclusion this experimental study in healthy adult volunteers has demonstrated an hyperalgesic effect related to 40 h TSD and an analgesic effect related to SWS recovery. The analgesic effect of SWS recovery is apparently greater than the analgesia induced by level I (World Health Organization) analgesic compounds in mechanical pain experiments in healthy volunteers.
Absence of penile erections during paradoxical sleep. Peculiar penile events during wakefulness and slow wave sleep in the armadillo
Authors: Affanni Jorge M. , Cervino Claudio O. , Marcos Hernan J. Aldana
Published: March 2003

The electroencephalogram (EEG) together with electromyogram (EMG) of the ischiocavernosus, bulbocavernosus and levator penis muscles were chronically monitored across behavioral states of the armadillo Chaetophractus villosus. This animal has a very long penis, which exhibits remarkable phenomena during wakefulness (W), slow wave sleep (SWS) and paradoxical sleep (PS). During W it remains retracted within a skin receptacle. During SWS penile protrusion can be observed together with very complex movements. Protrusion is a non erectile event during which the penis remains out of its receptacle but without rigidity. Penile erections are observed only during SWS. Contrasting with other mammals, no erections occur during PS. During this phase the penile muscles share the atonia of the body musculature characteristic of that phase. Some reflections on mechanisms of those penile events are presented.
Sleep propensity varies with behaviour and the situation in which it is measured: the concept of somnificity
Authors: JOHNS MURRAY W.
Published: March 2003

It is self‐evident that we fall asleep more readily when lying down than when standing up. Nevertheless, the influence of this and more subtle changes in posture, activity and the situation in which sleep propensity is measured have been largely ignored. The term somnificity is introduced here, defined as the general characteristic of a posture, activity and situation that reflects its capacity to facilitate sleep‐onset in a majority of subjects. The relative somnificities of different activities and situations in the Epworth Sleepiness Scale (ESS) were investigated in 23 groups, involving 2802 subjects from seven different countries. The means of the different ESS item‐scores were ranked from highest to lowest in each group. There was a high concordance (Kendall's C=0.84, P < 0.0001) among these ranks for all groups, whether of normal subjects or patients with sleep disorders, regardless of age, sex, or average sleepiness in daily life assessed by total Epworth scores. The ESS item‐ranks formed an ordinal scale of somnificities with five different levels. Analysis of raw ESS item‐scores for all 987 individual Australian subjects showed the same pattern of somnificities with six different levels, but with a lower concordance (C=0.39, P < 0.0001). This was probably because of subject × situation‐specific interactions that were averaged within groups. A conceptual model of sleepiness is outlined that includes interactions between separate sleep and wake drives as a possible way of including behavioural and situational influences on sleep propensity.
An examination of evoked K‐complex amplitude and frequency of occurrence in the elderly
Authors: Crowley Kate , Trinder John , Colrain Ian M.
Published: March 2003

The elderly consistently display lower levels of slow wave sleep (SWS), primarily because of the small amplitude of their delta activity. Given that delta electroencephalogram (EEG) and K‐complexes are thought to be generated by the same mechanisms, it was hypothesized that K‐complex amplitude and rate of production would be lower in the elderly. K‐complex amplitude was assessed by averaging K‐complex responses to auditory stimuli, and measuring the amplitude of the N550 component of the averaged evoked response. Ten young (five males and five females; mean age 23.10 ± 5.36 years) and 10 elderly adults (six males and four females; mean age=75.60 ± 4.48 years) who were neurologically healthy and free from medication spent two non‐consecutive nights in the sleep laboratory. EEG was recorded from six gold plate electrodes (Fz, Fcz, Cz, Cpz, Pz and O2) referenced to A1 + A2. Tone clicks (1000 Hz), of varying intensity from 70 to 100 decibels above measured awake detection threshold, were presented binaurally during stage 2 sleep. Responses were classified according to whether they produced: a K‐complex, a vertex sharp wave (VSW), both of these responses or neither response. They were then averaged separately for each response type. The elderly showed a substantially smaller N350 (averaged VSWs) and N550 amplitudes compared with the young subjects. The elderly also showed an augmented but delayed P2 component, followed by a long‐lasting positive EEG shift. The smaller amplitude of the averaged K‐complex N550 component is consistent with lower delta amplitudes previously reported in the elderly and with the hypothesis that K‐complexes and delta activity share the same generator mechanisms. The enhanced P2 component and the long‐lasting positive deflection in the EEG in the elderly indicate the existence of age differences other than smaller EEG amplitude.
Time course of EEG background activity level before spontaneous awakening in infants
Authors: Zampi Chiara , Fagioli Igino , Salzarulo Piero
Published: March 2003

This research aimed to investigate the time course of the cortical activity level preceding spontaneous awakening as a function of age and state. Two groups of infants (1–4 and 9–14 weeks of age) were continuously monitored by polygraphic recording and behavioural observation during the night. The electroencephalographic (EEG) activity recorded by the C3–O1 lead was analysed through an automatic analysis method which provides, for each 30‐s epoch, a single measure, time domain based, of the EEG synchronization. The EEG parameter values were computed in the 6 min preceding each awakening out of non‐rapid eye movement (NREM) sleep and out of rapid eye movement (REM) sleep. The EEG background activity level did not change in the minutes preceding awakening out of REM sleep. Awakening out of NREM sleep was preceded by a change of EEG activity level in the direction of higher activation with different time course according to the age. Both REM and NREM sleep results suggest that a high level of EEG activity is a prerequisite for the occurrence of a spontaneous awakening.
Comparative in vitro effects of closantel and selected β‐ketoamide anthelmintics on a gastrointestinal nematode and vertebrate liver cells
Authors: BACON J.A. , ULRICH R.G. , DAVIS J.P. , THOMAS E.M. , JOHNSON S.S. , CONDER G.A. , SANGSTER N.C. , ROTHWELL J.T. , MCCRACKEN R.O. , LEE B.H. , CLOTHIER M.F. , GEARY T.G. , THOMPSON D.P.
Published: March 2003

PNU‐87407 and PNU‐88509, β‐ketoamide anthelmintics that are structurally related to each other and to the salicylanilide anthelmintic closantel, exhibit different anthelmintic spectra and apparent toxicity in mammals. The basis for this differential pharmacology was examined in experiments that measured motility and adenosine triphosphate (ATP) levels in larval and adult stages of the gastrointestinal nematode, Haemonchus contortus, and in a vertebrate liver cell line and mitochondria. PNU‐87407 and PNU‐88509 both exhibited functional cross‐resistance with closantel in larval migration assays using closantel‐resistant and ‐sensitive isolates of H. contortus. Each compound reduced motility and ATP levels in cultured adult H. contortus in a concentration‐ and time‐dependent manner; however, motility was reduced more rapidly by PNU‐88509, and ATP levels were reduced by lower concentrations of closantel than the β‐ketoamides. Tension recordings from segments of adult H. contortus showed that PNU‐88509 induces spastic paralysis, while PNU‐87407 and closantel induce flaccid paralysis of the somatic musculature. Marked differences in the actions of these compounds were also observed in the mammalian preparations. In Chang liver cells, ATP levels were reduced after 3 h exposures to 0.25 μM PNU‐87407, 1 μM closantel or 10 μM PNU‐88509. Reductions in ATP caused by PNU‐88509 were completely reversible, while the effects of closantel and PNU‐87407 were irreversible. PNU‐87407, closantel and PNU‐88509 uncoupled oxidative phosphorylation in isolated rat liver mitochondria, inhibiting the respiratory control index (with glutamate or succinate as substrate) by 50% at concentrations of 0.14, 0.9 and 7.6 μM, respectively.
The pharmacokinetics of furosemide in anaesthetized horses after bilateral ureteral ligation
Authors: Dyke  , Hubbell  , Grosenbaugh  , Beard  , Mitten  , Sams  , Hinchcliff
Published: March 2003

The pharmacokinetics of furosemide were investigated in anaesthetized horses with bilateral ureteral ligation (BUL) with (n = 5) or without (n = 5) premedication with phenylbutazone. Horses were administered an intravenous (i.v.) bolus dose of furosemide (1 mg/kg) ≈ 60–90 min after BUL. Plasma samples collected up to 3 h after drug administration were analysed by a validated high performance liquid chromatography method. Median plasma clearance (CLp) of furosemide in anaesthetized horses with BUL was 1.4 mL/min/kg. Apparent steady state volume of distribution (Vdss) ranged from 169 to 880 mL/kg and the elimination half life (t½) ranged from 83 min to 209 h.  No differences in plasma concentration or kinetic parameter estimates were observed when phenylbutazone was administered before furosemide administration. BUL markedly reduces the elimination of furosemide in horses and models the potential effects that severe changes in kidney function may have on drug kinetics in horses.
A pharmacodynamic and pharmacokinetic study with vedaprofen in an equine model of acute nonimmune inflammation
Authors: Lees  , May  , Hoeijmakers  , Coert  , Rens
Published: March 2003

The pharmacodynamics and enantioselective pharmacokinetics of vedaprofen were studied in six ponies in a two period cross‐over study, in which a mild acute inflammatory reaction was induced by carrageenan soaked sponges implanted subcutaneously in the neck. Vedaprofen, administered intravenously at a dosage of 1 mg/kg, produced significant and prolonged inhibition of ex vivo serum thromboxane B2 (TXB2) synthesis and short‐lived inhibition of exudate prostaglandin E2 (PGE2) and TXB2 synthesis. Vedaprofen also partially inhibited oedematous swelling and leucocyte infiltration into exudate. Vedaprofen dis‐played enantioselective pharmacokinetics, plasma concentrations of the R(–) enantiomer exceeding those of S(+) vedaprofen. The plasma concentration ratio, R:S, increased from 69: 31 at 5 min to 96: 4 at 3 h and plasma mean AUC values were 7524 and 1639 ng.h/mL, respectively. Volume of distribution was greater for S(+) vedaprofen, whilst elimination half‐life (t½β) and mean residence time were greater for R(–) vedaprofen. The penetration of vedaprofen into inflammatory exudate was also enantioselective. For R(–) and S(+) veda‐profen maximum concentration (Cmax) values were 2950 and 1534 ng/mL, respectively, and corresponding AUC values were 9755 and 4400 ng.h/mL. Vedaprofen was highly protein bound (greater than 99%) in both plasma and exudate. The significance of these data for the therapeutic use of vedaprofen is discussed.