bluuebunny/crossref_metadata_2025 huggingface dataset:
The Development of a Miniature Optical Sensor for Balloon-Borne Measurements of Ozone Profiles
Authors: Wolff Mareile A. , Herber Andreas , Jacobi Hans-Werner , Schrems Otto , Hoops Jan , Ruhe Wilfried
Published: January 2008

A new autonomous balloon-borne sounding system for the measurement of stratospheric trace gas profiles was designed and constructed. Major components of the sonde are a miniature grating spectrometer, which covers a wavelength range from the ultraviolet (200 nm) to the visible (850 nm), and a commercial radiosonde. The low-weight sonde (approximately 1.7 kg) measures the spectral solar irradiance and meteorological parameters during the ascent through the atmosphere. Because of the decreasing ambient temperature during an ascent, the temperature of the spectrometer decreases by about 15 K. Active temperature stabilization is not included, and the irradiance measurements show a strong temperature dependence. The temperature-induced wavelength shift, the absolute irradiance, and the dark signal behavior were characterized as a function of the spectrometer’s temperature. Based on this laboratory characterization, an inflight correction for changes in the dark current and for the wavelength drift was applied. In the test program described herein, ozone profiles were determined from changes in the measured solar spectral irradiance caused by ozone absorption in the Hartley and Huggins bands. Comparisons were performed with results of simultaneous electrochemical ozonesonde and lidar measurements. The ozone number density profile retrieved using the new sonde agrees with the independently measured ozone profiles within 20% for altitudes above 18 km. In the lower stratosphere, the discrepancies increase to 50%.
An Infrared Sea Surface Temperature Autonomous Radiometer (ISAR) for Deployment aboard Volunteer Observing Ships (VOS)
Authors: Donlon C. , Robinson I. S. , Wimmer W. , Fisher G. , Reynolds M. , Edwards R. , Nightingale T. J.
Published: January 2008

The infrared SST autonomous radiometer (ISAR) is a self-calibrating instrument capable of measuring in situ sea surface skin temperature (SSTskin) to an accuracy of 0.1 K. Extensive field deployments alongside two independent research radiometers measuring SSTskin using different spectral and geometric configurations show that, relatively, ISAR SSTskin has a zero bias ±0.14 K rms. The ISAR instrument has been developed for satellite SST validation and other scientific programs. The ISAR can be deployed continuously on voluntary observing ships (VOS) without any service requirement or operator intervention for periods of up to 3 months. Five ISAR instruments have been built and are in sustained use in the United States, China, and Europe. This paper describes the ISAR instrument including the special design features that enabled a single channel radiometer with a spectral bandpass of 9.6–11.5 μm to be adapted for autonomous use. The entire instrument infrared optical path is calibrated by viewing two blackbody reference cavities at different temperatures to maintain high accuracy while tolerating moderate contamination of optical components by salt deposition. During bad weather, an innovative storm shutter, triggered by a sensitive optical rain gauge, automatically seals the instrument from the external environment. Data are presented that verify the instrument calibration and functionality in such situations. A watchdog timer and auto-reboot function support automatic data logging recovery in case of power outages typically encountered on ships. An RS485 external port allows supporting instruments that are not part of the core ISAR package (e.g., a solarimeter) to be logged using the ISAR system. All data are processed by the ISAR instrument and are relayed to a host computer via the RS232 serial link as (National Electronics Manufacturers Association) NEMA-style strings allowing easy integration into many commercial onboard scientific data logging systems. In case of a communications failure, data are stored on board using a CompactFlash card that can be retrieved when the instrument is serviced. The success of the design is demonstrated using results obtained over 21 months in the English Channel and Bay of Biscay as part of a campaign to validate SSTskin observations derived from the Environmental Satellite (Envisat) Advanced Along-Track Scanning Radiometer (AATSR).
Otters as Actors
Authors: Goedeke T.L. , Rikoon S.
Published: January 2008

In this paper, we use scientific controversy emerging from a river otter restoration project in Missouri to explore the role of nonhuman actors in the dynamism of networks forming to establish the ideals and outcomes of ecological restoration. We demonstrate how an epistemic controversy, sparked by the failure of authoritative spokespersons (such as scientists) to enroll river otters, fish, and waterways, opened the door for a more diverse group of spokespersons who, in turn, enrolled more actors to settle the controversy. Thus, we emphasize the need to recognize the role of nonhumans as catalysts and actors because of their potential to challenge and change networks. Second, we explore the struggle between the networks that emerged to (re)define the restoration narrative as accomplished (necessitating the trapping of otters) or incomplete (with the otter population in possible jeopardy). Finally, our discussion highlights the importance of convergence and power when competing networks are involved. The otter restoration case study makes evident that a successful exercise of power has significant consequences for human and nonhuman actors alike, all of which have a stake in the landscape.
Doing Distinctions
Authors: Burri Regula Valérie
Published: January 2008

The transformations in radiology induced by new imaging technology can be understood as instances of `doing distinctions' by both technology and human actors. This paper combines the analytical frameworks of Gieryn and Bourdieu to understand the reconfigurations engendered by the medical implementation of visualization apparatuses such as magnetic resonance imaging (MRI). It examines the reactions of radiologists to these transformations, which forced them to renegotiate visual expertise and to reconstitute their professional and disciplinary identity. The paper argues that imaging practices are practices of boundary work and distinction, aimed at regaining professional authority and accumulating symbolic capital within the professional field. Boundary work and distinction practices are thus means to improve both the prestige of the profession and the actors' individual status within the scientific or hospital community. The paper further argues that visualization machines and images are not exclusively used for diagnostic and research purposes but are also material and epistemic resources that are deployed in practices of boundary work and distinction. Technology and pictures serve as tools to demonstrate professional skills and power, to increase one's reputation, and to renegotiate identity. Drawing on interviews, documents and fieldwork in several radiology departments and MRI centres in Europe and the USA, the paper reconstructs processes of `doing distinctions' related to the implementation of MRI and other imaging technologies in medicine. It explores the identity and accumulation strategies of radiologists and other medical specialists through an examination of their boundary work and distinction practices, which are focused on material, social and epistemic resources, and boundaries.
Configuring 'Interactivity'
Authors: Heath Christian , vom Lehn Dirk
Published: January 2008

There is a growing commitment within science centres and museums to develop exhibitions that engender new forms of participation that contribute to the public's understanding of science. Information and communication systems play an important role in this regard, enabling new forms of `interaction' with and around exhibits. In this paper we consider how visitors respond to these exhibits and explore the forms of interaction that arise within these new exhibition areas. The analysis addresses the ways in which these so-called `interactives' create highly constrained sequences of action that prioritize the individual user while undermining the opportunities for co-participation and collaboration. It examines the ecologies of participation that arise with, around and within different types of exhibit and exhibition. The paper suggests that many `interactive' exhibits rely upon a model of `interaction' and the `user' that pervades computer-based systems, a model that has been subject to sustained criticism over some years. In other words, the paper points to the ways in which `interactivity' is conflated with social interaction and how the seemingly innovative and entertaining exhibits may fail to engender the co-participation and collaboration that is seen as critical to learning and engagement.
Contrasting perspectives on narrating selves and identities: an invitation to dialogue
Authors: Smith Brett , Sparkes Andrew C.
Published: January 2008

In recent years, qualitative researchers have in varied ways conceptualized selves and identities as narratively constructed. In this article, we offer a typology for viewing, the various conceptualizations of narrative identities and selves. Five perspectives are presented for discussion. These are, the psychosocial, the inter-subjective, the storied resource, the dialogic and the performative perspectives. Insights into contrasts between them are also generated by exploring the emphasis given by each perspective to both the social and individual in creating selves and identities. These contrasts are organized along a continuum, with perspectives that adopt a `thick individual' and `thin social relational' view to the self and identity at one end, and those that adopt a `thin individual' and `thick social relational' view at the other. We close by suggesting that each perspective is worthy of consideration in its own right and that coexistence is possible despite their differences.
`Entering the blogosphere': some strategies for using blogs in social research
Authors: Hookway Nicholas
Published: January 2008

Since 1999 blogs have become a significant feature of online culture. They have been heralded as the new guardians of democracy, a revolutionary form of bottom-up news production and a new way of constructing self and doing community in late-modern times. In this article I highlight the significance of the `blogosphere' as a new addition to the qualitative researcher's toolkit and some of the practical, theoretical and methodological issues that arise from this. Some of the key ethical issues involved in blog data collection are also considered. The research context is a project on everyday understandings and experiences of morality.
`Thus I salute the Kentucky Daisey's claim': gender, social memory, and the mythic West at a proposed Oklahoma monument
Authors: DeLyser Dydia
Published: January 2008

On 22 April 1889, at the beginning of the first Oklahoma land run when the US federal government allowed non-Indian settlers to claim what had been Native American lands, Nannita R.H. Daisey entered the newly opened territory by train to become one of the very first women to stake a quarter-section land claim, on land today part of Edmond. According to local lore, Daisy leapt from the cowcatcher of the train to stake her claim, removing her petticoat to mark the spot. Over 100 years later Edmond has proposed a bronze monument to Daisey, petticoat flying, riding on the cowcatcher, in an effort both to attract tourists with public art, and to recognize women's contributions to Oklahoma settlement. On the surface this seems a laudable attempt to re-inscribe women's lives in the history of the American West, the social memories of Oklahomans, and the landscape of contemporary Edmond — except that the story about the cowcatcher and the petticoat, though passed down in local lore for more than 100 years, is false. And that, in turn, provides feminist historical geographers with an opportunity to examine the canonization of an exaggerated version of an already heroicized tale of Euro-American conquest, and what that implies for the representation of women in the American West. In this article, in an effort to improve upon decades of superficial scholarship, and in the face of the proposed monument's mis-portrayal, I attempt to detail Daisey's biography and describe her actual deeds. But, since the lives of prominent westerners are often difficult to disentangle from the powerful romanticizing influence of the mythic West on themselves and on their representations, my attempt itself raises issues about the study and representation of westerners in the US as the article explores ways that western women have been represented, the role of a monument as the landscape representation of a western woman, and the specific gendered spatial framework for the creation of contemporary social memory that Nannita Daisey's monument and legendary tale present.
Patient Education: The Art of Waist Management
Authors: Miner Martin
Published: January 2008

Although given an ICD9 code for diagnosis, variability exists for the definition of metabolic syndrome. In fact, these definitions do not always define the same patient population. The author discusses the various definitions, their applicability to clinical practice, and the teachings of a national best-seller: You: On a Diet: The Owner's Manual for Waist Management by Roizen and Oz. He shares basic tenets and humor for clinical guidance of patients suffering from metabolic syndrome.
CD27-CD70 interactions in the pathogenesis of Waldenström macroglobulinemia
Authors: Ho Allen W. , Hatjiharissi Evdoxia , Ciccarelli Bryan T. , Branagan Andrew R. , Hunter Zachary R. , Leleu Xavier , Tournilhac Olivier , Xu Lian , O'Connor Kelly , Manning Robert J. , Santos Daniel Ditzel , Chemaly Mariana , Patterson Christopher J. , Soumerai Jacob D. , Munshi Nikhil C. , McEarchern Julie A. , Law Che-Leung , Grewal Iqbal S. , Treon Steven P.
Published: January 2008

Waldenström macroglobulinemia (WM) is a B-cell malignancy characterized by an IgM monoclonal gammopathy and bone marrow (BM) infiltration with lymphoplasmacytic cells (LPCs). Excess mast cells (MCs) are commonly present in WM, and provide growth and survival signals to LPCs through several TNF family ligands (CD40L, a proliferation-inducing ligand [APRIL], and B-lymphocyte stimulator factor [BLYS]). As part of these studies, we demonstrated that WM LPCs secrete soluble CD27 (sCD27), which is elevated in patients with WM (P < .001 vs healthy donors), and serves as a faithful marker of disease. Importantly, sCD27 stimulated expression of CD40L on 10 of 10 BM MC samples and APRIL on 4 of 10 BM MC samples obtained from patients with WM as well as on LAD2 MCs. Moreover, the SGN-70 humanized monoclonal antibody, which binds to CD70 (the receptor-ligand partner of CD27), abrogated sCD27 mediated up-regulation of CD40L and APRIL on WM MCs. Last, treatment of severe combined immunodeficiency–human (SCID-hu) mice with established WM using the SGN-70 antibody blocked disease progression in 12 of 12 mice, whereas disease progressed in all 5 untreated mice. The results of these studies demonstrate a functional role for sCD27 in WM pathogenesis, along with its utility as a surrogate marker of disease and a target in the treatment of WM.
Loss of Bcl-x in Ph+ B-ALL increases cellular proliferation and does not inhibit leukemogenesis
Authors: Harb Jason G. , Chyla Brenda I. , Huettner Claudia S.
Published: January 2008

The kinase inhibitors imatinib mesylate and dasatinib are the preferred treatment for Philadelphia chromosome–positive (Ph+) leukemias, and they are highly successful in the chronic phase of chronic myeloid leukemia (CML). However, they are not efficient in Ph+ B-cell acute lymphoblastic leukemia (B-ALL). Ph+ leukemia cells are highly resistant to apoptosis, and evidence from cell lines and primary cells suggest Bcl-xL as a critical mediator of resistance to apoptosis: however, this concept has never been rigorously tested in an animal model. To clarify the role of Bcl-xL in Ph+ B-ALL, we generated 2 mouse models. In the first model, Ph+ B-ALL and loss of Bcl-xL expression are coinduced; in the second model, leukemia is induced with expression of Bcl-xL protein well above the levels found in wild-type lymphoblasts. Deletion of Bcl-xL did not inhibit leukemogenesis or affect apoptosis, but increased cellular proliferation. Consistent with this result, overexpression of Bcl-xL led to decreased cellular proliferation. These models reveal an unexpected role for Bcl-xL in cell-cycle entry and the proliferation of tumor cells.
CD32B is highly expressed on clonal plasma cells from patients with systemic light-chain amyloidosis and provides a target for monoclonal antibody–based therapy
Authors: Zhou Ping , Comenzo Raymond L. , Olshen Adam B. , Bonvini Ezio , Koenig Scott , Maslak Peter G. , Fleisher Martin , Hoffman James , Jhanwar Suresh , Young James W. , Nimer Stephen D. , Boruchov Adam M.
Published: January 2008

Despite advances in therapy, many patients with systemic light-chain amyloidosis (AL) die within 3 years from diagnosis. The humanized 2B6 monoclonal antibody (MoAb) is specific for the low-affinity IgG Fc receptor CD32B and effective in a human CD32B+ B-cell lymphoma murine xenograft model. Because MoAb therapy could improve outcomes in AL, we studied CD32B expression by clonal plasma cells obtained from 48 patients with AL. Transcript profiling showed that expression of CD32B was significantly higher than expression of all other Fc receptor family members. Reverse-transcriptase polymerase chain reaction (RT-PCR) using double-enriched CD138+ plasma cells showed uniform expression of the stable cell surface CD32B1 isoform at diagnosis and relapse, and flow cytometry showed intense CD32B cell surface staining on 99% of CD138+ plasma cells at diagnosis and relapse. These data provide a rationale for the novel therapeutic targeting of CD32B using the humanized 2B6 MoAb in patients with systemic AL-amyloidosis.
European reference equations for CO and NO lung transfer
Authors: Aguilaniu B. , Maitre J. , Glénet S. , Gegout-Petit A. , Guénard H.
Published: January 2008

The aim of the present study was to calculate reference equations for carbon monoxide and nitric oxide transfer, measured in two distinct populations.

The transfer factor of the lung for nitric oxide (TL,NO) and carbon monoxide (TL,CO) were measured in 303 people aged 18–94 yrs. Measurements were similarly made in two distant cities, using the single-breath technique. Capillary lung volume (Vc) and membrane conductance, the diffusing capacity of the membrane (Dm), for carbon monoxide (Dm,CO) were derived.

The transfer of both gases appeared to depend upon age, height, sex and localisation. The rate of decrease in both transfers increased after the age of 59 yrs.TL,NO/alveolar volume (VA) andTL,CO/VAwere only age-dependent. The meanTL,NO/TL,COwas 4.75 and the meanDm/Vcwas 6.17 min−1·kPa−1; these parameters were independent of any covariate.VcandDm,COcalculations depend upon the choice of coefficients included in the Roughton–Forster equation. Values of 1.97 forDm,NO/Dm,COratio and 12.86 min·kPa−1for 1/red cell CO conductance are recommended.

The scatter of transfer reference values in the literature, including the current study, is wide. The present results suggest that differences might be due to the populations themselves and not the methods alone.
Validation of assays for inflammatory mediators in exhaled breath condensate
Authors: Bayley D. L. , Abusriwil H. , Ahmad A. , Stockley R. A.
Published: January 2008

The use of exhaled breath condensate (EBC) as a tool for noninvasive assessment of lung inflammation is becoming commonplace. Many authors use commercial ELISA kits to measure inflammatory mediators within EBC. However, the very low concentrations of mediators within EBC are often below the commercially validated concentration range of the relevant ELISA and crucially below the linear part of the sigmoid standard curve. The present study seeks to validate a series of assays for use in EBC and to compare the results in EBC with those from matched sol phase sputum samples.

The following mediators were measured by ELISA: leukotriene (LT)B4, interleukin (IL)-8, secretory leukoprotease inhibitor and α1-antitrypsin (AAT). Myeloperoxidase was measured by chromogenic substrate assay.

Mediator concentrations reached the lower limit of quantification in only one assay (AAT) in 19.6% of subjects, while mediator concentrations reached the lower limit of detection in three assays (LTB4, IL-8 and AAT in 31, 6.5 and 61% of subjects, respectively). No significant correlations were present between any mediators in EBC and sol phase sputum.

The results of the present study indicate that care must be exercised when interpreting mediator measurements in exhaled breath condensate and that assays must be validated at concentrations relevant to those found within the biological fluid.
Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis
Authors: Maimon N. , Nopmaneejumruslers C. , Marras T. K.
Published: January 2008

The aim of the present study was to systematically compare outcomes between antibiotic classes in treating outpatient community-acquired pneumonia, with regard to antibacterials active against atypical organisms, as well as between various antibacterial classes with similar atypical coverage.

A meta-analysis was performed on randomised controlled trials of antibacterials for community-acquired pneumonia in outpatients aged ≥18 yrs. The studies were independently reviewed by two reviewers. Clinical success and mortality were compared between different oral antibiotic classes, and antibacterials with atypical coverage (macrolides and fluoroquinolones) were specifically compared with other antibacterials.

In total, 13 eligible studies involving a total of 4,314 patients were included. The quality of the studies was variable. Five studied macrolides and fluoroquinolones, three macrolides and β-lactams, three fluoroquinolones and β-lactams and two cephalosporinsversusβ-lactams/ β-lactamase inhibitors. No significant difference was detected regarding clinical success or mortality, regardless of atypical coverage or between antibacterial classes with similar atypical coverage.

It was not possible to demonstrate any advantage of specific antibacterials for mild community-acquired pneumonia in relatively healthy outpatients. The need for coverage of atypical pathogens in this setting was not apparent. In mild-to-moderate cases of outpatient-treated community-acquired pneumonia, it might be most appropriate to select antibacterials according to side-effects, patient preferences, availability and cost.
Evidence for an evolutionary conserved role ofhomothorax/Meis1/2during vertebrate retina development
Authors: Heine Peer , Dohle Eva , Bumsted-O'Brien Keely , Engelkamp Dieter , Schulte Dorothea
Published: January 2008

During eye development in D. melanogaster, the TALE-homeodomain protein Homothorax (Hth) is expressed by progenitor cells ahead of the neurogenic wave front, promotes rapid proliferation of these cells and is downregulated before cells exit the cell cycle and differentiate. Here, we present evidence that hth function is partially conserved in vertebrates. Retinal progenitor cells (RPCs) in chicks and mice express two Hth-related proteins, Meis1 and Meis2 (Mrg1), in species-specific temporal sequences. Meis1 marks RPCs throughout the period of neurogenesis in the retina, whereas Meis2 is specific for RPCs prior to the onset of retinal differentiation. Transfection of Meis-inactivating constructs impaired RPC proliferation and led to microphthalmia. RNA-interference-mediated knock-down of expression indicated that progenitor cells expressing Meis1 together with Meis2 proliferate more rapidly than cells expressing Meis1 alone. Transfection of Meis-inactivating constructs reduced the expression of cyclin D1 (Ccnd1) in the eye primordium and co-transfection of cyclin D1 partially rescued RPC proliferation. Collectively, these results suggest that (1) Meis1 and Meis2, similar to hth, maintain retinal progenitor cells in a rapidly proliferating state; (2) they control the expression of some ocular-determination genes and components of the cell cycle machinery; and (3)together with the species-specific differences in Meis1/Meis2expression, combinatorial expression of Meis family proteins might be a candidate mechanism for the differential regulation of eye growth among vertebrate species.
A Prospective Study of the Case-Notes of MRSA-Positive Patients: A Vehicle of MRSA Spread
Authors: Hamza N , Bazoua G , Al-Shajerie Y , Kubiak E , James P , Wong C
Published: January 2008

INTRODUCTION

Methicillin-resistant Staphylococcus aureus (MRSA) has received much publicity and remains a major problem for the health service. The aim of this study was to determine whether case-notes of MRSA-positive patients can act as a vehicle for MRSA transmission.

PATIENTS AND METHODS

A prospective study was performed of patients with active MRSA infection identified from a microbiology department database. Two swabs were taken from the cover of the case-notes and the page with the most recent entry for identification of MRSA using MRSA ID (Chromogenic agar medium), Pastorex and DNase tests. Positive case-notes were re-swabbed 96 h later.

RESULTS

A total of 50 MRSA-positive patients were identified from medical, surgical, high dependency and intensive care Three sets of notes were MRSA positive (3/50; 6%). None of the positive case-notes was positive on re-swabbing at 96 h.

CONCLUSIONS

Case-notes of MRSA-positive patients can act as carriers of MRSA with the potential to spread MRSA to both healthcare and non-healthcare workers without direct contact with infected patients. We recommend extending the universal precautions to the handling of case-notes belonging to MRSA-infected patients.
What do Patients Think About Minimally Invasive Total Hip Arthroplasty?
Authors: Gerrand C , McNulty G , Brewster N , Holland J , McCaskie A
Published: January 2008

INTRODUCTION

The introduction of minimally invasive techniques for hip replacement into clinical practice has been driven by the perceived benefits of smaller incisions, shorter in-patient stays and faster rehabilitation. This may be at the cost of higher complication rates. The purpose of this study was to explore the opinions and priorities of patients in relation to these techniques.

PATIENTS AND METHODS

A cross-sectional survey was performed in an elective out-patient setting.

RESULTS

Of 44 patients approached, 36 agreed to participate. From most important to least important, patients rated the following items in order: ‘rate of complications’; ‘implant survival’; ‘length of rehabilitation’; ‘time in hospital’ and ‘length of scar’. Despite this, 21 of 35 (60%) responders stated they would accept the offer of minimally invasive techniques if made.

CONCLUSIONS

Patients appear to prioritise long-term outcomes and low complication rates over the shorter scars, reduced in-patient stay and reduced rehabilitation times potentially offered by minimally invasive hip arthroplasty. Despite this, the technique remains popular among patients.
With Adequate Supervision, the Grade of the Operating Surgeon is not a Determinant of Outcome for Patients Undergoing Urgent Colorectal Surgery
Authors: Hawkins WJ , Moorthy KM , Tighe D , Yoong K , Patel RT
Published: January 2008

INTRODUCTION

It is essential that higher surgical trainees (HSTs) obtain adequate emergency operative experience without compromising patient outcome. The aim of this study was to compare the outcomes of patients operated by HSTs with those operated by consultants and to look at the effect of consultant supervision.

PATIENTS AND METHODS

A retrospective analysis of 362 patients who underwent urgent colorectal surgery was performed. The primary outcome was 30-day mortality. Secondary outcomes were intra-operative and postoperative surgery, specific and systemic complications, and delayed complications.

RESULTS

Comparison of the patients operated by a consultant (n = 190) and a HST (n = 172) as the primary surgeon revealed no significant difference between the two groups for age, gender, ASA status or indication for surgery. There was a difference in the type of procedure performed (left-sided resections: consultants 122/190, HST 91/172; P = 0.050). There was no difference between the two groups for the primary and secondary outcomes. However, HSTs operating unsupervised performed significantly fewer primary anastomoses for left-sided resections (P =0.019) and had more surgery specific complications (P = 0.028) than those supervised by a consultant.

CONCLUSIONS

HSTs can perform emergency colorectal surgery with similar outcomes to their consultants, but adequate consultant supervision is vital to achieving these results.
The Implementation of European Association of Urology Guidelines in the Management of Acute Epididymo-Orchitis
Authors: Garthwaite Mary AE , Johnson G , Lloyd S , Eardley I
Published: January 2008

INTRODUCTION

Acute epididymo-orchitis is a common and increasing problem. This retrospective study reviewed whether the European Association of Urology guidelines for the management of acute epididymo-orchitis, which form the basis of this Trust's present inter-departmental guidelines, are being effectively implemented.

PATIENTS AND METHODS

Case notes of 53 patients attending the emergency department with acute epididymo-orchitis over a 6-month period were reviewed retrospectively. The hospital results' database was used to confirm the diagnostic tests requested on patients at the time of their initial presentation.

RESULTS

Of the study cohort, 26 patients were aged ≤ 35 years and 27 patients were aged > 35 years. The results demonstrated that a sexual history was documented in only 43.4% of cases. A mid-stream urine sample was sent for routine culture in 54.7% of cases whilst urine for the Chlamydia polymerase chain reaction (PCR) test was obtained in 17% and a urethral swab performed in 5.6%. Antibiotics were prescribed in 81% of cases. Of these patients, 46.5% received ciprofloxacin alone (mean age, 52 years; range, 18–87 years), 25.5% received doxycycline alone (mean age, 30 years; range, 18–45 years) and 21% received both ciprofloxacin and doxycycline (mean age, 33 years; range 18–49 years). In 26.4% of cases, verbal advice to attend a genito-urinary medicine clinic was given, whilst a formal telephone referral was made in only one case. Formal urological follow-up was arranged for only three out of 11 patients aged > 50 years.

CONCLUSIONS

Although a joint emergency department/urology clinical protocol for the investigation and treatment of acute epididymo-orchitis already exists within the Trust, our current management conforms to this in only a minority of cases. Many different strategies can be employed in the implementation of clinical practice guidelines and all are associated with variable degrees of success. The regular movement of junior staff through each department necessitates that the distribution of management protocols and guidelines occurs at frequent intervals throughout the year and that their implementation is continuously monitored so that, if necessary, further implementation strategies can be employed.
The Management of Foreign Bodies in the Pharynx and Oesophagus Using Transnasal Flexible Laryngooesophagoscopy (TNFLO)
Authors: Bennett AMD , Sharma A , Price T , Montgomery PQ
Published: January 2008

INTRODUCTION

We describe our experience of the diagnosis and removal of foreign bodies from the pharynx and oesophagus using transnasal flexible laryngo-oesophagoscopy (TNFLO) under local analgesic. The advantages of this novel instrumentation and technique are discussed.

PATIENTS AND METHODS

Patients were examined with a Pentax 80K Series Digital Video Endoscope after local analgesia. The instrument was passed transnasally examining the oro- and hypopharynx, and then passed into the oesophagus. The presence, type and site of a foreign body could then be established. If a foreign body was detected, such as fish bone, it was extracted using flexible grabbing forceps passed down the instrument channel and delivered through the nasal or oral cavity. The object was then inspected to ensure removal in its entirety.

RESULTS

Five cases have been successfully managed using TNFLO.

CONCLUSIONS

TNFLO represents an improvement in the diagnosis and subsequent treatment of a selected group of foreign bodies as compared with established methodologies.
Age as a Predictive Factor for In-Patient Admission Following Day-Case Shoulder Arthroscopic Sub-Acromial Decompression – A District General Hospital Audit
Authors: Jain NPM , Ogonda L , Trimmings NP
Published: January 2008

INTRODUCTION

Admission following day-case surgery can be problematic for both the patient and the health service. The purpose of this study was to identify any factors predictive of admission following arthroscopic sub-acromial decompression (ASAD) of the shoulder planned as day-case procedures.

PATIENTS AND METHODS

A postal questionnaire provided data for 27 patients undergoing ASAD as a day-case procedure between June 2002 and June 2004.

RESULTS

Eighteen (66.7%) questionnaires were returned. Of respondents, 38.9% (mean age, 58 years) felt the procedure required in-patient admission due to postoperative pain. These patients had an older mean age than those (61.1%) content with a day-case procedure (mean age, 49 years; P = 0.04). Of patients 55 years and older, 67% felt that the procedure should have an in-patient admission due to postoperative pain compared to 11% of patients under the age of 55 years (P = 0.04).

CONCLUSIONS

Patient age may be useful as a predictor of the likelihood of postoperative admission for pain control following day-case shoulder surgery and should be taken into account when planning day case lists.
The Misuse of ‘No Significant Difference’ in British Orthopaedic Literature
Authors: Sexton SA , Ferguson N , Pearce C , Ricketts DM
Published: January 2008

INTRODUCTION

Many studies published in medical journals do not consider the statistical power required to detect a meaningful difference between study groups. As a result, these studies are often underpowered: the sample size may not be large enough to pick up a statistically significant difference (or other effect of interest) of a given size between the study groups. Therefore, the conclusion that there is no statistically significant difference between groups cannot be made unless a study has been shown to have sufficient power. The aim of this study was to establish the prevalence of negative studies with inadequate statistical power in British journals to which orthopaedic surgeons regularly submit.

MATERIALS AND METHODS

We assessed all papers in the last consecutive six issues prior to the start of the study (April 2005) in The Journal of Bone and Joint Surgery (British), Injury, and Annals of the Royal College of Surgeons of England. We sought published evidence that a power analysis had been performed in association with the main hypothesis of the paper.

RESULTS

There were a total of 170 papers in which a statistical comparison of two or more groups was undertaken. Of these 170 papers, 49 (28.8%) stated as their primary conclusion that there was no statistically significant difference between the groups studied. Of these 49 papers, only 3 (6.1%) had performed a power analysis demonstrating adequate sample size.

CONCLUSIONS

These results demonstrate that the majority of negative studies in the British orthopaedic literature that we have looked at have not performed the statistical analysis necessary to reach their stated conclusions. In order to remedy this, we recommend that the journals sampled include the following guidance in their instructions to authors: the statement ‘no statistically significant difference was found between study groups’ should be accompanied by the results of a power analysis.
Clostridium Difficile in Urology
Authors: Hossain M , Crook TJ , Keoghane SR
Published: January 2008

INTRODUCTION

The objective was to determine the incidence of Clostridium difficile infection in a UK urology ward from 2000 to 2005, and correlate and compare the data with other specialty wards and national figures.

PATIENTS AND METHODS

Urology patients with a positive stool culture for C. difficile between 2000 and 2005 were identified from a hospital database. The medical records of these patients were reviewed and data such as antibiotic use, urological diagnosis and elective/emergency status of the patient were recorded and analysed. The number of C. difficile cases on an elderly care ward, an acute medical ward and an acute surgical ward were also recorded for this period. Data on the number of admissions and occupied bed-days on all 4 wards were compared.

RESULTS

There were 33 cases of C. difficile on the urology ward between 2000 and 2005. The incidence of this infection varied between 10.2 and 48.4 cases per 10,000 patient episodes (mean 21.0). There was a significant difference between the number of C. difficile cases per 1000 patient days between the urology ward and the acute medical ward (P = 0.002) and the elderly care ward (P = 0.03).

CONCLUSIONS

There is no evidence to suggest that there has been an increase in the incidence of C. difficile in a UK urology ward. The rates on the urology ward were lower than the national average, and significantly lower than those rates on an acute medical ward and an elderly care ward. There is a 0.21% chance of a patient testing positive for C. difficile during their stay on a urology ward.
Change Management in a Group Dental Practice
Authors: Holt Vernon P
Published: January 2008

The drive for quality assurance in general dental practice has arisen as a response to changing standards and demands. Dentists need to develop skills in change management in this new culture of change. Groups of practitioners often encounter difficulties when managing change, yet it is essential that they lead the process. Such problems are common among groups of professionals.

A wide range of topics is presented that may, from one point of view, represent challenging or problem areas ( obstacles) for a group practice but may also, from a different point of view, provide a framework of opportunities for improvement, and facilitate the management processes within the practice and the management of change in particular ( tools).

The range of skills required to assist a professional group is such that individual dentists or advisers may not be able to achieve much on their own. The best way forward may be to interpret the problems as a professional training need and to organise training as a group. These issues will be considered under the following headings: partners and teams; introduction: the need for change management; the challenge for group practices; obstacles and tools; conclusion: the way forward—a case for training.
Removable Prostheses Revisited: Challenges for Primary Dental Care. 3. Overdentures
Authors: Preston Antony J
Published: January 2008

The overdenture is, perhaps, an under-used form of treatment in the primary dental care sector. In this, the final paper in a series of three, the reader will be reminded of the basic concepts concerning overdentures. The author will outline some of the important changes that are likely to influence overdenture provision in the United Kingdom, and describe clinical aspects of this form of treatment.
Education in surgery: competency-based training
Authors: Davis Margery H , Ponnamperuma Gominda G
Published: January 2008

Competence-based training flourished in the 1980s in several spheres of education. The approach, however, was seen as focusing on units of competence that were too narrow and technically oriented for postgraduate training in the health professions. 'Competence-based approaches,' suggests Norris, 'tend to reduce job competence to atomised, observable behaviours, which may not embody competence in the sense of generalisable or holistic capability.' Saunders argued that 'competence-based systems embody a reductionist concept of work practice' and that 'the danger of reductionism may be more acute at the higher levels of qualification and their associated training.'
Completing a higher degree thesis
Authors: Kumar B , Mirsadraee S , Oswal D
Published: January 2008

Completion of a higher degree is considered a major milestone in the career of a surgical trainee. One of the greatest obstacles to achieving completion is writing and submitting the thesis. Having been through the hoops of this process we hope to share with you some tips on how to complete your thesis, from planning to writing through to the viva examination.
August used to be a quiet month…
Authors: Ribeiro Bernard
Published: January 2008

Against the background of Modernising Medical Careers (MMC) and the Medical Training Application Service (MTAS), August came and went without quite the catastrophe the newspapers predicted. This was because we had feared for the worst and had made preparations to ensure that our patients' care would not be affected. A recent survey by doctors.net of 180 consultants, chosen to be representative of the NHS by region and medical specialty, reported concerns that patient care had been affected during August with cancelled clinics and operating lists, although almost half of all respondents did not find any evidence of such cancellations. It was noted that there was low morale among some junior doctors who had been appointed and concern that they had been pushed into roles for which they were not adequately trained.
Surgical training in Italy
Authors: Cola Bruno
Published: January 2008

There are 41 faculties of medicine in Italy, located at 36 different universities, some of which have 2 (Naples, Bari) or even 4 faculties (Rome, Milan). Each faculty has one or more schools of specialisation in general surgery, making a total of 60 schools. On average, each school accepts 6 students a year, ranging from 1 to 32. At present, there are 1,812 students registered in the various academic years of the schools of general surgery in Italy.
The Eagle has Landed
Authors: Thomas WEG , Rainsbury R
Published: January 2008

On Wednesday 17 October 2007, Phase 1 of the Eagle Project was opened by Lord Wolfson and the president. This was a milestone in the history of the College and was the first step in an ambitious but much-needed development of the fourth floor of the College, in order to meet educational requirements today and for the future. This four-phase multi-million pound project is going to be key for the delivery of the College's agenda to support education and training, and for ensuring the delivery of the Intercollegiate Surgical Curriculum Programme (ISCP).
Epistemological beliefs in child care: Implications for vocational education
Authors: Brownlee J. , Boulton‐Lewis G. , Berthelsen D.
Published: January 2008

Background. The quality of child care is of social and economic significance worldwide. The beliefs that child care workers hold about knowing and knowledge (epistemological beliefs) influence the quality of their professional work. However, attention to epistemological beliefs is rarely a focus in vocational education programmes.

Aim. The aim of this study was to investigate the nature of child care students' epistemological beliefs.

Sample(s). All first‐ and second‐year students completing a Diploma of Children's Services at three separate training institutes in a large metropolitan area in Australia were invited to participate in the study. There were 46 first‐ and 31 second‐year students (77 in total, 71 females).

Method. This study used semi‐structured interviews based on a child care scenario to enable students to articulate their epistemological beliefs. A descriptive‐interpretative approach in which interviews were analysed for patterns of meaning was used in the content analysis. The categories, based on the work of Kuhn and Weinstock (2002), included objectivism, subjectivism, and evaluativism. While this proved to be a useful framework, the authors remained open to new categories emerging. This constituted the interpretive component of the analysis. Therefore, the data were analysed using both data‐driven and theory‐led approaches to analysis, which still made it possible to take account of many viewpoints before arriving at the categories of beliefs. The categories were audited by a second researcher to establish trustworthiness and credibility.

Results. The findings of this study revealed a range of epistemological beliefs; however, a new way of thinking about evaluativistic beliefs called ‘basic evaluativism’ emerged. This view of knowledge relates to the construction of evidence‐based practice rather than knowledge as is typically the case in evaluativistic beliefs.

Conclusions. Implications for the need to address epistemological beliefs in vocational education programmes for child care workers are discussed.
The influence of context‐specific and dispositional achievement goals on children's paired collaborative interaction
Authors: Harris Amanda , Yuill Nicola , Luckin Rosemary
Published: January 2008

Background. Research has demonstrated that working collaboratively can have positive effects on children's learning. While key factors have been identified which influence the quality of these interactions, little research has addressed the influence of children's achievement goals on collaborative behaviour.

Aims. This paper investigates the influence of mastery and performance goals on the nature of children's collaborative participation while playing a problem‐solving computer game with a peer.

Sample. Forty‐eight primary schoolchildren aged 8–10 years were divided into two groups: those displaying strong personal goal preferences (dispositional group: N = 14) and those whose goal preferences were context‐dependent, displaying no consistent bias for either mastery or performance goals (context‐dependent: N = 34). Children were paired on the basis of same gender, year group, and goal orientation.

Method. Context‐dependent pairs were assigned to either a mastery or a performance condition in which they received goal‐focused instructions. Dispositional pairs received only the instructions to collaborate given to all groups. Collaborative sessions were videotaped and interactions coded.

Results. Children who were assigned mastery goals engaged in significantly more elaborated problem‐solving discussion whilst children who were assigned performance goals engaged in more executive help seeking and displayed lower levels of metacognitive control. Dispositional pairs shared some similar patterns, according to goal orientation, as context‐dependent pairs.

Conclusions. Goal‐focused instructions can be used to influence the nature and quality of children's paired interactions. Instructing children towards mastery goals appears to promote a more collaborative style of interaction.