bluuebunny/crossref_metadata_2025 huggingface dataset:
Validez de constructo de la necesidad de auto-realización en el contexto laboral
Authors: Fortea Miguel Ángel , Fuertes Francisco
Published: June 2003

El Modelo Motivacional de las Características de las Tareas de Hackman y Oldham, (1974, 1980), Kulik, Oldham y Hackman, (1987), se operacionaliza frecuentemente con el cuestionario JDS (Job Diagnostic Survey) el cual mide satisfactoriamente la mayoría de los constructos (Taber y Taylor, 1992). No obstante, trabajos como los de Stone y otros (1979), Fuertes y otros (1993), Fortea (1994) plantean dudas respecto a la interpretación de las dos escalas del cuestionario que miden la Intensidad de la Necesidad de Auto-realización (INA).

Nuestro trabajo presenta un estudio empírico de la validez de constructo de esta medida, buscando alternativas, para optimizarla en nuestro contexto cultural y abstraerla de coyunturas socioeconómicas.

Nuestros resultados muestran que la Necesidad de Auto-realización no parece ser un factor unidimensional, ni un rasgo estable. Algunas de sus subdimensiones, además de ser sensibles a influjos contextuales, no producen el efecto modulador esperado. En todo caso, los resultados más coherentes se obtienen con trabajadores de nivel cultural medio-alto. Todo ello abogaría por una revisión del formato y redacción de estas escalas.
Identidad de género en contexto: un estudio empírico
Authors: Ortiz Garbiñe , Valencia José F.
Published: June 2003

Si bien tradicionalmente la investigación en este campo se ha centrado en las diferencias generales derivadas de la clasificación de los sujetos en función de su adscripción a características femeninas-expresivas y/o masculinas-instrumentales, sólo más recientemente se ha atendido a la variación inter-situacional de las mismas. Este estudio tiene como objeto evaluar la relación entre la identidad de género y el contexto. Utilizando un diseño de 2 (contexto: trabajo-pareja) x 2 (género de pertenencia) x 2 (condición real-condición ideal), tomando esta última como una variable intrasujeto, se pidió a los sujetos muestrales que describieran su comportamiento en cada uno de los contextos y condiciones citados en función de las características del Bem Sex Role Inventory. En los análisis factoriales que se realizaron encontramos claramente diferenciadas las dimensiones de instrumentalidad y expresividad. Por otra parte, se encontró un efecto de interacción entre las variables género, contexto y condición, mostrando los hombres puntuaciones altas de instrumentalidaden el contexto de trabajo y bajas en el contexto de pareja en la dimensión real, mientras aparece el caso contrario en las mujeres. En la condición ideal, las mujeres cambian esta tendencia, dándose un patrón más similar entre los sexos. También encontramos un efecto de interacción entre contexto, y condición, mientras la interacción entre las variables género y condición no fue significativa. Finalmente, se plantean reflexiones teóricas y aplicadas en función de los resultados encontrados.
Atribución y estigmas sociales: anorexia nerviosa y abuso sexual infantil
Authors: Sansinenea Eneko , Valencia José Francisco
Published: June 2003

El objetivo de la presente comunicación es examinar la controlabilidadpercibida de un moderno estigma social: La anorexia nerviosa. Se estudiaron 8 estigmas, cuatro de origen físico y cuatro de origen mental-comportamental, entre los que se hallaba la anorexia nervosa. En un primer estudio se encontró que los estigmas de origen físico se percibían como más controlables, elicitando afectos más positivos así como una mayor intención comportamental de ayuda. En un segundo estudio, se empleó una manipulación de la información sobre la controlabilidad del estigma para analizar su rol en la percepción de los mismos. Los resultados muestran las diferencias en la percepción de la controlabilidad, el afecto y el comportamiento hacia los estigmas sociales de acuerdo con la condición en la información sobre controlabilidad.
Estudio de la identidad social urbana en un barrio de nueva creación. El caso de la Villa Olímpica de Barcelona
Authors: Valera Sergi , Guàrdia Joan , Cruells Eva , Paricio Ana , Pol Olga , Reixach Núria , Schilman Natalia , Vallés Núria
Published: June 2003

El artículo se centra en el papel de los entornosfísicos en la configuración de la identidad social en personas y grupos. Se revisa la literatura existente incidiendo especialmente en los conceptos de identidad social urbana y espacio simbólico urbano, aplicándose estos conceptos al análisis del surgimiento de identidad social entre los habitantes de la Villa Olímpica de Barcelona. Los datos de un cuestionario administrado a 295 personas del barrio permiten constatar una identificación con el barrio fundamentada en una imagen preconfigurada de la zona más que en un proceso de construcción socialpropia de una identidad de barrio. La corta historia, la composición social, el tipo de estructura y paisaje urbano y los mecanismos de apropiación espacial como precursores de identidad estructuran las conclusiones del estudio.
Potential Vorticity Diagnosis of a Simulated Hurricane. Part I: Formulation and Quasi-Balanced Flow
Authors: Wang Xingbao , Zhang Da-Lin
Published: June 2003

Because of the lack of three-dimensional (3D) high-resolution data and the existence of highly nonelliptic flows, few studies have been conducted to investigate the inner-core quasi-balanced characteristics of hurricanes. In this study, a potential vorticity (PV) inversion system is developed, which includes the nonconservative processes of friction, diabatic heating, and water loading. It requires hurricane flows to be statically and inertially stable but allows for the presence of small negative PV. To facilitate the PV inversion with the nonlinear balance (NLB) equation, hurricane flows are decomposed into an axisymmetric, gradient-balanced reference state and asymmetric perturbations. Meanwhile, the nonellipticity of the NLB equation is circumvented by multiplying a small parameter ɛ and combining it with the PV equation, which effectively reduces the influence of anticyclonic vorticity. A quasi-balanced ω equation in pseudoheight coordinates is derived, which includes the effects of friction and diabatic heating as well as differential vorticity advection and the Laplacians of thermal advection by both nondivergent and divergent winds.

This quasi-balanced PV–ω inversion system is tested with an explicit simulation of Hurricane Andrew (1992) with the finest grid size of 6 km. It is shown that (a) the PV–ω inversion system could recover almost all typical features in a hurricane, and (b) a sizeable portion of the 3D hurricane flows are quasi-balanced, such as the intense rotational winds, organized eyewall updrafts and subsidence in the eye, cyclonic inflow in the boundary layer, and upper-level anticyclonic outflow. It is found, however, that the boundary layer cyclonic inflow and upper-level anticyclonic outflow also contain significant unbalanced components. In particular, a low-level outflow jet near the top of the boundary layer is found to be highly unbalanced (and supergradient). These findings are supported by both locally calculated momentum budgets and globally inverted winds. The results indicate that this PV inversion system could be utilized as a tool to separate the unbalanced from quasi-balanced flows for studies of balanced dynamics and propagating inertial gravity waves in hurricane vortices.
The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care
Authors: Campinha-Bacote Josepha
Published: June 2003

Several models of service care delivery have emerged to meet the challenges of providing health care to our growing multiethnic world. This article will present Campinha-Bacote’s model of cultural competence in health care delivery: The Process of Cultural Competence in the Delivery of Health-care Services. This model views cultural competence as the ongoing process in which the health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client (individual, family, community). This ongoing process involves the integration of cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.
Culture Care Theory: A Major Contribution to Advance Transcultural Nursing Knowledge and Practices
Authors: Leininger Madeleine
Published: June 2003

This article is focused on the major features of the Culture Care Diversity and Universality theory as a central contributing theory to advance transcultural nursing knowledge and to use the findings in teaching, research, practice, and consultation. It remains one of the oldest, most holistic, and most comprehensive theories to generate knowledge of diverse and similar cultures worldwide. The theory has been a powerful means to discover largely unknown knowledge in nursing and the health fields. It provides a new mode to assure culturally competent, safe, and congruent transcultural nursing care. The purpose, goal, assumptive premises, ethnonursing research method, criteria, and some findings are highlighted.
The Purnell Model for Cultural Competence
Authors: Purnell Larry
Published: June 2003

This article provides an overview of the Purnell Model for Cultural Competence and the assumptions on which the model is based. The 12 domains comprising the organizing framework are briefly described along with the primary and secondary characteristics of culture, which determine variations in values, beliefs, and practices of an individual’s cultural heritage. All health care providers in any practice setting can use the model, which makes it especially desirable in today’s team-oriented health care environment. The model has been used by nurses, physicians, and physical and occupational therapists in practice, education, administration, and research in Australia, Belgium, Canada, Central America, Great Britain, Korea, South America, and Sweden. The model has also been translated into Flemish, French, Korean, and Spanish. Although the model is only 4 years old, it shows promise for becoming a major contribution to transcultural nursing and health care.
Context of Care for Jordanian Women
Authors: Miller June E. , Petro-Nustas Wasileh
Published: June 2003

The purpose of this research study was to document, describe, and analyze diverse and universal care patterns for Jordanian women. The authors used a qualitative design of observation-participation and interview data collected from 15 women in two cities and three villages in Jordan over a 4-month period. Methods used incorporated Leininger’s theory of culture care diversity and universality as well as the ethnonursing research method. Themes discovered from the data include (a) culture of caring connectedness, (b) caring for family honor: the agony and the ecstasy, (c) Islam as feminist thought, (d) political care as intertwined with tribal and religious influences, and (e) reviving Rufaida: return to community care. Findings are being used for collaborative curriculum design for new community health nursing roles focusing on women’s health.
Cultural Diversity: Students’ Perspectives
Authors: Yearwood Edilma L. , Brown Daryle L. , Karlik Eileen C.
Published: June 2003

This article is the result of the interest of several faculty members in obtaining information from students about their experiences with cultural diversity. Faculty identified a need for baseline information from the student population to assess the impact of diversity programs on campus. A small, volunteer group of 7 nursing students met for one focus group to share their experiences. The discussion supported the need for ongoing faculty-student interactions to promote cultural sensitivity and knowledge development about diversity within this university population.
Building Transcultural Knowledge through Intercollegiate Collaboration
Authors: Hilgenberg Cheryl , Schlickau Jane
Published: June 2003

Although the importance of providing culturally congruent care is widely recognized among nurses, many nurses lack the skill and knowledge necessary to successfully provide culturally competent care. Nursing programs need to better prepare students in transcultural nursing. This article describes an innovative collaborative learning activity that was implemented between two different nursing programs in different states aimed at improving students’transcultural knowledge. Students worked in small groups and used the Internet to collaborate on case studies that focused on transcultural health care issues. Responses collected by anonymous evaluations at the end of three semesters identified both strengths and weaknesses of the project. Results and suggestions for improvement are reported.
Providing Nursing Care for a Chagga Client of Tanzania
Authors: Savage Angela Ruth
Published: June 2003

A case study is used to present features of a cultural assessment of the Chagga tribe. The purpose is to identify guidelines for provision of culturally congruent nursing care. “Mrs. Chuwa” lives on the foothills of Kilimanjaro. Daily survival is a major concern; the extended family is an important source of support. Traditional beliefs have a major impact on her life; traditional practitioners are alternative resources to dispensaries and clinics. Nurses providing care for Chaggas need to be aware of how important it is to communicate with respect, to obtain an accurate treatment history, and to ensure social and spiritual care is provided. Nurses need to be proactive in issues such as improving health for the community, addressing poverty, and professional development.
A mathematical model of the contribution of endothelial progenitor cells to angiogenesis in tumors: implications for antiangiogenic therapy
Authors: Stoll Brian R. , Migliorini Cristiano , Kadambi Ananth , Munn Lance L. , Jain Rakesh K.
Published: June 2003

The traditional view of angiogenesis emphasizes proliferation and migration of vessel wall-associated endothelial cells. However, circulating endothelial progenitor cells have recently been shown to contribute to tumor angiogenesis. Here we quantify the relative contributions of endothelial and endothelial progenitor cells to angiogenesis using a mathematical model. The model predicts that during the early stages of tumor growth, endothelial progenitors have a significant impact on tumor growth and angiogenesis, mediated primarily by their localization in the tumor, not by their proliferation. The model also shows that, as the tumor grows, endothelial progenitors adhere preferentially near the tumor periphery, coincident with the location of highest vascular density, supporting their potential utility as vectors for targeted delivery of therapeutics. Model simulations of various antiangiogenic strategies show that those therapies that effectively target both endothelial and endothelial progenitor cells, either by restoring the balance between angiogenic stimulators and inhibitors or by targeting both types of cells directly, are most effective at delaying tumor growth. The combination of continuous low-dose chemotherapy and antiangiogenic therapy is predicted to have the most significant effect on therapeutic outcome. The model offers new insight into tumor angiogenesis with implications for the rational design of antiangiogenic therapy. (Blood. 2003;102:2555-2561)
Tracheobronchial deposition and clearance in small airways in asthmatic subjects
Authors: Svartengren K , Philipson K , Svartengren M , Anderson M , Camner P
Published: June 2003

Asthma tends to impair mucociliary clearance, as assessed from measurements in large airways. However, very little is known about clearance in the smallest airways of the tracheobronchial region. Deposition and clearance was estimated in 11 subjects with stable asymptomatic asthma and 10 healthy subjects after inhalation of 6 microns (aerodynamic diameter) monodisperse Teflon particles labelled with 111In. The particles were inhaled at an extremely slow flow, 0.05 L.s-1. Theoretical calculations and experimental data in healthy subjects using this slow flow support an enhanced deposition in the tracheobronchial region, in particular in the small ciliated airways (bronchioles). Lung retention was measured at 0, 24, 48 and 72 h. Clearance was significant every 24 h both for asthmatic and healthy subjects, with similar fractions of retained particles at all time-points. The fractions of tracheobronchially-deposited particles were on average 41 and 47% for asthmatic and healthy subjects, respectively, as compared to a maximal deposition of 30% using a normal inhalation flow (0.5 L.s-1). No significant correlation was found between lung retention and lung function, either in asthmatics or in healthy subjects. Our results indicate that particles clear equally well from small ciliated airways in asthmatic and healthy subjects, maybe as a consequence of an optimal asthma therapy. Furthermore, our results show that it is possible to enhance tracheobronchial deposition both in healthy and asthmatic subjects, i.e. practically independent of airway dimensions, by inhaling rather large aerosol particles extremely slowly. This may be a useful therapeutic approach.
The effect of alcohol ingestion on exhaled nitric oxide
Authors: Yates DH , Kharitonov SA , Robbins RA , Thomas PS , Barnes PJ
Published: June 2003

The concentration of nitric oxide (NO) is increased in the exhaled air of patients with inflammatory lung diseases, including asthma, possibly reflecting cytokine-mediated chronic airway inflammation. Endogenous NO is generated from L-arginine by the action of several types of NO synthase (NOS). NOS have structural similarities with cytochrome P450 reductases. Alcohol decreases exhaled NO in animals, but this has not previously been investigated in man. We studied the effect of alcohol ingestion in nine asthmatic and 12 normal subjects, measuring the peak concentration of exhaled NO using a modified chemiluminescence analyser. A significant decrement in NO occurred in asthmatic patients (mean +/- SEM before ethanol 204 +/- 58 to 158 +/- 59 parts per billion (ppb) after ethanol; p < 0.02), without significant change in the normal subjects (122 +/- 14 to 114 +/- 15 ppb). Thus, in our study, alcohol decreased exhaled nitric oxide in asthmatic subjects but not in normal individuals. This may reflect preferential action on inducible nitric oxide synthase which is expressed in asthmatic airways. An inhibitory effect of ethanol on inducible nitric oxide synthase may contribute towards the effect of alcohol in asthma.
Asthmatic bronchial hyperresponsiveness varies with ambient levels of summertime air pollution
Authors: Taggart SC , Custovic A , Francis HC , Faragher EB , Yates CJ , Higgins BG , Woodcock A
Published: June 2003

It is widely believed that the mechanisms of action of outdoor air pollutants are the same as those found in the laboratory, although few studies have attempted to clarify this issue. This study investigates the relationship of asthmatic bronchial hyperresponsiveness (BHR), a marker of airway inflammation, and pulmonary function to ambient levels of summertime air pollution. Thirty eight nonsmoking adult asthmatic subjects underwent repeated measurement of methacholine BHR, using Yan's method, at differing levels of air pollution (O3, SO2, NO2, smoke) during summer 1993. A total of 109 evaluable tests were performed: 31 subjects completed three or more challenge tests, and seven managed two. Levels of all pollutants remained within current World Health Organization (WHO) Guidelines for Health. Changes in BHR were found to correlate significantly with changes in the levels of 24 h mean SO2, NO2 and smoke; 48 h mean NO2 and smoke; 24 h lag NO2; although the effect was only small, accounting for approximately 10% of the variability in within-subject BHR between visits. Twenty four hour lag NO2 was also associated with forced vital capacity (FVC). In conclusion, in subjects with asthma, methacholine bronchial hyperresponsiveness varies with ambient levels of summertime air pollution. This suggests that changes in airway inflammation underlie the increased respiratory morbidity known to accompany pollution episodes.
Flow cytometric detection of cell-associated cytokines in alveolar macrophages
Authors: Nakamura H , Fujishima S , Soejima K , Waki Y , Nakamura M , Ishizaka A , Kanazawa M
Published: June 2003

To elucidate the cytokine-producing capacity of alveolar macrophages (AMs), we have introduced a method of flow cytometry combined with saponin treatment to detect the cell-associated cytokines. We studied bronchoalveolar lavage fluid cells from six patients with sarcoidosis (SAR) and six control (CTL) subjects. Cells were either left uncultured, or cultured with and without lipopolysaccharide (LPS), then treated with paraformaldehyde and saponin and analysed for cell-associated interleukin-1 beta (IL-1 beta) and tumour necrosis factor-alpha (TNF-alpha) by flow cytometry. Cell-associated IL-1 beta and TNF-alpha were also analysed by immunoassays. The flow cytometric cytokine values were correlated with the immunoreactive cell-associated cytokines (IL-1 beta: r = 0.45, p < 0.05; TNF-alpha: r = 0.82, p < 0.001). The histograms of cell-associated IL-1 beta yielded a single peak both in the patients and controls, whereas the histograms of cell-associated TNF-alpha exhibited two peaks in SAR patients, but just a single peak in the CTL subjects. The mean value of the cell-associated TNF-alpha in LPS+ AMs was higher in the SAR patients than in the CTL subjects (p < 0.001). In conclusion, the flow cytometric method can be applied to the semiquantitative detection of cell-associated cytokines in alveolar macrophages at the single cell level.
Response to high frequency jet ventilation may predict the need for extracorporeal membrane oxygenation
Authors: Stewart DL , Dela Cruz TV , Duncan SD , Cook LN
Published: June 2003

The aim of this study was to determine predictors of response whilst using high frequency jet ventilation (HFJV) for infants in intractable respiratory failure, in order to avoid the utilization of extracorporeal membrane oxygenation (ECMO). We reviewed patient demographics, ventilator parameters, blood gas values, length of oxygen therapy and use of surfactant and outcome, in infants given a 4 h trial of HFJV as the minimum to eliminate those infants where HFJV is used as a bridge to ECMO. The study was carried out in the neonatal intensive care nursery at Kosair Children's Hospital in Louisville, Kentucky, which provides high frequency ventilation and ECMO. Thirty infants who were eligible for ECMO and who met the study criteria were divided into two groups based upon response to HFJV. Twenty two infants responded to HFJV and eight nonresponders required ECMO after a trial of HFJV. Infants responding during HFJV demonstrated a significant decrease in oxygenation index without an escalation of mean airway pressure within 4 h after the initiation of HFJV. These infants had lower birth weights and an increased incidence of respiratory distress syndrome. No statistical differences were found in length of ventilation, days of oxygen therapy or duration of HFJV between the groups. Infants in intractable respiratory failure, who are eligible for extracorporeal membrane oxygenation, should receive a trial of high frequency jet ventilation, especially if the cause is respiratory distress syndrome unresponsive to surfactant therapy. During high frequency jet ventilation, the oxygenation index and mean airway pressure should be monitored serially, since they may predict the need for extracorporeal membrane oxygenation.
Peripheral chemoresponses of infants measured by a minimally invasive method utilizing two-breath alternations in Fl,02
Authors: Thomas DA , Poole K , McArdle EK , Beardsmore CS , Goodenough PC , Thompson J , Simpson H
Published: June 2003

The aim of this study was to develop a minimally invasive and reliable method for measuring peripheral chemoresponsiveness to oxygen in infants, and to establish baseline data from normal infants at 12 weeks of age. Two-breath alternations in fractional inspired oxygen (FI,O2), switching between 0.42 to 0.00 were given for 2 min periods via a face mask (held close to the face but without contact) to 18 healthy infants during quiet sleep. End-tidal oxygen concentrations alternated between 21 and 11%. Instantaneous minute ventilation (V'E) and its components tidal volume (VT), respiratory frequency (fR) inspiratory and expiratory times (tI and tE), inspiratory flow (VT/tT), and inspiratory duty cycle (tI/ttot) were measured by respiratory inductance plethysmography. Two-breath alternations in each of the ventilatory components were matched with the corresponding alternating end-tidal oxygen record and compared with contiguous pre- and post-test data obtained in control periods of air breathing. Alternations in all ventilatory components except fR changed significantly during FI,O2 alternations; VT 26%, tE-8%, VT/tI 18%, tI/ttot 11% and V'E 28% of baseline values. Within and between infant variances are reported for the individual components of ventilation. Differences among infants were best detected by alternations in V'E; within infant variance 76, between infant variance 171. We conclude that the test described is a safe, reliable and relatively easily applied method of measuring peripheral chemoresponsiveness, which is suitable for clinical application in infancy.
Transfer factor (diffusing capacity) standardized for alveolar volume: validation, reference values and applications of a new linear model to replace KCO (TL/VA)
Authors: Chinn DJ , Cotes JE , Flowers R , Marks AM , Reed JW
Published: June 2003

Transfer factor (TL) varies with alveolar volume (VA), but not in the manner implied by the carbon monoxide transfer coefficient (KCO (TL/VA)). This paper considers two other simple models (one linear and one exponential) which might standardize TL for VA, and asks the questions: 1) Is either model valid? 2) What are appropriate reference values? and 3) Will the model be useful? The relationship of TL to VA within subjects at different depths of inspiration, and between subjects having lungs of different sizes, were measured and compared. The subjects were asymptomatic, nonsmoking, Caucasian adults, including 31 males assessed in the laboratory and 503 male and female participants in population studies. The linear partial regression coefficients of TL on VA (L corrected for body temperature, atmospheric pressure and water saturation (BTPS)) standardized for height (H) in metres, were similar within- and between-subjects; the coefficients applied over a wide range of values for VA. This was not the case for the exponential model. The resulting reference equations in SI units for males and females were: TL = 11.52 H + 2.72 VA.H-2 - 0.051 Age -12.35. RSD 1.17; and TL = 4.87 H + 2.29 VA.H-2 - 0.019 Age -3.03. RSD 0.92, respectively. The residual standard deviations (RSD) about the new relationships were less than in other series. The new linear model could account for much of the variation between different published reference values for TL; it could be useful clinically, in circumstances when VA deviates from the norm. The model does not explain differences in TL associated with gender. Inclusion of VA.H-2 as a covariate in the reference equation for transfer factor, in addition to age and height, improves the accuracy of prediction of normal transfer factor compared with current reference values; its use suggests that some of the differences between published values is due to the volume term. The equations can be used clinically, and eliminate the need for carbon monoxide transfer coefficient.
Feather wreath lung: chasing a dead bird
Authors: Meyer FJ , Bauer PC , Costabel U
Published: June 2003

We report the case of a 50 year old clerk with chronic extrinsic allergic alveolitis due to a wreath of feathers from his dead budgerigar hanging in his living-room. Diagnosis was confirmed by serum precipitins, bronchoalveolar lavage and open lung biopsy. It is important to recognize unusual sources of exposure in this disease.
Land administration and GIS: the case of Ghana
Authors: Karikari Isaac , Stillwell John , Carver Steve
Published: June 2003

In June 1999, the government of Ghana launched a new National Land Policy document that sought to address some fundamental problems associated with land administration and management in the country. One proposed solution was the adoption of computer-aided information systems in the ‘lands sector’. In 2001, the government made proposals to prepare and implement a Land Administration Programme to provide a better platform for evolving an effective and efficient land administration that would translate, within a holistic environment, the National Land Policy into action. The proposed project is consistent with the World Bank’s Country Assistance Strategy of March 2000 for Ghana. As expected, an up-to-date land information system that supports good management of land records is to be constructed. These developments provide the context for this paper, which examines some key characteristics of Ghana’s lands sector, explains why geographic information systems are needed and suggests how they might be introduced.
Adaptation to climate change in the developing world
Authors: Adger W. Neil , Huq Saleemul , Brown Katrina , Conway Declan , Hulme Mike
Published: June 2003

The world’s climate is changing and will continue to change into the coming century at rates projected to be unprecedented in recent human history. The risks associated with these changes are real but highly uncertain. Societal vulnerability to the risks associated with climate change may exacerbate ongoing social and economic challenges, particularly for those parts of societies dependent on resources that are sensitive to changes in climate. Risks are apparent in agriculture, fisheries and many other components that constitute the livelihood of rural populations in developing countries. In this paper we explore the nature of risk and vulnerability in the context of climate change and review the evidence on present-day adaptation in developing countries and on coordinated international action on future adaptation. We argue that all societies are fundamentally adaptive and there are many situations in the past where societies have adapted to changes in climate and to similar risks. But some sectors are more sensitive and some groups in society more vulnerable to the risks posed by climate change than others. Yet all societies need to enhance their adaptive capacity to face both present and future climate change outside their experienced coping range. The challenges of climate change for development are in the present. Observed climate change, present-day climate variability and future expectations of change are changing the course of development strategies - development agencies and governments are now planning for this adaptation challenge. The primary challenge, therefore, posed at both the scale of local natural resource management and at the scale of international agreements and actions, is to promote adaptive capacity in the context of competing sustainable development objectives.
Repetitive transcranial magnetic stimulation for the treatment of depression
Authors: Martin José Luis R. , Barbanoj Manuel J. , Schlaepfer Thomas E. , Thompson Elinor , Pérez Víctor , Kulisevsky Jaime
Published: June 2003

Background

Repetitive transcranial magnetic stimulation (rTMS) may be useful in the treatment of depression but results from trials have been inconclusive to date.

Aims

To assess the efficacy of rTMS in treating depression.

Method

We conducted a systematic review of randomised controlled trials that compared rTMS with sham in patients with depression. We assessed the quality of design of all studies and conducted a metaanalysis of data from trials with similar rTMS delivery.

Results

We included a total of 14 trials. The quality of the included studies was low. Pooled analysis using the Hamilton Rating Scale for Depression showed an effect in favour of rTMS compared with sham after 2 weeks of treatment (standardised mean difference=–0.35; 95% CI –0.66 to –0.04), but this was not significant at the 2-week follow-up (standardised mean difference= — 0.33; 95% CI —0.84 to 0.17).

Conclusions

Current trials are of low quality and provide insufficient evidence to support the use of rTMS in the treatment of depression.
The Aberfan disaster: 33-year follow-up of survivors
Authors: Morgan Louise , Scourfield Jane , Williams David , Jasper Anne , Lewis Glyn
Published: June 2003

Background

Experiencing life-threatening events often contributes to the onset of such psychiatric conditions as post-traumatic stress disorder (PTSD). Children can develop PTSD; however, there is controversy over whether PTSD symptoms decrease or persist over time.

Aims

To examine the long-term effects of surviving the 1966 Aberfan disaster in childhood.

Method

Survivors (n=41) were compared with controls (n=72) matched for age and background. All were interviewed using the Composite International Diagnostic Interview, measures of current health and social satisfaction, and the General Health Questionnaire. The survivor group also completed the Impact of Event Scale to assess current levels of PTSD.

Results

Nineteen (46%; 95%CI 31–61) survivors had had PTSD at some point since the disaster, compared with 12 (20%; 95% CI 10–30) controls (OR=3.38 (95% CI 1.40–8.47)). Of the survivors, 12 (29%; 95% CI 15–43) met diagnostic criteria for current PTSD. Survivors were not at a significantly increased risk of anxiety, depression or substance misuse.

Conclusions

Trauma in childhood can lead to PTSD, and PTSD symptoms can persist for as long as 33 years into adult life. Rates of other psychopathological disorders are not necessarily raised after life-threatening childhood trauma.
Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation
Authors: Hammersley Paul , Dias Anton , Todd Gillian , Bowen-Jones Kim , Reilly Bernadette , Bentall Richard P.
Published: June 2003

Background

Strong evidence exists for an association between childhood trauma, particularly childhood sexual abuse, and hallucinations in schizophrenia. Hallucinations are also well-documented symptoms in people with bipolar affective disorder.

Aims

To investigate the relationship between childhood sexual abuse and other childhood traumas and hallucinations in people with bipolar affective disorder.

Method

A sample of 96 participants was drawn from the Medical Research Council multi-centre trial of cognitive–behavioural therapy for bipolar affective disorder. The trial therapists recorded spontaneous reports of childhood sexual abuse made during the course of therapy. Symptom data were collected by trained research assistants masked to the hypothesis.

Results

A significant association was found between those reporting general trauma (n=38) and auditory hallucinations. A highly significant association was found between those reporting childhood sexual abuse (n=15) and auditory hallucinations.

Conclusions

The relationship between childhood sexual abuse and hallucinations in bipolar disorder warrants further investigation.
Extended matching items (EMIs): solving the conundrum
Authors: George Sanju
Published: June 2003

The membership examination of the Royal College of Psychiatrists is an important hurdle in the pursuit of psychiatry as a career. These examinations (MRCPsych Parts I and II), if not exactly popular with trainees, are an imperative and unavoidable part of training.
Mass Spectrometric Behaviour of Carboxylated Polyethylene Glycols and Carboxylated Octylphenol Ethoxylates
Authors: Frańska Magdalena , Zgoła Agnieszka , Rychłowska Joanna , Szymański Andrzej , Łukaszewski Zenon , Frański Rafał
Published: June 2003

The mass spectrometric behaviour of mono- and di-carboxylated polyethylene glycols (PEGCs and CPEGCs) and carboxylated octylphenol ethoxylates (OPECs) is discussed. The tendency for ionisation (deprotonation, protonation and cationisation by alkali–metal cations) of carboxylated PEGs was compared with that of non-carboxylated analogues by using both secondary-ion mass spectrometry (SIMS) and electrospray ionisation (ESI). The fragmentation of the PEGCs and CPEGCs is discussed and also compared with their neutral analogues, PEGs. B/E linked-scan mass spectra were recorded, using secondary-ion mass spectrometry as a method for ion generation, for deprotonated and protonated molecules as well as for molecules cationised by alkali–metal cations. The fragmentation behaviour of PEGs is found to be different from that of CPEGCs, The presence of carboxyl groups may be confirmed not only by the determination of molecular weights of the ethoxylates studied, but also on the basis of the fragment ions formed. The metastable decomposition of the [OPEC-H]− ions proceeds through the cleavage of the bond between the octylphenol moiety and the ethoxylene chain and leads to the octylphenoxyl anions. It permits determination of the mass of the hydrophobic moiety of the studied carboxylated alkylphenol ethoxylate. ESI mass spectra recorded in the negative-ion mode were found to be more suitable than SI mass spectra for the determination of the average molecular weight of carboxylated ethoxylates.
Biotin-Enhanced Fragmentation for Direct Deoxyribo-Nucleic Acid Sequencing Using Matrix-Assisted Laser Desorption/Ionization Mass Spectrometry
Authors: Liu Z. , Isola N.R. , Allman S.L. , Chen C.H.
Published: June 2003

Fragmentation of synthetic oligonucleotides under the influence of biotin was investigated using 3-hydroxypicolinic acid (3-HPA) as a matrix-assisted laser desorption/ionization (MALDI) matrix. Addition of biotin into the sample enhanced fragmentation of the oligonucleotide between bases. However, when the biotin was tagged to the 5′-terminus of the oligonucleotide, enhancements were observed not only in desorption/ionization efficiency but also in the fragmentation of molecular ions. The fact that the protonation/deprotonation process occurs on the tagged biotin is a possible reason for the enhancement in desorption/ionization. Site-specific backbone cleavage fragmentation patterns were observed. The sequences of oligonucleotides can be obtained from their fragment ions. The direct sequencing of a 5′-biotin-tagged 25-mer is demonstrated.
What is Sluder’s neuralgia?
Authors: Ahamed S. H. , Jones N. S.
Published: June 2003

In 1908 Sluder described a symptom complex consisting of neuralgic, motor, sensory and gustatory manifestations that he attributed to the sphenopalatine ganglion. He stated that treatment directed at the ganglion successfully alleviated these symptoms. Over the last 90 years several reports have described patients as having sphenopalatine neuralgia and have directed treatment at the ganglion. The symptoms described and the criteria for patient selection in these studies has often been varied and deviated from Sluder’s description. In reports claiming cures with treatment directed at the ganglion the duration of post-treatment follow-up has been short. This article discusses Sluder’s description and attempts to analyse its features in the light of current understanding of the different mechanisms and categories of facial pain. It is proposed that the condition described by Sluder is a neurovascular headache that most closely resembles cluster headache in its aetiology and clinical manifestations. Wepropose that the term Sluder’s neuralgia should be discarded as there are serious flaws in its original description and many authors have misused the term leading to persistent confusion about it.
Comparative study of the underlay and overlay techniques of myringoplasty in large and subtotal perforations of the tympanic membrane
Authors: Singh Mangal , Rai Ashutosh , Bandyopadhyay Sarmishtha , Gupta S. C.
Published: June 2003

Myringoplasty is an established procedure. However, the quest is on to improve the results further by studying the different influencing factors, that could possibly affect the outcome. In the present randomized prospective study of one year’s duration, 60 patients having dry, large and subtotal perforations of the tympanic membrane were subjected to myringoplasty, 30 by the overlay technique and 30 by the underlay technique keeping all other influencing factors constant. The graft take-up rate was found to be the same (93.3 per cent) in both techniques but the underlay technique was judged to be better because of its technical ease, better assessment of ossicular chain integrity and mobility, less time consumption (55 minutes vs 90 minutes), earlier healing of graft (four to six weeks vs six to eight weeks), hearing gain in more patients (92.8 per cent vs 57.1 per cent) and fewer minor complications (6.6 per cent vs 33.3 per cent).
Increased antimicrobial resistance in organisms recovered from otitis media with effusion
Authors: Brook Itzhak , Yocum Paula , Shah Kiran , Feldman Bruce , Epstein Stephen
Published: June 2003

Previous studies concerning the microbiology of otitis media with effusion (OME) did not correlate the past use of antimicrobial agents with the recovered organism’s antimicrobial susceptibility. A retrospective analysis of cultures obtained from aspirates of 129 children with OME was performed. The study identified the isolated organisms and determined their susceptibility to the most recently administered antimicrobials. Bacterial growth was noted in 58 (45 per cent) patients. Aerobic organisms only were recovered in 37 aspirates (63 per cent of the culture-positive aspirates); anaerobic bacteria in seven (12 per cent); and mixedaerobic and anaerobic bacteria in 14 (24 per cent). A total of 92 bacterial isolates were recovered, accounting for 1.6 isolates per specimen (1.1 aerobes and 0.5 anaerobes). There were a total of 66 aerobic isolates, including Haemophilus influenzae non type-b (20 isolates), Streptococcus pneumoniae (17), and Staphylococcus spp. (seven). Twenty-six anaerobes were recovered, including Peptostreptococcus spp. and Prevotella spp.(eight each) and Propionibacterium acnes (four). Resistance to the antimicrobial used was found in 60 (65 per cent) isolates, recovered from 41 (71 per cent) of the patients. Of the41 patients in whom resistance was detected, 37 (90 per cent) had been treated within three months of culture and four (10 per cent) had completed treatment more than three months before thecultures were taken (p < 0.01). The highest rate of recovery of resistant organismswas following trimethoprim-sulfamethoxazole (96 per cent), amoxycillin (71 per cent), and azithromycin (56 per cent). Of the patients treated with amoxycillin, H influenzae predominated. S pneumoniae was recovered from four of the seven (57 per cent) after trimethoprim-sulfamethoxazole, four of 14 (29 per cent) following amoxycillin, and three of 11 (27 per cent) after azithromycin. The data illustrate the relationship between resistance to the antimicrobials given to children and their recovery from the middle ear of patients with OME.
Glomus tympanicum tumour: an alternative surgical technique
Authors: Rohit  , Jain Y. , Caruso A. , Russo A. , Sanna M.
Published: June 2003

Glomus tympanicum tumour is one of the commonest neoplasms of the middle ear. It is more common in females. The most common presenting symptom is pulsatile tinnitus. A retrotympanic mass is found in the middle ear in all the cases. Computed tomography (CT) scan is the investigation of choice, however in difficult cases magnetic resonance imaging (MRI) can be helpful. Surgery is regarded as the gold standard of treatment in spite of the fact that radiation therapy has also been advocated in the literature. In this series 17 cases of glomus tympanicum treated at Gruppo Otologico Piacenza – Rome (Italy) were analysed retrospectively. A simple and safe technique has been described. All the cases were female and treated by surgery. The tumour was removed completely in all the cases and the ossicular chain kept intact. Recurrence was encountered in only one case after nine years. Surgical removal of the tumour is recommended as the treatment of choice with the following advantages: complete removal, a low complication rate, a low recurrence rate, acceptable hearing level and minimum morbidity.
Relevance of plasma D-dimer measurement in patients with acute peripheral vertigo
Authors: Fattori Bruno , Ursino Francesco , Cristofani Renza , Galetta Fabio , Nacci Andrea
Published: June 2003

The aetiopathogenesis of acute unilateral peripheral vestibular dysfunction (APV), also known as vestibular neuritis, is still debated: the principal cause is viral infection with vascular factors second in importance.

Plasmatic D-dimer, considered a plasmatic index of hypercoagulation, was measured in a group of 45 APV patients and in a group of 25 patients suffering from Ménière’s disease. Measurements were taken both during the acute stage and after a four to six week period of pharmacological washout. The mean D-dimer levels were significantly higher than those measured in the controls both during the acute phase (301 SD161 vs 202 SD113 ng/mL) and after follow up (304 SD211 vs 192 SD111 ng/mL) (p = 0.008). Moreover, during the acute stage 23 of the APV patients (51.1 per cent) had plasmatic D-dimer levels above the upper normal limit (i.e.: <300 ng/mL), compared to four of those with Ménière’s disease (16 per cent).

Our results lead us to postulate an involvement of the haemostatic system in APV.
Retroauricular skin flap and primary Z-plasty for donor site closure in partial ear reconstruction
Authors: Horch Raymund E. , Schipper Joerg , Laszig Roland
Published: June 2003

Helical rim defects are noticeable and may well need reconstruction, especially in men. A method for reconstructing this type of defect together with primary donor site closure by Z-plasty is described.

To close partial helical rim defects, a retroauricular caudally based rotational skin flap is performed to cover a conchal cartilage graft from the same ear that is harvested first and sutured into place to remodel the helical rim. To primarily close the donor site defect a retroauricular Z-plasty was developed which easily allowed primary closure of the donor site.

The technique described here is straightforward, safe and reproducible. The Z-plasty approach for closing the donor site is useful, since the slight disturbance of the hairline is well hidden retroauricularly. This technique can be considered as a single-stage repair modality for the reconstruction of helical rim defects within primary donor site closure.
Fine needle aspiration
Authors: Shah Ketan A.
Published: June 2003

Fine needle aspiration test is a useful tool in the investigation of head and neck masses, be they of salivary gland, lymphoid, thyroid or other (branchial cyst) origin. Some practical aspects of this procedure are presented.
Modified endoscopic optic nerve decompression in idiopathic intracranial hypertension
Authors: Gupta Ashok K. , Ganth M. G. Rajini , Gupta Amod
Published: June 2003

A case of idiopathic intracranial hypertension (IIH) with visual field loss was decompressed in the intracanalicular segment of the optic nerve transnasally under endoscopic control. Visual functions improved after surgery.