bluuebunny/crossref_metadata_2025 huggingface dataset:
National Validation of the NACNS Clinical Nurse Specialist Core Competencies
Authors: Baldwin Kathleen M. , Clark Angela P. , Fulton Janet , Mayo Ann
Published: June 2009

Purpose: To validate the 75 core National Association of Clinical Nurse Specialists' (NACNS) clinical nurse specialist (CNS) competencies among practicing CNSs. Specific aims were to (a) determine the extent to which 75 core CNS competencies were used in current CNS practice, (b) determine the importance of those competencies to practicing CNSs, and (c) identify gaps between CNS core competencies and role expectations in current practice.

Design: A survey design was used with both paper‐and‐pencil and online instruments. The survey included 150 items and three open‐ended questions.

Methods: A convenience sampling method was used, which targeted practicing CNSs.

Findings: Respondents (N=505) were practicing CNSs who entered the field as RNs between 1956 and 2006. The survey had a high degree of internal consistency reliability (0.967%) between the subscales. The 75 NACNS core competencies were found to be useful and important for CNSs. A few gaps were identified between CNS core competencies and CNS role expectations in current practice.

Conclusions: No one method for validating competencies will be satisfactory for all situations; however, the processes and methods used in this study were well suited to accomplish the goal of validating CNS core competencies. The process described here may be instructive to leaders of other national and international professional organizations interested in developing and evaluating competencies. Core competencies are useful and important to currently practicing CNSs.

Clinical Relevance: The CNS role is growing internationally. Core CNS competencies can be a framework for CNS role development, education, and practice. As described here, a competency validation survey is one way to assure that CNSs are meeting healthcare needs.
Trust, Mistrust, Racial Identity and Patient Satisfaction in Urban African American Primary Care Patients of Nurse Practitioners
Authors: Benkert Ramona , Hollie Barbara , Nordstrom Cheryl K. , Wickson Bethany , Bins‐Emerick Lisa
Published: June 2009

Purpose: To analyze relationships between cultural mistrust, medical mistrust, and racial identity and to predict patient satisfaction among African American adults who are cared for by primary‐care nurse practitioners using Cox's Interaction Model of Client Health Behaviors.

Design: A descriptive‐correlational study was conducted with a convenience sample of 100 community‐dwelling adults.

Methods: Participants completed the Cultural Mistrust Inventory; Group Based Medical Mistrust Scale; Black Racial Identity Attitude Scale; Trust in Physician Scale; Michigan Academic Consortium Patient Satisfaction Questionnaire; and provided demographic and primary care data.

Analysis: Correlations and stepwise multiple regression techniques were used to examine the study aims and correlational links between the theoretical constructs of client singularity, client‐professional interaction, and outcome.

Findings and Conclusions: Cox's model indicated a complex view of African American patients’ perspectives on nurse practitioners. Participants simultaneously held moderate cultural mistrust of European American providers and mistrust of the health care system, and high levels of trust and satisfaction with their nurse practitioners. One racial identity schema (conformity) and trust of nurse‐practitioner (NP) providers explained 41% of variance in satisfaction.

Clinical Relevance: An African American patient's own attitudes about racial identity and the client‐professional relationship have a significant effect on satisfaction with primary care.
Fabrication of Na0.5Bi0.5TiO3–BaTiO3‐Textured Ceramics Templated by Plate‐Like Na0.5Bi0.5TiO3 Particles
Authors: Zhao Wei , Ya Jing , Xin Ying , E Lie , Zhao Dan , Zhou Heping
Published: June 2009

Textured 0.94Na0.5Bi0.5TiO3–0.06BaTiO3 (NBT–6BT) ceramics were fabricated by templated grain growth (TGG) using anisotropically shaped Na0.5Bi0.5TiO3 (NBT) templates. Platelet NBT was synthesized by the topochemical technique, using precursor Na0.5Bi4.5Ti4O15 (NBIT). The NBT particles have an average length of 10–15 μm and a thickness of 1 μm, which are suitable templates for obtaining textured ceramics (especially NBT‐based ceramics) by the TGG process. This study revealed that the NBT templates are effective in inducing grain orientation in NBT–6BT ceramics. For NBT–6BT ceramics textured with 5 vol% NBT templates, a Lotgering factor of 0.87 and a d33 of 299 pC/N are given.
Ex‐Situ Stress Measurements in Polycrystalline Ceramics Using Photo‐Stimulated Luminescence Spectroscopy and High‐Energy X‐Rays
Authors: Raghavan Seetha , Imbrie Peter K.
Published: June 2009

The photo‐stimulated luminescence spectroscopy (PSLS) technique provides the means to establish stress dependencies of the well‐known R‐line peak positions in polycrystalline alumina. The uniaxial compression tests presented in this paper, which determine the coefficients describing this piezospectroscopic (PS) behavior, tackle two previously unexplored areas. Firstly, the vibronic band peaks in the emission spectrum are introduced here, and the PS coefficients of several peaks within these bands are established. These results set the foundation for the exploitation of vibronic band peakshifts, along with the R‐lines, in order to provide the non‐symmetric components of the stress tensor and therefore the measurement of the complete stress state in polycrystalline alumina. Secondly, high‐energy X‐rays serve as an ex‐situ stress measurement method upon which the optical fluorescence shifts are based, thereby advancing the accuracy of PS coefficient determination in a unique approach. The results of PSLS and synchrotron X‐ray experiments are presented here and used in conjunction to reveal new information on the PS behavior of polycrystalline alumina.
Low‐Temperature Sintering Barium Titanate‐Based X8R Ceramics with Nd2O3Dopant and ZnO–B2O3Flux Agent
Authors: Sun Changku , Wang Xiaohui , Ma Chao , Li Longtu
Published: June 2009

To demonstrate that barium titanate‐based ceramics could be sintered at a low temperature thus reducing the cost of capacitor production, systematic investigation has been made on the structure and dielectric properties of barium titanate‐based X8R ceramics, doped with various Nd2O3content and different ZnO–B2O3solution as the sintering aids. The dielectric ceramic powder with good permittivity and low dielectric loss were obtained at a sintering temperature of 900°C, meeting X8R specifications. Transmission electron microscopy and EDS analysis shows a high concentration of Nd element in the boundary regions, which verifies the beneficial role of Nd in facilitating the formation of core‐shell structure. The results also suggest that the developed BaTiO3‐based ceramics may serve as a promising candidate for fabricating cheap multilayer capacitors with pure Ag as inner electrode.
XRD and Raman Studies on the Ordering/Disordering of Ba(Mg1/3Ta2/3)O3
Authors: Wang Chun‐Hai , Jing Xi‐Ping , Wang Lu , Lu Jing
Published: June 2009

The samples of complex perovskite Ba(Mg1/3Ta2/3)O3 (BMT) were synthesized at various sintering temperatures and the X‐ray diffraction (XRD) patterns and Raman spectra of the samples were collected. Both the structure refinements using the XRD data and the Raman spectra show that the samples sintered above 1500°C with high pellet relative density (>95%) take almost‐perfect B‐site‐ordered structure; while the samples sintered below 1400°C with low pellet relative density (<70%) take the more disordered structure at B‐sites. The vibrational modes of 1:2 ordered BMT

were obtained and illustrated by using first‐principle calculations. With the assistance of the calculation results, Raman peaks of BMT were assigned as A1g(1) (107 cm−1), A1g(2) (212 cm−1), A1g(3) (433 cm−1), A1g(4) (798 cm−1), and Eg(1) (104 cm−1), Eg(2) (160 cm−1), Eg(3) (264 cm−1), Eg(4) (386 cm−1), Eg(5) (576 cm−1). The highly ordered BMT sample at B‐site shows longer phonon lifetime and weaker coupling among phonons than the disordered BMT, which probably are the intrinsic reasons for the highly ordered BMT sample to have the low dielectric loss.
Controlled Crystallization of Calcite Under Surface Electric Field Due to Polarized Hydroxyapatite Ceramics
Authors: Wada Norio , Tanaka Yumi , Nakamura Miho , Kanamura Kiyoshi , Yamashita Kimihiro
Published: June 2009

We examined effects of surface electric fields for the crystallization of calcite on polarized hydroxyapatite ceramics with and without polyacrylic acid (PAA) as soluble additive. Both on negatively and positively charged surfaces without PAA, the only precipitates were rhombohedra calcite crystals with the face of the {10.4} plane favorably oriented parallel to the surfaces. This oriented growth was explained by the nucleation theory in the presence of an external electric field. However, the addition of PAA drastically changed the situation of the calcite crystals, i.e., the crystallites were the hemispheric aggregates of calcite needles with a facetted rhombohedral {10.4} end face and flat island‐shaped aggregates of ones with a rough (00.1) end face having a triangular shape. The calcite needles grew along the crystallographic [00.1] axis. This oriented growth was explained by epitaxy on the PAA–Ca2+ complexes adsorbing on the surfaces. The morphology of the PAA–Ca2+ complex assemblies adsorbing on the surfaces before the calcite nucleation was an important factor to control the structure of calcite aggregates formed following. This morphology was controlled by properties of the surface electric field and the spatial distribution of the negatively and positively charged sites in the PAA–Ca2+ complexes.
Architectural Control of Freeze‐Cast Ceramics Through Additives and Templating
Authors: Munch Etienne , Saiz Eduardo , Tomsia Antoni P. , Deville Sylvain
Published: June 2009

The freezing of concentrated colloidal suspensions is a complex physical process involving a large number of parameters. These parameters provide unique tools to manipulate the architecture of freeze‐cast materials at multiple length scales in a single processing step. However, we are still far from developing predictive models to describe the growth of ice crystals in concentrated particle slurries. In order to exert reliable control over the microstructural formation of freeze‐cast materials, it is necessary to reach a deeper understanding of the basic relationships between the experimental conditions and the microstructure of the growing solid. In this work, we explore the role of several processing variables (e.g., composition of the suspension, freezing rate, and patterning of the freezing surface) that could affect the formulation strategies for the architectural manipulation of freeze‐cast materials. We also demonstrate, using freeze‐cast lamellar structures, that reducing the lamellar thickness by less than half increases the compressive strength by more than one order of magnitude.
Chemical Synthesis of a Blue‐Emitting NaSr1−X PO4:EuX Phosphor Powder
Authors: Tung Yi‐Ling , Jean Jau‐Ho
Published: June 2009

Pure, crystalline, blue‐emitting NaSr1−XPO4:EuX with X=0–0.06 phosphor powder is formed by the thermal decomposition of a metal–nitrate–citrate–polyethylene glycol complex at 1300°C in a reducing atmosphere. The resulting phosphor powder emits blue luminescence with a peak intensity at 428 nm under ultraviolet excitation at 374 nm. Compared with the powder synthesized by a conventional solid‐state reaction, the chemically prepared powder exhibits a higher emission intensity and requires a lower Eu content to reach the maximum intensity.
Fabrication of Thin‐Film SrCe0.9Eu0.1O3−δ Hydrogen Separation Membranes on Ni–SrCeO3 Porous Tubular Supports
Authors: Yoon Heesung , Song Sun‐Ju , Oh Takkeun , Li Jianlin , Duncan Keith L. , Wachsman Eric D.
Published: June 2009

SrCe0.9Eu0.1O3−δ thin‐film (∼30 μm) tubular hydrogen separation membranes were developed in order to obtain high hydrogen fluxes. Fifteen centimeters long, one end closed, NiO–SrCeO3 tubular supports were fabricated by tape casting, followed by rolling the green tape on a circular rod. SrCe0.9Eu0.1O3−δ powders were prepared by the citrate process and coated on partially sintered NiO–SrCeO3 tubular supports. Leakage‐free hydrogen membrane cells were obtained by adjusting the presintering and final sintering temperatures to reduce the difference of linear shrinkage rates between SrCe0.9Eu0.1O3−δ thin films and NiO–SrCeO3 supports. A hydrogen flux of 2.2 cm3/min was obtained for the SrCe0.9Eu0.1O3−δ on Ni–SrCeO3 tubular hydrogen separation membranes at 900°C using 25% H2 balanced with Ar and 3% H2O as the feed gas and He as the sweep gas. Thus, a 40% single pass yield of pure H2 was achieved with this membrane.
High‐Energy Density Capacitors Utilizing 0.7 BaTiO3–0.3 BiScO3 Ceramics
Authors: Ogihara Hideki , Randall Clive A. , Trolier‐McKinstry Susan
Published: June 2009

A high, temperature‐stable dielectric constant (∼1000 from 0° to 300°C) coupled with a high electrical resistivity (∼1012Ω·cm at 250°C) make 0.7 BaTiO3–0.3 BiScO3 ceramics an attractive candidate for high‐energy density capacitors operating at elevated temperatures. Single dielectric layer capacitors were prepared to confirm the feasibility of BaTiO3–BiScO3 for this application. It was found that an energy density of about 6.1 J/cm3 at a field of 73 kV/mm could be achieved at room temperature, which is superior to typical commercial X7R capacitors. Moreover, the high‐energy density values were retained to 300°C. This suggests that BaTiO3–BiScO3 ceramics have some advantages compared with conventional capacitor materials for high‐temperature energy storage, and with further improvements in microstructure and composition, could provide realistic solutions for power electronic capacitors.
Novel Mg2Zr5O12/Mg2Zr5O12–ZrO2–MgF2 Gradient Layer Coating on Magnesium Formed by Microarc Oxidation
Authors: Han Yong , Song Jingfeng
Published: June 2009

A novel Mg2Zr5O12‐based coating on magnesium was formed by microarc oxidation (MAO) in a K2ZrF6‐containing electrolyte. The structure of the coating was examined by X‐ray diffraction using the grazing angle method, scanning electron microscopy, and transmission electron microscopy. The friction and wear properties of the MAO‐coated and ‐uncoated Mg samples were evaluated in a ball‐on‐disk testing system. The corrosion resistance of the coating in a 3.5% NaCl solution was investigated by the potentiodynamic polarization test. The coating is relatively dense and composed of a Mg2Zr5O12–ZrO2–MgF2 inner layer and a nanocrystalline Mg2Zr5O12 outer layer with a maximum hardness of 1240 Hv. The friction coefficient of the coating against Si3N4 is 0.35 under a dry‐sliding condition. The corrosion resistance of the magnesium substrate is improved considerably by MAO treatment. The corrosion potential of the Mg2Zr5O12‐coated sample is −1.43 V with a current density as low as 7.06 × 10−8 A/cm2. It is expected that the coating can considerably protect magnesium from wear and corrosion.
Preparation of a Calcium Titanium Phosphate Glass–Ceramic with Improved Chemical Durability
Authors: Kasuga Toshihiro , Kimata Takafumi , Obata Akiko
Published: June 2009

A calcium titanium phosphate glass–ceramic for use as a dental material with excellent chemical durability was derived from a mother glass with a small amount of fluorine. The laser Raman spectroscopic analysis showed that 35CaO–10CaF2–30P2O5–25TiO2 glass, as the nominal composition, consists of ortho‐, pyro‐, and meta‐phosphate groups. On heating the glass at 865°C, orthophosphate crystals, such as fluorine‐containing oxyapatite (Ca10(PO4)6(O,F2)) and the Nasicon‐type phase (CaTi4(PO4)6), were preferentially precipitated; the apatite particles of several tens of nanometers in size were embedded in the CaTi4(PO4)6 phase. The pale bluish color of the glass–ceramic indicated that titanium ions were included in the residual glassy phase. When the glass–ceramic was treated with dilute hydrochloric acid, only the apatite particles at the surface were leached out, while no CaTi4(PO4)6 phase was etched; the dissolution of the glass–ceramic was effectively controlled. Almost no dissolution of ions from the glass–ceramic occurred in water. It was suggested that the behavior is a result of the microstructure of the glass–ceramic, which consists of crystalline and glassy phases with excellent chemical durability.
Improved Energy Storage Density in Barium Strontium Titanate by Addition of BaO–SiO2–B2O3Glass
Authors: Zhang Qingmeng , Wang Lei , Luo Jun , Tang Qun , Du Jun
Published: June 2009

The energy storage density of a Ba0.4Sr0.6TiO3ceramic with the addition of 5–20 vol% glass was investigated. The results show that the improvement of the energy density in glass‐added Ba0.4Sr0.6TiO3samples arises due to two factors: one is that the breakdown strength is notably improved due to the decrease of the porosity and the reduction of the grain size and pore size in glass‐added samples and the other is that the remnant polarization of glass‐added samples is decreased. The energy density of the samples containing 5 vol% glass additive was improved by a factor of 2.4 compared with that of pure Ba0.4Sr0.6TiO3.
Preparation of a Dense/Porous BiLayered Ceramic by Applying an Electric Field During Freeze Casting
Authors: Zhang Yumin , Hu Luyang , Han Jiecai
Published: June 2009

Dense/porous bilayered ceramics were fabricated by introducing an electric field into the freeze‐casting process. A unidirectional solidification was performed by placing an aqueous ceramic on refrigerating equipment, at a constant cooling rate of 6°C/min. When the bottom temperature of the slurry was reduced to 0°C, an electric field along the vertical direction was applied until the freezing process was completed. After drying and sintering of the green part, an as‐prepared ceramic with dense/porous bilayered architectures was obtained. It was shown that the thickness of the dense layer in the sample could be controlled by tuning the electric field intensity from 51 to 155 μm as the electric field increased from 15 to 90 V. On the other hand, all samples exhibited almost an identical lamellae thickness and interlayer distance in the porous region, as large as ∼14 and ∼24 μm, respectively.
Growth of Nanograins in Electrospun ZnO Nanofibers
Authors: Park Jae Young , Kim Sang Sub
Published: June 2009

ZnO nanofibers were synthesized using an electrospinning method with polyvinyl alcohol and zinc acetate as precursor materials. The effects of the processing parameters on the microstructure of the synthesized ZnO nanofibers were investigated. X‐ray diffraction, Raman spectroscopy, scanning electron microscopy, and transmission electron microscopy showed that the ZnO nanofibers were distributed uniformly over the Si substrates and had a polycrystalline nature. Individual nanofibers consisted of nanograins. Interestingly, the nanograins coalesced and grew under higher calcination temperatures and longer calcination times. The activation energy for grain‐growth was estimated to be 13.126 kJ/mol, and the dominant growth mechanism was most likely to be related to lattice diffusion in pore control mode.
Effect of Acceptor (Mg) Concentration on the Resistance Degradation Behavior in Acceptor (Mg)‐Doped BaTiO3 Bulk Ceramics: I. Impedance Analysis
Authors: Yoon Seok‐Hyun , Randall Clive A. , Hur Kang‐Heon
Published: June 2009

Degradation behavior of the electrical resistance of acceptor (Mg)‐doped BaTiO3 ceramics was contrasted against different acceptor concentrations. Coarse‐grained specimens with uniform grain sizes and different acceptor concentrations were prepared by sintering both in air and a reducing atmosphere. The specimens sintered under both atmospheres showed similar trends in the degradation behavior with a critical dependence on the acceptor concentration. The time to degradation decreased systematically with the increase of acceptor concentration. An impedance spectroscopy study was conducted on these samples at various temperatures. An equivalent circuit analysis of these data was considered, from which bulk and grain‐boundary conductivity was determined for each composition as a function of grain size. Attempts were made also to determine the ionic conductivity for the different samples as a function of temperature and doping concentration.
Investigation on the Microstructure and Dielectric Properties of BaTiO3–Nb2O5–Fe2O3 Materials Doped with La2O3
Authors: Gong‐An Yang , Yong‐Ping Pu , Jin‐Fei Wang , Xiao‐Long Chen , Yong‐Yong Zhuang
Published: June 2009

The influence of La2O3 doped on the microstructure and dielectric properties, including the phase structure, temperature dependence of permittivity, and the hysteresis loop of BaTiO3–Nb2O5–Fe2O3 (BTNF) materials has been investigated in X‐ray diffraction, SEM, and LCR analyzer, respectively. Experiments revealed that incorporation of proper content of La2O3 basically soluted in the lattice of BaTiO3 and can control the grain‐growth, reduce the dielectric loss of the BTNF materials. The development of microstructure promoted by the additives can result in the improvement of the dielectric constant. When the doping concentration of La2O3 was 3.846 wt%, the relative dielectric constant of the sample sintered at 1280°C only for 2 h could reach 4308, and improve the dielectric‐temperature characteristics markedly. As a result, a novel Y5P can be achieved in the BTNF ceramics, which is very promising for practical use in Y5P multilayer ceramic capacitors.
Hydrothermal Synthesis and Spark Plasma Sintering of (K, Na)NbO3 Lead‐Free Piezoceramics
Authors: Liu Nan , Wang Ke , Li Jing‐Feng , Liu Zonghuai
Published: June 2009

A facile hydrothermal route was adopted for synthesis of lead‐free piezoceramics (K, Na)NbO3 powders. The influences of temperature and KOH/NaOH concentration on the resultant powders were investigated. Although two similar perovskite phases appeared when K/Na ratio tended toward 1:1, the two‐phase coexistence tendency was weakened by increasing hydrothermal reaction temperature, and consequently only one phase could be obtained after spark plasma sintering. Reasonably good ferroelectric and piezoelectric properties were obtained for the samples after postannealing, whose piezoelectric constant (d33) reached 135 pC/N. The optimal remnant polarization (Pr) and mechanical quality factor (Qm) were 26.2 μC/cm2 and 164, respectively, which were both twice as much as those of the samples using powders prepared from solid‐state reaction.
Locally Er‐Doped Near‐Stoichiometric LiNbO3 Crystals Prepared by Standard Er Diffusion and Post‐VTE Treatment
Authors: Zhang De‐Long , Wang Yi‐Peng , Hua Ping‐Rang , Jia Qi‐Shen , Liu Hong‐Li , Cui Yu‐Ming , Pun Edwin Yue‐Bun
Published: June 2009

The feasibility of preparing locally Er‐doped near‐stoichiometric (NS) LiNbO3 crystals for integrated optics applications is demonstrated by a two‐step process with standard diffusion (1130°C/154 h) of Er metal followed by vapor transport equilibration (VTE) treatment under three different conditions of 1135°C/22 h, 1115°C/50 h, and 1125°C/60 h. Detailed studies on the crystalline phase, Li composition, diffused surface roughness, and emission characteristics of Er3+ ions indicate that there is an upper limit on the initial Er metal film thickness: ∼20 nm for an X‐cut crystal and ∼30 nm for a Z‐cut crystal. When the initial Er film thickness is below this limit, the post‐VTE does not induce formation of ErNbO4 precipitate and the diffused surface retains high quality with a root mean square roughness <3 nm. Depending on the VTE condition adopted, the VTE results in the increase of ([Li]+[Er])/[Nb] ratio in the diffused layer from congruent point (94.5%) to 97.4%–99.4%. Secondary ion mass spectrometry study shows that the post‐VTE does not affect the Gauss nature of the Er profile, but leads to the increase of diffusion depth by as much as 1.6 μm. In comparison with the standard Er diffusion, the post‐VTE results in the decrease of Er diffusivity by three to nine times. The higher the VTE temperature is, the lower the Er diffusivity is. In addition, the post‐VTE also results in definite reduction of OH− content in crystal, slight lengthening of lifetime and slight narrowing of linewidth of Er3+ emission at 1530 nm.
Water Vapor Adsorption and Desorption on Materials Hydrothermally Solidified from Clay Minerals
Authors: Maeda Hirotaka , Ishida Emile Hideki
Published: June 2009

Water vapor isotherms were examined and 1H‐magic‐angle spinning nuclear magnetic resonance (1H‐MAS NMR) analysis was conducted to determine the amount of water vapor adsorbed and desorbed on hydrothermally solidified materials derived from clay minerals. The amount of water vapor adsorbed and desorbed decreased with increasing mesopore volume of the materials, which disagreed with the estimation obtained using the Kelvin equation. Water vapor was physisorbed on alumina‐like sites in the materials. An increase in the binding energy between water vapor and the materials led to an improvement in the water vapor adsorption–desorption properties of materials.
Thermochemistry and Aqueous Durability of Ternary Glass Forming Ba‐Titanosilicates: Fresnoite (Ba2TiSi2O8) and Ba‐Titanite (BaTiSiO5)
Authors: Park Tae‐Jin , Davis Mark J. , Vullo Paula , Nenoff Tina M. , Krumhansl James L. , Navrotsky Alexandra
Published: June 2009

Barium titanosilicates are possible oxide forms for the immobilization of short‐lived fission products in radioactive waste. Ba2TiSi2O8 (fresnoite) and BaTiSiO5 (Ba‐titanite) samples were prepared by a solid‐state synthesis. The enthalpies of formation of Ba2TiSi2O8 crystal and glass at 25°C and of BaTiSiO5 glass were obtained from drop solution calorimetry in a molten lead borate (2PbO–B2O3) solvent at 701°C. The enthalpy of formation for fresnoite composition samples from constituent oxides was exothermic and became more exothermic with increasing crystallinity. Differential scanning calorimetry revealed that the crystallization rate of the fresnoite glasses increased with increasing devitrification. A modified Product Consistency Test‐Procedure B (PCT‐B) was used to collect solubility data on the fresnoite and titanate phases. The tests suggest that both glassy and crystalline fresnoite exhibit favorable aqueous stability and should be explored further as radioactive waste forms for long‐term storage.
Treatment of ANCA‐associated systemic small‐vessel vasculitis
Authors: JAYNE DAVID
Published: June 2009

Much has been learnt over the last 30 years to optimize the use of immunosuppressive and glucocorticoid therapies that has allowed the publication of treatment guidelines. However, major unmet needs remain in the treatment of ANCA‐associated vasculitis (AAV) and include refractory disease, only partial efficacy and toxicity of current drugs and the need for long‐term regimens. Newer therapies, including mycophenolate mofetil, leflunomide and rituximab, are providing a real opportunity for improved outcomes of AAV in the future. The development of therapy has been facilitated by international clinical research networks but delayed by the complexities of studying an uncommon, multi‐system disease.
The spectrum of vascular involvement in giant‐cell arteritis: clinical consequences of detrimental vascular remodelling at different sites
Authors: CID MARIA C. , PRIETO‐GONZÁLEZ SERGIO , ARGUIS PEDRO , ESPÍGOL‐FRIGOLÉ GEORGINA , BUTJOSA MONTSERRAT , HERNÁNDEZ‐RODRÍGUEZ JOSÉ , SEGARRA MARTA , LOZANO ESTER , GARCÍA‐MARTÍNEZ ANA
Published: June 2009

Although repeatedly reported in the literature, the extracranial involvement by giant‐cell arteritis has been considered anecdotal until recent years. The emergence of new or improved imaging techniques along with a closer follow‐up of these patients and their increase in life expectancy are beginning to underline that the clinical impact of extracranial involvement by GCA may be more relevant than previously thought. This review focuses on the extent of vascular involvement in GCA as reported by pathology and imaging studies as well as the clinical consequences of imperfect vascular remodelling in various vascular territories.
ANCA‐small vessel vasculitides: what have we (not yet) learned from animal models?
Authors: VAN DER VEEN BETTY S. , HEERINGA PETER
Published: June 2009

Anti‐neutrophil cytoplasmic autoantibodies (ANCA) with a specificity for myeloperoxidase or proteinase 3 are closely associated with small vessel vasculitides (SVV). In vitro, ANCA activate primed neutrophils to release toxic substances that destroy endothelial cells, suggesting a pathogenic role for these autoantibodies in disease development. However, to study the complex interplay between ANCA, neutrophils, and the local environment in vivo, animal models are required. Here, we will review the animal models developed for ANCA‐SVV and discuss how these models have been applied to study ANCA‐SVV pathogenesis. In addition, some directions for future research pertaining to unresolved issues relevant for the pathogenesis and immunogenesis of ANCA‐SVV are proposed.
Neutrophils and B lymphocytes in ANCA‐associated vasculitis
Authors: WITKO‐SARSAT VÉRONIQUE , DANIEL SOIZIC , NOËL LAURE‐HÉLÈNE , MOUTHON LUC
Published: June 2009

The pathogenesis of antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis (AAV) is unknown but is most consistent with a primary role for neutrophils in the acute injury. Thus, neutrophils are cardinal cells in the pathophysiological process in AAV because they are both effector cells responsible for endothelial damage and targets of autoimmunity. In addition, because of their capacity to synthesize a wide variety of cytokines and chemokines, neutrophils can be considered as important modulators of the inflammatory and potentially of the autoimmune process. ANCA directed against two main autoantigens, namely proteinase 3 and myeloperoxidase, are likely to play a modulatory role in the inflammatory process. Interestingly, neutrophils are an important source of lymphocyte stimulator (BLy), a cytokine that plays a fundamental role in B‐cell physiology, including differentiation, proliferation and immunoglobulin production. The issue of B‐cell activation and/or dysregulation in vasculitis will be discussed.
Granuloma formation in ANCA‐associated vasculitides
Authors: LAMPRECHT PETER , WIECZOREK STEFAN , EPPLEN JÖRG T. , AMBROSCH PETRA , KALLENBERG CEES G. M.
Published: June 2009

Granuloma formation is a key pathologic finding in two of the anti‐neutrophil cytoplasmic autoantibody (ANCA)‐associated vasculitides: Wegener's granulomatosis (WG) and Churg–Strauss syndrome (CSS). So far, no animal models have been established convincingly reproducing both vasculitic and granulomatous features typical of WG and CSS. In biopsies, granulomatous lesions are found both at distant extravascular sites and in the vicinity of inflamed vessels, e.g. in the lung. Intriguingly, WG‐granulomata appear to display features of tertiary lymphoid tissue. Cartilaginous and osseous destruction is caused by granulomatous inflammation invading adjacent tissues. Rhinosinusitis is regularly encountered in WG and CSS. Septal perforation, saddle nose deformity, middle and inner ear symptoms, and granulomatous invasion of the palate, orbita, meninges, or the pituitary gland may complicate WG. Both common (e.g. FCGR3B copy number) and distinct (e.g. HLA‐DP, IL‐10.2) genetic factors have been identified in AAV potentially favouring inflammation and autoimmunity. The HLA‐DPB1/RING1/RXRB region constitutes a quantitative trait locus for ANCA‐positive WG with the strongest association to be reported up to now. A profound alteration of the T‐cell response including Th1 and Th17 responses, anomalously NK‐receptor‐expressing ‘NK‐like’ T cells, and dysfunctional regulatory T cells could facilitate and sustain granuloma formation and autoimmunity.
Vascular biology and vasculitis
Authors: SAVAGE CAROLINE O. S.
Published: June 2009

The inflammation of blood vessel walls that is associated with autoimmune disorders characterized by anti‐neutrophil cytoplasm antibodies (ANCA) represents dysregulation of normal physiological processes, whereby neutrophils recruited to the vessel wall by cytokine‐activated endothelium show destructive behaviours that initiate damage with endothelial apoptosis and denudation. Anti‐endothelial cell antibodies may also help to focus and escalate injury. Understanding the molecular mechanisms underlying the interplay between ANCA, aberrant neutrophil behaviour and vascular damage will allow development of more focused therapies.
Epitope‐specific anti‐neutrophil cytoplasmic antibodies: Do they matter? Can they be detected?
Authors: SPECKS ULRICH
Published: June 2009

Proteinase 3 (PR3)‐anti‐neutrophil cytoplasmic antibodies (ANCA) and myeloperoxidase (MPO)‐ANCA are suggested to play a pathogenic role as they are closely related to the small‐vessel vasculitis syndromes, Wegener's granulomatosis and microscopic polyangiitis. A large body of in vitro and animal experiments supports this concept. The mechanisms of action involve a direct interaction between ANCA and its antigen. The epitope specificity of ANCA may therefore influence the functional effects of ANCA and/or may reflect the mechanisms behind different disease manifestations or disease courses.
Linezolid‐induced purpuric medication reaction
Authors: Kim Flora S. , Kelley Walter , Resh Brooke , Goldenberg Gary
Published: June 2009

A 64‐year‐old Caucasian male was seen in consultation for a petechial eruption that began 9 days after he started linezolid therapy for a retroperitoneal abscess. Skin findings included confluent non‐blanching petechiae and purpura covering his entire body, without any active bleeding. A punch biopsy from the left lateral arm was performed and showed a perivascular inflammatory infiltrate composed of lymphocytes, histiocytes and rare eosinophils, and extravasated erythrocytes. Changes of leukocytoclastic vasculitis were not noted. Linezolid was promptly discontinued. To our knowledge, this is the first report of a biopsy‐proven purpuric medication reaction secondary to linezolid therapy.
Dermatofibroma with intracytoplasmic eosinophilic globules: an unusual phenomenon
Authors: Spaun Eva , Zelger Bernhard
Published: June 2009

Dermatofibroma (DF) is a very common lesion of the skin and presents in many guises that might cause problems in differential diagnosis. We present a new curiosity: a DF with intracytoplasmic eosinophilic globules.
Porokeratoma (porokeratotic acanthoma): immunohistological study of a new case
Authors: Kanitakis Jean , Rival‐Tringali Anne Laure , Chouvet Brigitte , Vignot Emmanuelle , Claudy Alain , Faure Michel
Published: June 2009

Porokeratoma (porokeratotic acanthoma) is a very recently described tumor‐like acanthoma with features of porokeratosis (cornoid lamellation). We report herein a new case of this poorly known lesion that was studied immunohistochemically and discuss briefly its relationship with porokeratosis.
Combined epidermal‐connective tissue nevus of proteoglycan (a type of mucinous nevus): a case report and literature review
Authors: Chi Ching‐Chi , Wang Shu‐Hui , Lin Paul Y.
Published: June 2009

Mucinous nevus is a rare entity with only 11 cases reported previously. It may be divided into two histopathologic types: connective tissue nevus of the proteoglycan (CTNP) and combined epidermal‐CTNP. We describe a boy with asymptomatic grouped brown papuloplaques on the lower back since birth. A diagnosis of mucinous nevus of the combined epidermal‐CTNP type was made after a biopsy. We vaporized two lesions with carbon dioxide laser, and the wounds healed satisfactorily. We present a literature review indicating a striking preponderance of male patients (M : F = 5 : 1) for mucinous nevus. In half of the cases, mucinous nevus did not appear until childhood, adolescence or early adulthood. The predominantly affected site was the trunk. Half of the cases can be assigned to the CTNP type and the other half to the combined epidermal‐CTNP type. We propose that carbon dioxide laser vaporization may be a treatment option for mucinous nevus of the combined epidermal‐CTNP type with multiple lesions but not for the CTNP type.
Bitumen products induce skin cell apoptosis in chronically exposed road pavers
Authors: Rapisarda Venerando , Carnazza Maria L. , Caltabiano Candida , Loreto Carla , Musumeci Giuseppe , Valentino Matteo , Martinez Giuseppa
Published: June 2009

Background:  Worker’s exposure to bitumen fumes, via inhalation and skin contamination, is related to adverse effects including an increased risk of lung, stomach and non‐melanoma skin cancers and leukaemia. The two major mechanisms regulating apoptosis include the mitochondria‐mediated intrinsic pathway and the extrinsic pathway induced by death signalling ligands. In a previous study, we showed activation of apoptosis‐regulating proteins BAX and BCL‐2 in road pavers chronically exposed to bitumen fumes. These molecules play a central role in activation of programmed cell death by the intrinsic pathway. In this study, we hypothesized that the apoptosis mechanism could be activated in the skin of road pavers chronically exposed to bitumen fumes also through the extrinsic pathway, via mediation by tumor necrosis factor‐related apoptosis‐inducing ligand (TRAIL) and its death receptor, DR5.

Methods:  Skin punch biopsies from 16 occupationally exposed workers and a control group were processed immunohistochemically for TRAIL and DR5. Activation of programmed cell death was also investigated by expression of caspase‐3 and visualization of DNA strand breaks.

Results and Conclusion:  TRAIL, DR5 and caspase‐3 overexpression and enhanced Terminal Deoxynucleotidyl Transferase Mediated dUTP Nick End Labeling (TUNEL) positivity were found in chronically bitumen‐exposed skin, suggesting activation of apoptosis as a defence mechanism.
Silver deposits in cutaneous burn scar tissue is a common phenomenon following application of a silver dressing
Authors: Wang Xue‐Qing , Chang Hong‐En , Francis Rod , Olszowy Henry , Liu Pei‐Yun , Kempf Margit , Cuttle Leila , Kravchuk Olena , Phillips Gael E. , Kimble Roy M.
Published: June 2009

Background:  Silver dressings have been widely and successfully used to prevent cutaneous wounds, including burns, chronic ulcers, dermatitis and other cutaneous conditions, from infection. However, in a few cases, skin discolouration or argyria‐like appearances have been reported. This study investigated the level of silver in scar tissue post‐burn injury following application of Acticoat™, a silver dressing.

Methods:  A porcine deep dermal partial thickness burn model was used. Burn wounds were treated with this silver dressing until completion of re‐epithelialization, and silver levels were measured in a total of 160 scars and normal tissues.

Results:  The mean level of silver in scar tissue covered with silver dressings was 136 μg/g, while the silver level in normal skin was less than 0.747 μg/g. A number of wounds had a slate‐grey appearance, and dissection of the scars revealed brown‐black pigment mostly in the middle and deep dermis within the scar. The level of silver and the severity of the slate‐grey discolouration were correlated with the length of time of the silver dressing application.

Conclusions:  These results show that silver deposition in cutaneous scar tissue is a common phenomenon, and higher levels of silver deposits and severe skin discolouration are correlated with an increase in the duration of this silver dressing application.
HER‐2/neu expression in extramammary Paget disease: a clinicopathologic and immunohistochemistry study of 47 cases with and without underlying malignancy
Authors: Plaza Jose A. , Torres‐Cabala Carlos , Ivan Doina , Prieto Victor G.
Published: June 2009

Extramammary Paget disease (EMPD) is an infrequent skin cancer sometimes representing a secondary event caused by extension of an underlying carcinoma. Her‐2/neu overexpression in breast cancer is correlated with a more aggressive behavior, but anti‐Her‐2/neu therapy improves survival in these patients. We investigated Her‐2/neu expression by immunohistochemistry in cases of EMPD with and without underlying malignancy to try to correlate with tumor recurrence, progression and possible targeted therapy. Forty‐seven cases were analyzed (6 from the scrotum, 7 perianal region, 1 axilla and 33 vulva). Two cases had invasive EMPD (one from vulva and one from scrotum). The overall Her‐2/neu expression was 31.9%. Of the noninvasive EMPD of the vulva (32 cases), Her‐2/neu was shown in 38%. The case of invasive vulvar EMPD was negative. All six scrotal EMPD lacked Her2/neu expression. Her‐2/neu was expressed in two of seven perianal cases (33.3%). The EMPD on the axilla (one case) was negative. Eighteen cases had recurrence, and of these, 44.4% expressed Her‐2/neu in the initial lesion. A high proportion of EMPD showed Her‐2/neu expression (31.9%), indicating that these patients may benefit from targeted therapy. The proportion of positive cases was higher in lesions that had recurred at last follow up (44.4%), suggesting a more aggressive behavior.
Hair counts in scalp biopsy of males and females with androgenetic alopecia compared with normal subjects
Authors: Aslani Fatemeh Sari , Dastgheib Ladan , Banihashemi Bibi Maryam
Published: June 2009

Background:  Hair counts were studied in scalp biopsy specimens of androgenetic alopecia (AGA) in male and female patients. We also assessed the normal value of hair count in scalp biopsy specimen from Iranians and compared with published data.

Methods:  Thirty subjects with clinically normal scalps, 25 male and 28 female patients with AGA were studied. Vertical and horizontal sections of 4‐mm punch biopsy specimens were examined at various levels from the papillary dermis to the subcutis. Hair counts of total, terminal, vellus, anagen and telogen hairs were obtained by ocular micrometer.

Results:  Hair counts were not significantly different from published data in American Whites but significantly higher in Iranians compared with Koreans (p < 0.001). There was no significant difference between male and female patients with AGA. Perifollicular inflammation was lower in both the normal subjects and the patients compared with other studies.

Conclusion:  In AGA patients, total and vellus hairs were lower and terminal to vellus (T:V) ratio was higher than the results of previous studies in Whites (p < 00.1). T:V ratio of control group was significantly higher in this study compared with previous published data. Perhaps the higher ratio than the reported data could means the onset of miniaturization.
Persistent subcutaneous nodules after immunotherapy injections for allergic asthma
Authors: Ozden Müge G. , Kefeli Mehmet , Aydin Fatma , Senturk Nilgün , Canturk Tayyar , Turanli Ahmet Y.
Published: June 2009

Adverse effects of desensitization injections mostly consist of local transient reactions. Rarely, persistent subcutaneous nodular lesions may also develop at the site of injection. These reactions have been attributed to the vaccines containing aluminium hydroxide. Aluminium hydroxide is used as an adjuvant in vaccines and hyposensitization solutions. We describe a patient who presented persistent, itchy subcutaneous nodules as a local reaction to allergen immunotherapy for the treatment of allergic asthma.
Investigation of the effect of UV irradiation on DNA damage: comparison between skin cancer patients and normal volunteers
Authors: Mabruk Mohamed J. E. M. F. , Toh Lim K. , Murphy Miriam , Leader Mary , Kay Elaine , Murphy Gillian M.
Published: June 2009

Background:  Susceptibility to environmental carcinogenesis is the consequence of a complex interplay between intrinsic hereditary factors and actual exposure to potential carcinogenic agents. Exposure to sunlight is the primary etiological agent for basal cell carcinoma (BCC).

Aim:  The aim of this study was to determine the effects of different ultraviolet (UV) doses on DNA damage in epidermal keratinocytes in vivo and to elucidate if patients with BCC are more susceptible to UV‐induced DNA damage in comparison with normal healthy volunteers in response to solar simulator radiation (SSR).

Materials and Methods:  Skin biopsies obtained post‐UV irradiation from both normal healthy volunteers and BCC patients were analyzed for DNA damage, using immunohistochemical approach with TDM‐2 antibody, which binds specifically to cyclobutane pyrimidine dimmers (CPDs).

Results:  In both normal volunteers and BCC patients, the peak of CPD‐positive cells occurred at 4.5 h post‐SSR. There was a statistically significant difference in CPD positivity between BCC patients and normal volunteers, at time points (from 4.5 h to 48 h post‐SSR). For a given dose of SSR based on each individual minimal erythema dose (MED), a greater number of CPD‐positive cells could be shown.

Conclusions:  This study has shown for the first time and in vivo in human volunteers that BCC patients are more susceptible to UV‐induced DNA damage in comparison with normal healthy volunteers.
Extra‐anogenital bilharziasis cutanea tarda revisited
Authors: Ramdial Pratistadevi K. , Calonje Eduardo , Singh Bhugwan , Sing Yetish , Govender Prashni
Published: June 2009

Background:  Even in schistosomiasis‐endemic areas, extra‐anogenital bilharziasis cutanea tarda (E‐BCT) is rare. To date, the occurrence of E‐BCT in pre‐existing cutaneous pathology is undocumented. The study was undertaken to document the expanded clinicopathological spectrum and to comment on the putative pathogenetic mechanisms of a Schistosoma hematobium‐associated E‐BCT.

Methods:  Eight‐year clinicopathological appraisal of E‐BCT.

Results:  The clinical details are as follows. Seventeen specimens from 16 patients formed the study cohort. All specimens showed granulomatous inflammation with eosinophils, aggregates of terminal‐spined S. hematobium ova and variable fibrosis. Copulating worms were identified in three biopsies. In 12/16 patients, E‐BCT occurred in pre‐existing pathology, including recurrent squamous papilloma (1), bilateral hidradenitis suppurativa (1) and scar tissue (10) with 7 showing a keloidal morphology. Prior and current urinary schistosomiasis was present in nine and seven patients, respectively.

Conclusion:  E‐BCT, a reflection of prior, re‐infective or inadequately treated urinary schistosomiasis, is deemed to be a function of egg‐laying consequent to the aberrant pathway of worms. Based on E‐BCT occurrence in pre‐existing extra‐anogenital cutaneous fibroinflammatory and cicatricial processes and the presence of adult worms in three extra‐anogenital biopsies in the present study, it is hypothesized that altered tissue mesenchymal repair reactions may promote extra‐anogenital cutaneous worm entrapment and egg‐laying.
Recent advances in T‐cell regulation relevant to inflammatory dermatopathology
Authors: Karai Laszlo J. , Bergfeld Wilma F.
Published: June 2009

Inflammatory dermatoses encompass an enormous area of dermatopathology. Our understanding of the subject comes from combination of histopathological observations and relevant clinical information. Diagnoses are generally reached at the hematoxylin and eosin (H&E) level by using various pattern recognition approaches including one devised by Dr Ackerman et al.1 Recent advances in cell biology and immunology especially the field of T‐cell regulation shed light to the intricate cellular interactions, associations and connect to inflammatory dermatopathology. This review attempts to identify and put into context the most significant advances in cellular biology relevant to the topic. Most of the information presented here is not necessarily relevant to our regular work at the moment; however, the new information will surely channel into our practice to provide a better, more accurate, semi‐individualized diagnostic approach in the not too far future.