bluuebunny/crossref_metadata_2025 huggingface dataset:
An in—Depth Interview Study of Health Care Policy Professionals and Their Research Needs
Authors: Sutton Sharyn M. , Thompson Elizabeth
Published: April 2010

This article presents the results of a qualitative research study that applied social marketing principles to better understand national health care policymakers' needs for research. The findings suggest that the current supply of health care policy research does not meet health care policymakers' needs and, as a result, often is not used to inform policy. As with any target audience, researchers and those who commission research must take into account the behavior, motivations and needs of policymakers in order to provide a “product or service” that is actually used. Those who want their research findings to inform policymakers' decisions must design their research, package results and develop distribution strategies that reflect an understanding of the policymakers' behavior process.

There are two main findings from this study. First, there is a high level of consistency among the different types of policymakers in terms of their research needs and where these needs are not being met. Second, policymakers perceive a conflict between their needs and the existing traditional system for rewarding researchers and distributing research findings.
A Financial Contracting Approach to the Role of Supermarkets in Farmers’ Credit Access
Authors: Marcoul Philippe , Veyssiere Luc
Published: April 2010

Traditional moneylenders monitor farmers to ensure that their investment is not diverted. Modern farming contracts offered by supermarkets in developing countries often entail a loan component, and monitoring arises as well. However, unlike moneylenders, supermarkets do care about the attributes of the product. Whether such attributes are obtained is influenced largely by the advice and the extension services received by farmers. We build a financial contracting model where we show that supermarkets optimally undertake both the monitoring and the advisory missions. This contract is shown to potentially enhance credit access for small farmers but sometimes also involves excessive monitoring.
Can an Education Program Be a Substitute for a Regulatory Program That Bans Pesticides? Evidence from a Panel Selection Model
Authors: Goodhue Rachael E. , Klonsky Karen , Mohapatra Sandeep
Published: April 2010

Governments, nonprofit organizations, and grower groups have expended considerable resources on agricultural extension and education programs, even though the evidence regarding the impact of these programs on farmers’ technology choices and productivity is mixed. Many of the studies finding substantial effects have methodological problems. We control for these methodological problems by using a panel selection model to examine the effect of the Biologically Integrated Orchard Systems program on California almond growers’ replacement of organophosphate pesticides with alternatives considered less environmentally harmful. We find that the program significantly decreased organophosphate use, suggesting that grower education programs can be an effective policy tool.
The coarse-grid problem in ecological monitoring
Authors: Petrovskaya Natalia B. , Petrovskii Sergei V.
Published: April 2010

Obtaining information about pest-insect population size is an important problem of pest monitoring and control. Usually, this problem has to be solved based on scarce spatial data about the population density. The problem of monitoring can thus be linked to a more general mathematical problem of numerical integration on a coarse grid. Numerical integration on coarse grids has rarely been considered in literature as it is usually assumed that the grid can be refined. However, this is not the case in ecological monitoring where fine grids are not available. In this paper, we introduce a method of numerical integration that allows one to accurately evaluate an integral on a coarse grid. The method is tested on several functions with different properties to show its effectiveness. We then use the method to obtain an estimate of the population size for different population distributions and show that an ecologically reasonable accuracy can be achieved on a very coarse grid consisting of just a few points. Finally, we summarize our mathematical findings as a protocol of ecological monitoring, thus sending a clear and practically important message to ecologists and pest-control specialists.
Acquisition of extended-spectrum β-lactamase producing Escherichia coli strains in male and female infants admitted to a neonatal intensive care unit: molecular epidemiology and analysis of risk factors
Authors: Shakil Shazi , Akram Mohammad , Ali Syed M. , Khan Asad U.
Published: April 2010

Extended-spectrum β-lactamases (ESBLs) are bacterial enzymes that confer resistance to advanced generation cephalosporins and can lead to therapeutic failures. There has been no analysis of factors associated with the risk of acquisition of ESBLs in neonates in an intensive care unit from northern India. The CTX-M ESBL enzymes impart resistance against advanced generation cephalosporins (e.g. cefotaxime) and CTX-M variants have become the most prevalent ESBLs worldwide. The CTX-M-15 enzyme in particular is increasingly being reported from Escherichia coli isolates from northern India together with TEM-1. Moreover, E. coli is the most common cause of neonatal sepsis. Accordingly, this study aimed to: (i) characterize the mode of transmission of bla
CTX-M and bla
TEM among ESBL-producing E. coli strains isolated from patients admitted to a neonatal intensive care unit (NICU), and (ii) identify factors associated with the acquisition of the said strains in male and female neonates. A total of 97 ESBL-producers was identified among 266 E. coli strains isolated from 238 neonates. The isolates were screened for bla
CTX-M, bla
TEM, armA, rmtA and rmtB, the last three genes being responsible for aminoglycoside resistance. PCR amplified bla
CTX-M genes were cloned and sequenced. Five bla
CTX-M-15, two rmtB, two bla
TEM-1 and thirteen class1 integrons were detected. All the bla
CTX-M-15 positive isolates, except one, were clonally related. Both univariate and multivariate analyses of factors for the acquisition of the said strains were performed with respect to the sex of the neonates. ‘Length of stay in the NICU’ was found to be the single independent factor associated with ESBL acquisition. In conclusion, our data suggest that male neonates who are colonized or infected by ESBL-producing E. coli have a longer stay in the NICU compared to their female counterparts. This prolonged stay may be due to male neonates becoming colonized/infected earlier than their female counterparts. Plasmid-mediated-conjugal transfer was found to be the mechanism of transfer of the bla
CTX-M-15 resistance marker in the described setting.
The cylindrospermopsin gene cluster of Aphanizomenon sp. strain 10E6: organization and recombination
Authors: Stüken Anke , Jakobsen Kjetill S.
Published: April 2010

Cylindrospermopsin (CYN), a potent hepatoxin, occurs in freshwaters worldwide. Several cyanobacterial species produce the toxin, but the producing species vary between geographical regions. Aphanizomenon flos-aquae, a common algae species in temperate fresh and brackish waters, is one of the three well-documented CYN producers in European waters. So far, no genetic information on the CYN genes of this species has been available. Here, we describe the complete CYN gene cluster, including flanking regions from the German Aphanizomenon sp. strain 10E6 using a full genome sequencing approach by 454 pyrosequencing and bioinformatic identification of the gene cluster. In addition, we have sequenced a ∼7 kb fragment covering the genes cyrC (partially), cyrA and cyrB (partially) of the same gene cluster in the CYN-producing Aphanizomenon sp. strains 10E9 and 22D11. Comparisons with the orthologous gene clusters of the Australian Cylindrospermopsis raciborskii strains AWT205 and CS505 and the partial gene cluster of the Israeli Aphanizomenon ovalisporum strain ILC-146 revealed a high gene sequence similarity, but also extensive rearrangements of gene order. The high sequence similarity (generally higher than that of 16S rRNA gene fragments from the same strains), atypical GC-content and signs of transposase activities support the suggestion that the CYN genes have been horizontally transferred.
Detection and quantification of intergenic transcription in Mycoplasma hyopneumoniae
Authors: Gardner Stuart W. , Minion F. Chris
Published: April 2010

Mycoplasmas are thought to control gene expression through simple mechanisms. The switching mechanisms needed to regulate transcription during significant environmental shifts do not seem to be required for these host-adapted organisms. Mycoplasma hyopneumoniae, a swine respiratory pathogen, undergoes differential gene expression, but as for all mycoplasmas, the mechanisms involved are still unknown. Since mycoplasmas contain only a single sigma factor and few regulator-type proteins, it is likely that other mechanisms control gene regulation, possibly involving intergenic (IG) regions. To study this further, we investigated whether IG regions are transcribed in M. hyopneumoniae, and measured transcription levels across five specific regions. Microarrays were constructed with probes covering 343 IG regions of the M. hyopneumoniae genome, and RNA isolated from laboratory-grown cells was used to interrogate the arrays. Transcriptional signals were identified in 321 (93.6 %) of the IG regions. Five large (>500 bp) IG regions were chosen for further analysis by qRT-PCR by designing primer sets whose products reside in flanking ORFs, bridge flanking ORFs and the IG region, or reside solely within the IG region. The results indicate that no single transcriptional start site can account for transcriptional activity within IG regions. Transcription can end abruptly at the end of an ORF, but this does not seem to occur at high frequency. Rather, transcription continues past the end of the ORF, with RNA polymerase gradually releasing the template. Transcription can also be initiated within IG regions in the absence of accepted promoter-like sequences.
Role of Hfq in iron-dependent and -independent gene regulation in Neisseria meningitidis
Authors: Mellin J. R. , McClure Ryan , Lopez Delia , Green Olivia , Reinhard Bjorn , Genco Caroline
Published: April 2010

In Neisseria meningitidis, iron-responsive gene regulation is mediated primarily by the ferric uptake regulator (Fur) protein. When complexed with iron, Fur represses gene expression by preventing transcription initiation. Fur can also indirectly activate gene expression via the repression of regulatory small RNAs (sRNA). One such Fur- and iron-regulated sRNA, NrrF, was previously identified in N. meningitidis and shown to repress expression of the sdhA and sdhC genes encoding subunits of the succinate dehydrogenase complex. In the majority of Gram-negative bacteria, sRNA-mediated regulation requires a cofactor RNA-binding protein (Hfq) for proper gene regulation and stabilization. In this study, we examined the role of Hfq in NrrF-mediated regulation of the succinate dehydrogenase genes in N. meningitidis and the effect of an hfq mutation on iron-responsive gene regulation more broadly. We first demonstrated that the stability of NrrF, as well as the regulation of sdhC and sdhA in vivo, was unaltered in the hfq mutant. Secondly, we established that iron-responsive gene regulation of the Fur-regulated sodB gene was dependent on Hfq. Finally, we demonstrated that in N. meningitidis, Hfq functions in a global manner to control expression of many ORFs and intergenic regions via iron-independent mechanisms. Collectively these studies demonstrate that in N. meningitidis, iron- and NrrF-mediated regulation of sdhC and sdhA can occur independently of Hfq, although Hfq functions more globally to control regulation of other N. meningitidis genes primarily by iron-independent mechanisms.
Dynamical theory calculations of spin-echo resolved grazing-incidence scattering from a diffraction grating
Authors: Ashkar Rana , Stonaha P. , Washington A. L. , Shah V. R. , Fitzsimmons M. R. , Maranville B. , Majkrzak C. F. , Lee W. T. , Schaich W. L. , Pynn Roger
Published: April 2010

Neutrons scattered or reflected from a diffraction grating are subject to a periodic potential analogous to the potential experienced by electrons within a crystal. Hence, the wavefunction of the neutrons can be expanded in terms of Bloch waves and a dynamical theory can be applied to interpret the scattering phenomenon. In this paper, a dynamical theory is used to calculate the results of neutron spin-echo resolved grazing-incidence scattering (SERGIS) from a silicon diffraction grating with a rectangular profile. The calculations are compared with SERGIS measurements made on the same grating at two neutron sources: a pulsed source and a continuous wave source. In both cases, the spin-echo polarization, studied as a function of the spin-echo length, peaks at integer multiples of the grating period but there are some differences between the two sets of data. The dynamical theory explains the differences and gives a good account of both sets of results.
Structural and microstructural changes during anion exchange of CoAl layered double hydroxides: anin situX-ray powder diffraction study
Authors: Johnsen Rune E. , Krumeich Frank , Norby Poul
Published: April 2010

Anion-exchange processes in cobalt–aluminium layered double hydroxides (LDHs) were studied byin situsynchrotron X-ray powder diffraction (XRPD). The processes investigated were CoAl–CO3→ CoAl–Cl → CoAl–CO3, CoAl–Cl → CoAl–NO3and CoAl–CO3→ CoAl–SO4. The XRPD data show that the CoAl–CO3→ CoAl–Cl process is a two-phase transformation, where the amount of the CoAl–CO3phase decreases exponentially while that of the CoAl–Cl phase increases exponentially. Energy-dispersive X-ray spectroscopy (EDXS) studies of a partially chloride-exchanged CoAl–CO3LDH sample along within situXRPD data suggested that the individual particles in the CoAl–CO3sample are generally anion-exchanged with chloride one at a time. In contrast with the CoAl–CO3→ CoAl–Cl transformation, the XRPD data show that the reverse CoAl–Cl → CoAl–CO3process is a one-phase transformation. Rietveld refinements indicate that the occupancy factors of the carbon and oxygen sites of the carbonate group increase, while that of the chloride site decreases. In the CoAl–Cl → CoAl–NO3anion-exchange reaction, the XRPD patterns reveal the existence of two intermediate phases in addition to the initial CoAl–Cl and final CoAl–NO3phases. Thein situdata indicate that one of these intermediates is a mixed nitrate- and chloride-based LDH phase, where the disorder decreases as the nitrate content increases. The XRPD data of the partial CoAl–CO3→ CoAl–SO4anion-exchange reaction show that the process is a two-phase transformation involving a sulfate-containing LDH with a 1H polytype structure.
Normalized one- and two-dimensional distribution functions for interatomic distance and angle data from crystallographic databases
Authors: Gavezzotti Angelo
Published: April 2010

An algorithm for producing properly normalized distribution functions representing the relative frequency of radial and angular contacts between atoms, as determined by a survey of atomic positions in crystallographic databases, is described and discussed with some examples. The algorithm is an extension and generalization of previously introduced methods for weighting radial and angular distributions. The procedure has been coded into a Fortran computer program, available for distribution. A few examples are given.
Double cancer of plantar malignant melanoma and vulvar extramammary Paget’s disease
Authors: TSUJI Masataka , NAKAI Noriaki , UEDA Eiichiro , TAKENAKA Hideya , KATOH Norito , KISHIMOTO Saburo
Published: April 2010

A 75‐year‐old woman presented with a 2‐year history of a pigmented nodular lesion on her left sole and a 9‐year history of a red infiltrative plaque on the vulva. The plantar lesion was a 15‐mm ulcerated nodule located at the center of a 25‐mm atypical pigmentation region; the nodule was clinically suspected to be a malignant melanoma. Histopathological analysis of the vulvar lesion biopsy sample indicated extramammary Paget’s disease (EMPD). There was no evidence of metastasis in the computed tomography (CT) and 18F‐fluorodeoxyglucose positron emission tomography scans. We simultaneously performed a wide excision of both lesions and a left inguinal sentinel lymph node biopsy. Melanoma cells were identified in the sentinel lymph nodes, and left radical lymph node dissection was performed after a course of neoadjuvant chemotherapy. All the lymph nodes that were resected during the second operation tested negative for melanomas, and the plantar lesion was diagnosed as a stage IIIB malignant melanoma (pT4b, Na2, M0). Thereafter, we administrated four courses of chemotherapy, and 8 months after the operation, there was no evidence of recurrence or metastatic lesions. We present a case report of double cancer: a plantar malignant melanoma and vulvar EMPD, and also discuss the possible genetic mutations responsible for these two tumors.
Characterization of a novel lymph node metastasis model from human colonic cancer and its preclinical use for comparison of anti‐metastatic efficacy between oral S‐1 and UFT/ LV
Authors: Ito Yuichi , Nakanishi Hayao , Kodera Yasuhiro , Hirai Takashi , Nakao Akimasa , Kato Tomoyuki
Published: April 2010

Although lymph node metastasis (LNM) is the most critical prognostic factor in colorectal cancer patients, the anti‐LNM efficacy of chemotherapeutic agents is largely unknown because of the limitations of reproducible human colorectal cancer LNM models. Here, we developed a new LNM model from a recently established colorectal cancer cell line (COLM‐5) and compared the anti‐LNM efficacy of two oral formulations of 5‐fluorouracil (5‐FU) derivatives, S‐1 and UFT/leucovorin (LV). COLM‐5 cells is a poorly differentiated adenocarcinoma cell line with unique features such as left‐sided, β‐catenin cytoplasmic localization, and microsatellite stable phenotype. COLM‐5 cells expressed vascular endothelial growth factor (VEGF‐C) and exhibited peritumoral lymphangiogenesis. Consequently, they showed high LNM potential at an incidence of approximately 90% when subcutaneously injected into nude mice, allowing use for preclinical study. When chemotherapy with S‐1 or UFT/LV started from the micrometastasis stage, not the advanced macroscopic metastasis stage, anti‐LNM efficacy of S‐1 was significantly higher than that of UFT/LV at the dosage in which antitumor activity of the two drugs against primary subcutaneous tumor was comparable. COLM‐5 cells showed expression pattern of 5‐FU metabolizing enzymes such as high dihydropyrimidine dehydrogenase (DPD) and low thymidylate synthase (TS)/orotate phosphoribosyltransferase (OPRT) both in vitro and in vivo. These results suggest that the preferential anti‐LNM activity of S‐1 compared with UFT/LV against high‐DPD COLM‐5 tumors is due to the higher DPD inhibitory activity of 5‐chloro‐2, 4‐dihydroxypyrimidine (CDHP) present in S‐1 than uracil in UFT. The COLM‐5 model would be an excellent tool for understanding the basic mechanism of LNM and for preclinical study on the anti‐LNM efficacy of the drugs. (Cancer Sci 2010)
XRCC3 Thr241Met polymorphism with lung cancer and bladder cancer: A meta‐analysis
Authors: Sun Haiming , Qiao Yuandong , Zhang Xuelong , Xu Lidan , Jia Xueyuan , Sun Donglin , Shen Chao , Liu An , Zhao Yanling , Jin Yan , Yu Yang , Bai Jing , Fu Songbin
Published: April 2010

Several studies have investigated the associations between X‐ray repair cross‐complementing group 3 (XRCC3) Thr241Met polymorphism and the susceptibility to lung cancer and bladder cancer, but results have been inconclusive. In order to derive a more precise estimation of the relationship, a meta‐analysis was performed. A total of 22 case control studies, including 2976 cases and 4495 controls for lung cancer, and 3445 cases and 4599 controls for bladder cancer, met the inclusion criteria and were selected. Overall, there was no evidence showing a significant association between XRCC3 Thr241Met polymorphism and lung cancer risk. Furthermore, the results for bladder cancer showed that significant decreased risk was found for the additive model (odds ratio [OR] = 0.959, 95% confidence interval [CI], 0.924–0.996) and dominant model (OR = 0.982, 95% CI, 0.963–1.000) but not for the recessive model (OR = 0.958, 95% CI, 0.905–1.014). In summary, our meta‐analysis indicates that XRCC3 Thr241Met polymorphism may be weakly associated with the risk of bladder cancer. (Cancer Sci 2010)
Meta‐analysis: polymorphisms in TNF‐α gene promoter and Crohn’s disease
Authors: Han Z. , Li C. , Han S. , Han Y. , Qiu J. , Shi Y. , Wang J. , Sun A. , Ding J. , Wu K. , Fan D.
Published: April 2010

Aliment Pharmacol Ther 2010; 32: 159–170

Background  Tumour necrosis factor alpha (TNF‐α) is involved in the pathogenesis of Crohn’s disease (CD). However, results on the association between the polymorphisms in TNF‐α promoter and the risk of CD are inconsistent.

Aim  To perform a quantitative synthesis for the genetic polymorphisms in TNF‐α promoter and CD risk.

Methods  Databases were searched (up to 2009) and 31 studies were included. Risks of CD associated with the polymorphisms in TNF‐α promoter were assessed.

Results  Overall, individuals with ‐1031 TC+CC genotype had a slightly increased risk to develop CD compared with individuals with ‐1031 TT genotype (OR, 1.32; 95% CI, 1.03–1.70). In the further stratified analysis, we found Asians with the ‐1031T>C, ‐863 C>A and ‐857 C>T variant polymorphisms have almost one and a half CD risk compared with other genotypes (OR, 1.58; 95% CI, 1.16–2.15; OR, 1.55; 95% CI, 1.18–2.02; OR, 1.54; 95% CI, 1.19–1.99 respectively). We did not find ‐308 G>A variant associated with CD location and disease behaviours in stratified analysis.

Conclusions  TNF‐α polymorphisms in the promoter region might be used as a biomarker for CD risk prediction. Larger studies with mixed ethnicity subjects and stratified by clinical and sub clinical characteristics are needed to validate our findings.
Modern management of severe platelet function disorders
Authors: Alamelu Jayanthi , Liesner Ri
Published: April 2010

Severe platelet function defects are rare disorders that require expertise in diagnosis and management. Therefore patients with such disorders should be referred to and managed in centres with the full laboratory repertoire of tests and clinical support necessary to optimise their quality of care. The aim of this review is to discuss the management of these patients in various clinical situations including surgical intervention.
Effectiveness of planning hospital discharge and follow‐up in primary care for patients with chronic obstructive pulmonary disease: research protocol
Authors: Abad‐Corpa Eva , Carrillo‐Alcaraz Andrés , Royo‐Morales Tania , Pérez‐García Maria Carmen , Rodríguez‐Mondejar Juan José , Sáez‐Soto Ángeles , Iniesta‐Sánchez Javier
Published: April 2010

abad‐corpa e., carrillo‐alcaraz a., royo‐morales t., pérez‐garcía m.c., rodríguez‐mondejar j.j., sáez‐soto a. & iniesta‐sánchez j. (2010) Effectiveness of planning hospital discharge and follow‐up in primary care for patients with chronic obstructive pulmonary disease: research protocol. Journal of Advanced Nursing 66(6), 1365–1370.

Title.  Effectiveness of planning hospital discharge and follow‐up in primary care for patients with chronic obstructive pulmonary disease: research protocol.

Aim.  To evaluate the effectiveness of a protocolized intervention for hospital discharge and follow‐up planning for primary care patients with chronic obstructive pulmonary disease.

Background.  Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality internationally. These patients suffer from high rates of exacerbation and hospital readmission due to active problems at the time of hospital discharge.

Methods.  A quasi‐experimental design will be adopted, with a control group and pseudo‐randomized by services (protocol approved in 2006). Patients with pulmonary disease admitted to two tertiary‐level public hospitals in Spain and their local healthcare centres will be recruited. The outcome variables will be readmission rate and patient satisfaction with nursing care provided. 48 hours after admission, both groups will be evaluated by specialist coordinating nurses, using validated scales. At the hospital, a coordinating nurse will visit each patient in the experimental group every 24 hours to identify the main caregiver, provide information about the disease, and explain treatment. In addition, the visits will be used to identify care problems and needs, and to facilitate communication between professionals. 24 hours after discharge, the coordinating nurses will inform the primary care nurses about patient discharge and nursing care planning. The two nurses will make the first home visit together. There will be follow‐up phone calls at 2, 6, 12 and 24 weeks after discharge.

Discussion.  The characteristics of patients with this pulmonary disease make it necessary to include them in hospital discharge planning programmes using coordinating nurses.
What does quality care mean to nurses in rural hospitals?
Authors: Baernholdt Marianne , Jennings Bonnie Mowinski , Merwin Elizabeth , Thornlow Deirdre
Published: April 2010

baernholdt m., jennings b.m., merwin e. & thornlow d. (2010) What does quality care mean to nurses in rural hospitals? Journal of Advanced Nursing 66(6), 1346–1355.

Title.  What does quality care mean to nurses in rural hospitals?

Aim.  This paper is a report of a study conducted to answer the question: ‘How do rural nurses and their chief nursing officers define quality care?’

Background.  Established indicators of quality care were developed primarily in urban hospitals. Rural hospitals and their environments differ from urban settings, suggesting that there might be differences in how quality care is defined. This has measurement implications.

Methods.  Focus groups with staff nurses and interviews with chief nursing officers were conducted in 2006 at four rural hospitals in the South‐Eastern United States of America. Data were analysed using conventional content analysis.

Findings.  The staff nurse and chief nursing officer data were analysed separately and then compared, exposing two major themes: ‘Patients are what matter most’ and ‘Community connectedness is both a help and a hindrance’. Along with conveying that patients were the utmost priority and all care was patient‐focused, the first theme included established indicators of quality such as falls, pressure ulcers, infection rates, readmission rates, and lengths of stay. A new discovery in this theme was a need for an indicator relevant for rural settings: transfer time to larger hospitals. The second theme, Community Connectedness, is unique to rural settings, exemplifying the rural culture. The community and hospital converge into a family of sorts, creating expectations for quality care by both patients and staff that are not typically found in urban settings and larger hospitals.

Conclusion.  Established quality indicators are appropriate for rural hospitals, but additional indicators need to be developed. These must include transfer times to larger facilities and the culture of the community.
Obesity among adolescents: sedentary leisure time and sleeping as determinants
Authors: Liou Yiing Mei , Liou Tsan‐Hon , Chang Lu‐Chuan
Published: April 2010

liou y.m., liou t.‐h. & chang l.‐c.
(2010) Obesity among adolescents: sedentary leisure time and sleeping as determinants. Journal of Advanced Nursing 66(6), 1246–1256.

Title.  Obesity among adolescents: sedentary leisure time and sleeping as determinants.

Aim.  This paper is a report of a study of the association between various risk factors and obesity among adolescents.

Background.  Over the past 30 years, the prevalence of overweight and obesity in children and adolescents has nearly tripled. Physical inactivity, unbalanced diet, and unhealthy lifestyles may cause lifelong obesity.

Methods.  A representative, national cross‐sectional study was carried out between 2006 and 2007 with 40 middle high schools with 384 classes. We used a three‐stage stratified systematic sampling design with a probability proportionate to the size from the northern, middle, southern, and eastern areas in Taiwan. Questionnaires were completed by 8640 students (51·7% boys and 48·3% girls) aged between 13 and 16 years.

Results.  Obesity was identified in 7·2% of the participants and 16·1% were overweight. Using stepwise logistic regression, we found that those whose fathers or mothers were obese, watched television for more than 2 hours/day on weekdays and slept for less than 7·75 hours/day at weekends had a statistically significantly greater risk of obesity (females: ORs = 3·4, 4·2, 1·8, and 4·2, respectively; P < 0·05; boys: ORs = 2·3, 1·7, 1·4, and 1·6, respectively; P < 0·05).

Conclusion.  To help prevent obesity, strategies are needed to decrease adolescents sedentary leisure time and help them have sufficient sleep. Nurses can play a key role in health promotion in relation to childhood and adolescent obesity.
Laxative use in care homes
Authors: Gage Heather , Goodman Claire , Davies Sue L. , Norton Christine , Fader Mandy , Wells Mandy , Morris Jackie , Williams Peter
Published: April 2010

gage h., goodman c., davies s.l., norton c., fader m., wells m., morris j. & williams p. (2010) Laxative use in care homes. Journal of Advanced Nursing 66(6), 1266–1272.

Title.  Laxative use in care homes.

Aim.  This paper is a report of an investigation into the factors associated with laxative‐taking by older people in care homes.

Background.  Constipation is a common source of discomfort, pain and morbidity for care home residents, and laxative‐taking is prevalent. Differences in the extent to which older people suffer from constipation may result from care routines rather than demographic or clinical factors.

Data sources.  Primary data were gathered from care records as part of a larger study in seven care homes (without on‐site nursing) in London, England in 2003–2004.

Methods.  Backward stepwise logistic regression modelling was used to investigate factors (age, sex, level of dependency [Barthel]), number of comorbidities, number of medications, constipating medications, length of stay in care home, diagnosis of dementia/Alzheimer disease) associated with regular laxative‐taking.

Results.  Of 168 residents, 99 (58·9%) were routinely given laxatives. Taking more medicines (moving up one category: 0, 1–2, 3–4, 5–6, ≥7) increased the likelihood of taking laxatives more than threefold, after controlling for all other factors. Women were 2·9 times more likely to take laxatives than men. Having dementia/Alzheimer disease increased the likelihood of taking laxatives by 2·6 times. Laxative‐taking was statistically significantly lower in two of the care homes.

Conclusion.  Laxative use amongst older people in care homes varies and may not be based on rational criteria. Nurses working in care homes and with care staff can help to implement appropriate bowel care for older people.
D‐Catch instrument: development and psychometric testing of a measurement instrument for nursing documentation in hospitals
Authors: Paans Wolter , Sermeus Walter , Nieweg Roos M.B. , Van Der Schans Cees P.
Published: April 2010

paans w., sermeus w., nieweg r.m.b. & van der schans c.p. (2010) D‐Catch instrument: development and psychometric testing of a measurement instrument for nursing documentation in hospitals. Journal of Advanced Nursing 66(6), 1388–1400.

Title.  D‐Catch instrument: development and psychometric testing of a measurement instrument for nursing documentation in hospitals.

Aim.  This paper is a report of the development and testing of the psychometric properties of an instrument to measure the accuracy of nursing documentation in general hospitals.

Background.  Little information is available about the accuracy of nursing documentation. None of the existing instruments that quantify accuracy of nursing diagnoses, interventions, and progress and outcome evaluations are suitable to measure documentation in general hospital environments, nor were they intended for this purpose.

Method.  The D‐Catch instrument, based on the Cat‐ch‐Ing instrument and the Scale for Degrees of Accuracy in Nursing Diagnoses, was developed in 2007–2008. Content validity of the D‐Catch instrument was assessed by two Delphi panels, in which pairs of independent reviewers assessed 245 patient records in seven hospitals in the Netherlands. Construct validity was assessed by explorative factor analysis with principal components and varimax rotation. Internal consistency was measured by Cronbach’s alpha. The inter‐rater reliability of the D‐Catch instrument was tested by calculating Cohen’s weighted kappa (Kw) for each pair of reviewers.

Results.  Quantity and quality variables were used to assess the accuracy of nursing documentation. Three constructs were identified in the factor analysis. ‘Accuracy of the nursing diagnosis’ was the only variable with substantial loading on component two (0·907) and a modest loading on component one (0·230). Internal consistency (Cronbach’s alpha) was 0·722. The inter‐rater reliability (Kw) varied between 0·742 and 0·896.

Conclusion.  The D‐Catch instrument is a valid and reliable measurement instrument to assess nursing documentation in general hospital settings.
So you want to conduct a cluster randomized controlled trial? Lessons from a national cluster trial of early labour
Authors: Hundley Vanora , Cheyne Helen , Bland J Martin , Styles Maggie , Barnett Carol A.
Published: April 2010

As the discipline of health services research has developed so methods of evaluation have become increasingly sophisticated; where once a ‘simple’ randomized controlled trial would have been considered the gold standard, now terms such as ‘complex interventions’ and the ‘cluster randomized controlled trial’ are hot topics for discussion. The challenges involved in carrying out such studies are rarely presented. In this paper we discuss some of these challenges in relation to ethical and statistical considerations, and illustrate them using a recently completed cluster randomized controlled trial of a decision tool for early labour.
Patient safety in primary care has many aspects: an interview study in primary care doctors and nurses
Authors: Gaal Sander , Van Laarhoven Esther , Wolters René , Wetzels Raymond , Verstappen Wim , Wensing Michel
Published: April 2010

Rationale, aims and objectives  Scientific definitions of patient safety may be difficult to apply in routine health care delivery. It is unknown what primary care workers consider patient safety. This study aimed to clarify the concept of patient safety in primary care.

Methods  We held 29 semi‐structured interviews with a purposeful sample of primary care doctors and nurses regarding their perceptions of patient safety. The answers were analysed in an iterative procedure with respect to common themes.

Results  A broad range of specific aspects of primary care were named in relation with patient safety. Medication safety was most frequently mentioned. Most items were categorized as organizational, while the remaining aspects were linked to culture or professionalism. Scientific definitions of patient safety were not mentioned, but some primary care workers gave ‘do not harm the patient’ as a short definition for patient safety.

Conclusion  Patient safety programmes have mostly targeted specific issues, such as incident reporting and medication safety. However, doctors and practice nurses had a broad view of what constitutes patient safety in primary care. This has implications for the measurement and improvement of patient safety in primary care.
Brassicaceae INDEHISCENT genes specify valve margin cell fate and repress replum formation
Authors: Girin Thomas , Stephenson Pauline , Goldsack Cassandra M. P. , Kempin Sherry A. , Perez Amandine , Pires Nuno , Sparrow Penelope A. , Wood Thomas A. , Yanofsky Martin F. , Østergaard Lars
Published: April 2010

Members of the Brassicaceae family, including Arabidopsis thaliana and oilseed rape (Brassica napus), produce dry fruits that open upon maturity along a specialised tissue called the valve margin. Proper development of the valve margin in Arabidopsis is dependent on the INDEHISCENT (IND) gene, the role of which in genetic and hormonal regulation has been thoroughly characterised. Here we perform phylogenetic comparison of IND genes in Arabidopsis and Brassica to identify conserved regulatory sequences that are responsible for specific expression at the valve margin. In addition we have taken a comparative development approach to demonstrate that the BraA.IND.a and BolC.IND.a genes from B. rapa and B. oleracea share identical function with Arabidopsis IND since ethyl methanesulphonate (EMS) mutant alleles and silenced transgenic lines have valve margin defects. Furthermore we show that the degree of these defects can be fine‐tuned for crop improvement. Wild‐type Arabidopsis produces an outer replum composed of about six cell files at the medial region of the fruits, whereas Brassica fruits lack this tissue. A strong loss‐of‐function braA.ind.a mutant gained outer replum tissue in addition to its defect in valve margin development. An enlargement of replum size was also observed in the Arabidopsis ind mutant suggesting a general role of Brassicaceae IND genes in preventing valve margin cells from adopting replum identity.
Strategies to improve patient retention on antiretroviral therapy in sub‐Saharan Africa
Authors: Harries Anthony D. , Zachariah Rony , Lawn Stephen D. , Rosen Sydney
Published: April 2010

The scale‐up of antiretroviral therapy (ART) has been one of the success stories of sub‐Saharan Africa, where coverage has increased from about 2% in 2003 to more than 40% 5 years later. However, tempering this success is a growing concern about patient retention (the proportion of patients who are alive and remaining on ART in the health system). Based on the personal experience of the authors, 10 key interventions are presented and discussed that might help to improve patient retention. These are (1) the need for simple and standardized monitoring systems to track what is happening, (2) reliable ascertainment of true outcomes of patients lost to follow‐up, (3) implementation of measures to reduce early mortality in patients both before and during ART, (4) ensuring uninterrupted drug supplies, (5) consideration of simple, non‐toxic ART regimens, (6) decentralization of ART care to health centres and the community, (7) a reduction in indirect costs for patients particularly in relation to transport to and from clinics, (8) strengthening links within and between health services and the community, (9) the use of ART clinics to deliver other beneficial patient or family‐orientated packages of care such as insecticide‐treated bed nets, and (10) innovative (thinking ‘out of the box’) interventions. High levels of retention on ART are vital for individual patients, for credibility of programmes and for on‐going resource and financial support.
Cost of using a patient tracer to reduce loss to follow‐up and ascertain patient status in a large antiretroviral therapy program in Johannesburg, South Africa
Authors: Rosen Sydney , Ketlhapile Mpefe
Published: April 2010

Objective  To evaluate a pilot intervention to engage a patient tracer to follow up lost patients at a large public clinic in South Africa.

Methods  A social worker spent 4 months contacting by telephone a random sample of patients who had initiated antiretroviral therapy (ART) at least 6 months earlier and were ≥1 month late for a scheduled visit. The tracer was authorized to assist patients to return to care if needed. Cost was calculated from the perspective of the clinic.

Results  The tracer was able to determine the final status of 260 of a sample of 493 lost patients. Of the 260, 55 (21%) had died, 56 (21%) were still on ART at the same site, 79 (30%) reported transferring to another site and 70 (27%) had discontinued treatment. Among those discontinuing, commonly cited reasons were relocation (n = 18, 26%), traditional medicine or religious beliefs (n = 11, 16%), fear of disclosure or other family barriers (n = 9, 13%), and employment obstacles (n = 7, 10%). Twenty patients returned to care at the original site as a result of the intervention, at an average cost of $432 per patient returned.

Conclusions  A patient tracer was an effective way to determine the final status of lost patients and succeeded in returning some to care, but the cost per patient returned was high. Better information systems allowing sites to track deaths and transfers would greatly improve the efficiency of loss to follow‐up interventions.
PRECLINICAL STUDY: FULL ARTICLE: Ethanol‐induced activation of AKT and DARPP‐32 in the mouse striatum mediated by opioid receptors
Authors: Björk Karl , Terasmaa Anton , Sun Hui , Thorsell Annika , Sommer Wolfgang H. , Heilig Markus
Published: April 2010

The reinforcing properties of ethanol are in part attributed to interactions between opioid and dopaminergic signaling pathways, but intracellular mediators of such interactions are poorly understood. Here we report that an acute ethanol challenge induces a robust phosphorylation of two key signal transduction kinases, AKT and DARPP‐32, in the striatum of mice. Ethanol‐induced AKT phosphorylation was blocked by the opioid receptor antagonist naltrexone but unaffected by blockade of dopamine D2 receptors via sulpiride. In contrast, DARPP‐32 phosphorylation was abolished by both antagonists. These data suggest that ethanol acts via two distinct but potentially synergistic striatal signaling cascades. One of these is D2‐dependent, while the other is not. These findings illustrate that pharmacology of ethanol reward is likely more complex than that for other addictive drugs.
DROUGHT STRESS: Comparative Time Course Action of the Foliar Applied Glycinebetaine, Salicylic Acid, Nitrous Oxide, Brassinosteroids and Spermine in Improving Drought Resistance of Rice
Authors: Farooq M. , Wahid A. , Lee D.‐J. , Cheema S. A. , Aziz T.
Published: April 2010

Worldwide rice productivity is being threatened by increased endeavours of drought stress. Among the visible symptoms of drought stress, hampered water relations and disrupted cellular membrane functions are the most important. Exogenous use of polyamines (PAs), salicylic acid (SA), brassinosteroids (BRs), glycinebetaine (GB) and nitrous oxide (NO) can induce abiotic stresses tolerance in many crops. In this time course study, we appraised the comparative role of all these substances to improve the drought tolerance in rice (Oryza sativa L.) cultivar Super‐Basmati. Plants were subjected to drought stress at four leaf stage (4 weeks after emergence) by maintaining soil moisture at 50 % of field capacity. Pre‐optimized concentrations of GB (150 mg l−1), SA (100 mg l−1), NO (100 μmol l−1 sodium nitroprusside as NO donor), BR (0.01 μm 24‐epibrassinolide) and spermine (Spm; 10 μm) were foliar sprayed at five‐leaf stage (5 weeks after emergence). There were two controls both receiving no foliar spray, viz. well watered (CK1) and drought stressed (CK2). There was substantial reduction in allometric response of rice, gas exchange and water relation attributes by drought stress. While drought stress enhanced the H2O2, malondialdehyde (MDA) and relative membrane permeability, foliar spray of all the chemicals improved growth possibly because of the improved carbon assimilation, enhanced synthesis of metabolites and maintenance of tissue water status. Simultaneous reduction in H2O2 and MDA production was also noted in the plants treated with these substances. Drought tolerance was sturdily associated with the greater tissue water potential, increased synthesis of metabolites and enhanced capacity of antioxidant system. Of all the chemicals, foliar spray with Spm was the most effective followed by BR.
DROUGHT STRESS: Role of Carbohydrate Metabolism in Drought‐Induced Male Sterility in Rice Anthers*
Authors: Nguyen G. N. , Hailstones D. L. , Wilkes M. , Sutton B. G.
Published: April 2010

Rice plants exposed to three consecutive days of water stress (−0.5 MPa) show a reduction in male fertility and grain set, which is attributed to increased levels of reactive oxygen species (ROS) and activation of a programmed cell death. This current research was conducted to further investigate the association of sugar metabolism with microspore abortion in rice anthers. Biochemical assays showed that sucrose, glucose and fructose contents were found to be significantly increased in anthers from water stressed plants compared with the control. qRT‐PCR analyses and in situ hybridization of metabolic genes (sugar transporters, invertase and phosphotransferase/kinases) demonstrated that the supply of sugars for developing microspores and the initial steps of sugar utilization e.g. glycolysis, were not repressed. However, it appears that the accumulation of sugars in stressed anthers might involve a reduction of mitochondrial activity during the tricarboxylic acid cycle, which could result in excessive production of ROS and a depletion of the ATP pool. These results also suggest that higher levels of sugars at all stages of anther development seemed to be associated with some measure of protection to the anthers against oxidative stress. Induced expression of sugar transporter genes might have maintained the high levels of sugar in the tapetum and the locules, which alleviated oxidant damage caused by excessive ROS generation. Thus, the increased level of sugars might potentially be a natural response in providing protection against oxidant damage by strengthening the antioxidant system in anthers.
Medical and Surgical Management of a Dystocia Because of Foetopelvic Disproportion in an African Lioness (Panthera Leo)
Authors: Batista‐Arteaga M , Santana M , Lozano O , Méndez J , Quesada O , Arbelo M , Espinosa J
Published: April 2010

Contents

Medical and surgical management of a foetopelvic dystocia in an African lioness (Panthera leo) and the post‐operative complications are reported. A caesarean section was performed to extract an oversize foetus blocked at the cervical canal; the lioness died 36 h after surgery. At necropsy, an abdominal effusion with sero‐haemorrhagic fluid was observed, along with a fibrinopurulent exudate adhered to the serosal surfaces of the pelvic and abdominal cavities. In addition, the pelvic symphysis was not cartilaginous, but formed a firm and rigid joint between the pubis and ischium of each hip. The macroscopic and microscopic findings confirmed the presence of metritis, vaginitis and peritonitis. Dystocia may be caused by the premature ossification of the pelvic symphysis, reducing the dimensions of the pelvic cavity.
PlayStation® purpura
Authors: Robertson Susan J , Leonard Jane , Chamberlain Alex J
Published: April 2010

A 16‐year‐old boy presented with a number of asymptomatic pigmented macules on the volar aspect of his index fingers. Dermoscopy of each macule revealed a parallel ridge pattern of homogenous reddish‐brown pigment. We propose that these lesions were induced by repetitive trauma from a Sony PlayStation® 3 (Sony Corporation, Tokyo, Japan) vibration feedback controller. The lesions completely resolved following abstinence from gaming over a number of weeks. Although the parallel ridge pattern is typically the hallmark for early acral lentiginous melanoma, it may be observed in a limited number of benign entities, including subcorneal haematoma.