bluuebunny/crossref_metadata_2025 huggingface dataset:
Impairment due to cannabis and ethanol: clinical signs and additive effects
Authors: Bramness Jørgen G. , Khiabani Hassan Zaré , Mørland Jørg
Published: March 2010

AimsStudies have shown that the impairing effects of Δ‐9‐tetrahydrocannabinol (THC) are dose‐related. Cannabis intake increases the risk of traffic accidents. The purpose of this study was to see how different clinical tests and observations were related to blood THC concentrations and to determine whether the combined influence of THC and ethanol was different from either drug alone.

DesignA retrospective cross‐sectional forensic database study.

SettingDrivers apprehended by the police suspected of driving under the influence of alcohol other drugs.

ParticipantsWe investigated 589 cases positive for THC only. In addition, 894 cases with THC and ethanol were included. A comparison was made with 3480 drivers with only ethanol in their blood and 79 drivers who tested negative.

MeasurementsData were analytical results of blood samples and the 27 clinical tests and observations included in the Norwegian clinical test for impairment (CTI).

FindingsNo relationship was found between blood THC concentration and most of the CTI tests. Blood THC concentration was, however, related to conjunctival injection, pupil dilation and reaction to light and to the overall risk of being judged impaired. When THC and ethanol were detected together the risk of being judged impaired was increased markedly.

ConclusionsThis study demonstrates that cannabis impairs driving ability in a concentration‐related manner. The effect is smaller than for ethanol. The effect of ethanol and cannabis taken simultaneously is additive. Conjunctival injection, dilated pupils and slow pupil reaction are among the few signs to reveal THC influence.
Initial axillary staging of breast cancer using ultrasound‐guided fine needle aspiration: a liquid‐based cytology study
Authors: Schiettecatte A. , Bourgain C. , Breucq C. , Buls N. , De Wilde V. , de Mey J.
Published: March 2010

A. Schiettecatte, C. Bourgain, C. Breucq, N. Buls, V. De Wilde and J. de Mey  Initial axillary staging of breast cancer using ultrasound‐guided fine needle aspiration: a liquid‐based cytology study

Objective:  To evaluate the preoperative detection of axillary metastasis combining ultrasound (US)‐guided fine needle aspiration cytology (FNAC) and liquid‐based cytology (Surepath®) to reduce sentinel node procedures.

Methods:  In total, 148 patients with clinically negative lymph nodes and no preoperative therapy were included. All patients underwent preoperative ultrasound of the axilla with FNAC if suspicious lymph nodes were found. Complete axillary lymph node dissection was performed at primary surgery when FNAC was positive. All other patients underwent a sentinel node procedure.

Results:  US‐guided FNAC of the axilla revealed metastasis in 34 (23.0%) of the 148 patients. These 34 patients were 53.1% of all patients (n = 64) with proven axillary lymph node involvement. In 66 patients (44.6%), both ultrasound and histopathology were negative. Overall sensitivity of US‐guided FNAC was 50.0%, specificity 100%, positive predictive value 100% and negative predictive value 70.2%. In T1 tumours, all patients referred for sentinel node procedure were node‐negative. The correlation between malignant FNAC and histopathology was 100%. US‐guided liquid‐based FNAC in patients with no clinically positive lymph nodes reduced the necessity for a sentinel node procedure by 23.0%.

Conclusions:  We advocate that US‐guided fine needle aspiration (FNA) combined with liquid‐based cytology of axillary lymph nodes should be included in the preoperative staging of breast cancer.
Effect of depth and width of cultivation and sowing date on establishment of red clover (Trifolium pratense L.) by rotary slot‐seeding into grassland
Authors: Komárek P. , Pavlů V. , Hejcman M.
Published: March 2010

The effect of different combinations of time of sowing and depth and width of soil cultivation using a rotary slot‐seeding machine to introduce red clover (Trifolium pratense) was determined for some characteristics of newly established red clover plants in a lowland Dactylis glomerata‐dominated grassland in the Czech Republic. Sowing was carried out on four sowing dates in one growing season: 11 May; 21 June (after the first cut); 9 August (after the second cut); and 19 September. The experimental treatments consisted of all combinations of four depths (5, 10, 15 and 20 cm) and four widths (5, 10, 15 and 20 cm) of soil cultivation. Measurements were made of number of plants, weight and height of plants, weight and height of roots. Measurements at 2 months after sowing showed fewer seedlings for the 11 May sowing than for later sowing dates. The number of red clover plants increased as the row width was increased up to 15 cm, regardless of the depth of slot. Positive effects of slot width on weight and height of plants and weight and length of roots were recorded. A highly positive correlation was found between weight of plants and weight of roots. Width of row was the key factor for the successful establishment of seedlings into the existing sward by slot‐seeding. A row width of 10 cm and depth of slot of 5 cm was considered a satisfactory combination.
The Psychological Reward Satisfaction Scale: developing and psychometric testing two refined subscales for nurses
Authors: De Gieter Sara , De Cooman Rein , Pepermans Roland , Jegers Marc
Published: March 2010

de gieter s., de cooman r., pepermans r. & jegers m. (2010) The Psychological Reward Satisfaction Scale: developing and psychometric testing two refined subscales for nurses. Journal of Advanced Nursing66(4), 911–922.

Title.  The Psychological Reward Satisfaction Scale: developing and psychometric testing two refined subscales for nurses.

Aim.  This paper is a report of the development and psychometric testing of two refined subscales of the Psychological Reward Satisfaction Scale.

Background.  Besides financial and material rewards, nurses also value psychological rewards: supportive and positively evaluated outcomes of the relationship an employee develops with the supervisor. Satisfaction with these rewards influences employees’ attitudes. Recently, the Psychological Reward Satisfaction Scale was developed to measure an employee’s satisfaction with psychological rewards. However, this instrument needs refinement before it can be used with a nursing sample.

Method.  We conducted a pilot study to test the reliability of the refined subscales. Forty nurses completed an online survey twice, with a time interval of 2 weeks. Afterwards, we gathered survey data with a larger sample of 337 nurses to examine the two subscales and their influence on turnover intention and the turnover antecedents job satisfaction and organizational commitment (measured by validated scales) in more detail. Data collection took place in Belgium in 2006.

Results.  The two refined subscales each contained four items. A series of hierarchical regression analyses suggested that satisfaction with psychological rewards from the head nurse has a statistically significant influence on nurses’ turnover intention, job satisfaction and affective commitment, whereas pay satisfaction has not. Satisfaction with psychological rewards from the physicians only explained nurses’ affective commitment.

Conclusion.  When trying to motivate nurses through rewarding them, hospital managers should not only concentrate on financial rewards, but also pay attention to psychological rewards.
The concept of ‘nursing’ in the abortion services
Authors: Gallagher Katie , Porock Davina , Edgley Alison
Published: March 2010

gallagher k., porock d. & edgley a. (2010) The concept of ‘nursing’ in the abortion services. Journal of Advanced Nursing66(4), 849–857.

Title.  The concept of ‘nursing’ in the abortion services.

Aim.  This paper is a report of a study of the perceptions of nurses who work in abortion services.

Background.  International debate surrounds abortion. In England and Wales the Abortion Act which was introduced in 1967 recently came under public review in relation to its legal limit of 24 weeks gestation. The review did not extend to those working within abortion services, and these nurses’ views remained unknown. Investigating the perceptions of nurses who work in abortion services adds a dimension to the debate from a professional perspective which has hitherto been absent.

Methods.  Qualitative semi‐structured interviews were conducted in 2007 with nine nurses working in three different abortion clinics in the United Kingdom. NVivo was used to manage the interview data and thematic analysis identified patterns of nursing concepts and attitudes.

Findings.  Two global themes of ‘Attitudes Towards’ and ‘Coping With’ abortion were identified. Six organizational themes detailed these: ‘society’, ‘nurses’ and ‘reasoning’ in ‘Attitudes Towards’ and ‘role’, ‘clients’ and ‘late gestation abortion’ in ‘Coping With’. Eleven basic themes further described the organizational themes. Kim’s theory of Human Living was used to clarify and provide a rationale for the nursing approach to care in this setting.

Conclusion.  The ability of participants to care for their clients as individuals illustrates the nature of empowerment of the nurses to attain the goals of the client. Making this support explicit through defined roles for nurses would potentially enable nurses in abortion services to perform their role more effectively at all gestation times.
Medication communication: a concept analysis
Authors: Manias Elizabeth
Published: March 2010

manias e. (2010) Medication communication: a concept analysis.Journal of Advanced Nursing66(4), 933–943.

Title. Medication communication: a concept analysis.

Aim. This paper is a report of a concept analysis of medication communication with a particular focus on how it applies to nursing.

Background. Medication communication is a vital component of patient safety, quality of care, and patient and family engagement. Nevertheless, this concept has been consistently taken‐for‐granted without adequate analysis, definition or clarification in the quality and patient safety literature.

Data sources. A literature search was undertaken using bibliographic databases, internet search engines, and hand searches. Literature published in English between January 1988 and June 2009 was reviewed. Walker and Avant’s approach was used to guide the concept analysis.

Discussion. Medication communication is a dynamic and complex process. Defining attributes consider who speaks, who is silent, what is said, what aspects of medication care are prioritized, the use of body language in conversations, and actual words used. Open communication occurs if there is cooperation among individuals in implementing plans of care. Antecedents involve environmental influences such as ward culture and geographical space, and sociocultural influences such as beliefs about the nature of interactions. Consequences involve patient and family engagement in communication, evidence of appropriate medication use, the frequency and type of medication‐related adverse events, and the presence of medication adherence. Empirical referents typically do not reflect specific aspects of medication communication.

Conclusion. This concept analysis can be used by nurses to guide them in understanding the complexities surrounding medication communication, with the ultimate goal of improving patient safety, quality of care, and facilitating patient and family engagement.
The role of the public health nurse in a changing society
Authors: Philibin Caitriona Aine Nic , Griffiths Colin , Byrne Gobnait , Horan Paul , Brady Anne‐Marie , Begley Cecily
Published: March 2010

nic philibin c.a., griffiths c., byrne g., horan p., brady a.‐m. & begley c. (2010) The role of the public health nurse in a changing society. Journal of Advanced Nursing66(4), 743–752.

Title.  The role of the public health nurse in a changing society.

Aim.  This study is a report of a study to clarify the role of the public health nurse in one Irish community care area in the light of acknowledged problems in defining boundaries of the role.

Background.  Demographic developments and planned reorientation towards primary care of the health service in Ireland have changed the workload of public health nurses, which is unique compared with other countries. However, there is a lack of clarity and consequent problems in defining the role of the Irish public health nurse.

Method.  A descriptive qualitative study was conducted with 25 representatives of community nursing from one county in Ireland with a population of 209,077 and a complement of 65 full‐time equivalent public health nurses. Purposive sampling was used and 21 public health nurses, two registered general nurses, one assistant director and one school nurse participated. Tape‐recorded, individual semi‐structured interviews were conducted over a 15‐month period from 2002 to 2004. The constant comparative method was used for analysis.

Findings.  Four themes emerged: ‘Jack of all trades: the role of the public health nurse defined and described’, ‘the essence of the role’, ‘challenges to the role of the public health nurse’ and ‘communication’. The first theme is discussed in this paper.

Conclusion.  Public health nurses need to define and redesign their role so that they no longer think that they are the catch‐all service in the community. This will enable them to deal with the rapid demographic, sociological and cultural changes in the population, a change that has international resonance.
Self‐efficacy, self‐care behaviours and quality of life of kidney transplant recipients
Authors: Weng Li‐Chueh , Dai Yu‐Tzu , Huang Hsiu‐Li , Chiang Yang‐Jen
Published: March 2010

weng l.‐c., dai y.‐t., huang h‐l. & chiang y‐j. (2010) Self‐efficacy, self‐care behaviours and quality of life of kidney transplant recipients. Journal of Advanced Nursing66(4), 828–838.

Title.  Self‐efficacy, self‐care behaviours and quality of life of kidney transplant recipients.

Aim.  This paper is a report of an exploration of the effects of self‐efficacy and different dimensions of self‐management on quality of life among kidney transplant recipients.

Background.  Self‐efficacy is an important factor influencing self‐management. Patients with higher self‐efficacy have better self‐management and experience better quality of life. Self‐efficacy influences the long‐term medication‐taking behaviour of kidney transplant recipients.

Method.  A longitudinal, correlational design was used. Data were collected during 2005–2006 with 150 adult kidney transplant recipients on self‐efficacy, self‐management and quality of life using a self‐efficacy scale, self‐management scale and the Medical Outcomes Scale SF‐36 (Chinese), respectively. Relationships among variables were analysed by path analysis.

Results.  Participants with higher self‐efficacy scored significantly higher on the problem‐solving (β = 0·51), patient–provider partnership (β = 0·44) and self‐care behaviour (β = 0·55) dimensions of self‐management. Self‐efficacy directly influenced self‐care behaviour and indirectly affected the mental health component of quality of life (total effect = 0·14). Problem‐solving and partnership did not statistically significantly affect quality of life. Neither self‐efficacy nor self‐management had any effect on the physical health component of quality of life.

Conclusion.  Transplant care teams should incorporate strategies that enhance self‐efficacy, as proposed by social cognitive theory, into their care programmes for kidney transplant recipients. Interventions to maintain and improve patients’ self‐care behaviour should continue to be emphasized and facilitated. Support to enhance patients’ problem‐solving skills and the partnership of patients with health professionals is needed.
Effects of self‐efficacy, affectivity and collective efficacy on nursing performance of hospital nurses
Authors: Lee Tae Wha , Ko Yu Kyung
Published: March 2010

lee t.w. & ko y.k. (2010) Effects of self‐efficacy, affectivity and collective efficacy on nursing performance of hospital nurses. Journal of Advanced Nursing66(4), 839–848.

Title.  Effects of self‐efficacy, affectivity and collective efficacy on nursing performance of hospital nurses.

Aim.  This paper is a report of a study conducted to examine the influence of self‐efficacy and affectivity (individual‐level variables) and collective efficacy (group‐level variable) on nursing performance among hospital nurses.

Background.  Previous studies of nursing performance, which have focused on individual factor outcomes, have shown limitations. Due to the heavy focus on the analysis of single‐level performances, the influence of organizational contextual factors on nursing performance has rarely been studied. Hence, for a better understanding of nurses’ professional development and effective functioning in hospitals, there is a need to study the effects of organizational characteristics as well as individual characteristics on nursing performance.

Method.  A descriptive‐correlational design was used with a convenience sample of 1996 nurses selected from 182 nursing units in 28 hospitals in six metropolitan cities and seven provinces in Korea. Data were collected in 2006 using self‐administered questionnaires, which were analysed with using descriptive statistics, Pearson correlation coefficients and multilevel analysis.

Results.  Individual‐level variables, including job position, years of experience, employment status, self‐efficacy and positive affectivity were positively related to nursing performance. Collective efficacy and the number of in‐service meetings within units were statistically significant group‐level variables. Group‐level variables reduced the error variances in nursing performance.

Conclusion.  Understanding the effects of group‐level variables on nursing performance improves performance management approaches in hospitals.
Realistic Evaluation of Early Warning Systems and the Acute Life‐threatening Events – Recognition and Treatment training course for early recognition and management of deteriorating ward‐based patients: research protocol
Authors: McGaughey Jennifer , Blackwood Bronagh , O’Halloran Peter , Trinder Thomas John , Porter Sam
Published: March 2010

mcgaughey j., blackwood b., o’halloran p., trinder t.j. & porter s. (2010) Realistic Evaluation of Early Warning Systems and the Acute Life‐threatening Events – Recognition and Treatment training course for early recognition and management of deteriorating ward‐based patients: research protocol. Journal of Advanced Nursing66(4), 923–932.

Title.  Realistic Evaluation of Early Warning Systems and the Acute Life‐threatening Events – Recognition and Treatment training course for early recognition and management of deteriorating ward‐based patients: research protocol.

Aim.  This paper is a description of a study protocol designed to evaluate the factors that enable or constrain the delivery and sustainability of Early Warning Systems and the Acute Life‐threatening Events – Recognition and Treatment training course in practice.

Background.  Rapid response system initiatives have been introduced to try to improve early detection and treatment of patients who deteriorate on general hospital wards. However, recent systematic reviews of the effectiveness of these initiatives show no effect on patient outcomes. Systematic reviews and professional consensus recommend that future research should focus on a broader range of process and outcome measures which consider the social, behavioural and organizational factors that had an impact on the delivery of these initiatives.

Design.  The design is a multiple case study on four wards in two hospitals in Northern Ireland that have implemented Early Warning Systems and Acute Life‐threatening Events – Recognition and Treatment training. Data will be collected from key stakeholders using individual and focus group interviews, non‐participant observation, Acute Life‐threatening Events – Recognition and Treatment training records and audit of patients’ observation charts and medical notes. Realistic Evaluation of the data will enable the development and refinement of theories to explain which mechanisms work in a particular context to achieve desired outcomes.

Discussion.  This study will produce important information that will contribute to knowledge of the organizational processes that have an impact on the delivery of initiatives to identify, respond and manage acutely ill patients in hospital.
Patient safety: numerical skills and drug calculation abilities of nursing students and Registered Nurses
Authors: McMullan Miriam , Jones Ray , Lea Susan
Published: March 2010

mcmullan m., jones r. & lea s. (2010) Patient safety: numerical skills and drug calculation abilities of nursing students and Registered Nurses. Journal of Advanced Nursing 66(4), 891–899.

Title.  Patient safety: numerical skills and drug calculation abilities of nursing students and Registered Nurses.

Aim.  This paper is a report of a correlational study of the relations of age, status, experience and drug calculation ability to numerical ability of nursing students and Registered Nurses.

Background.  Competent numerical and drug calculation skills are essential for nurses as mistakes can put patients’ lives at risk.

Method.  A cross‐sectional study was carried out in 2006 in one United Kingdom university. Validated numerical and drug calculation tests were given to 229 second year nursing students and 44 Registered Nurses attending a non‐medical prescribing programme.

Results.  The numeracy test was failed by 55% of students and 45% of Registered Nurses, while 92% of students and 89% of nurses failed the drug calculation test. Independent of status or experience, older participants (≥35 years) were statistically significantly more able to perform numerical calculations. There was no statistically significant difference between nursing students and Registered Nurses in their overall drug calculation ability, but nurses were statistically significantly more able than students to perform basic numerical calculations and calculations for solids, oral liquids and injections. Both nursing students and Registered Nurses were statistically significantly more able to perform calculations for solids, liquid oral and injections than calculations for drug percentages, drip and infusion rates.

Conclusion.  To prevent deskilling, Registered Nurses should continue to practise and refresh all the different types of drug calculations as often as possible with regular (self)‐testing of their ability. Time should be set aside in curricula for nursing students to learn how to perform basic numerical and drug calculations. This learning should be reinforced through regular practice and assessment.
Top predators, mesopredators and their prey: interference ecosystems along bioclimatic productivity gradients
Authors: Elmhagen B. , Ludwig G. , Rushton S. P. , Helle P. , Lindén H.
Published: March 2010

1. The Mesopredator Release Hypothesis (MRH) suggests that top predator suppression of mesopredators is a key ecosystem function with cascading impacts on herbivore prey, but it remains to be shown that this top‐down cascade impacts the large‐scale structure of ecosystems.

2. The Exploitation Ecosystems Hypothesis (EEH) predicts that regional ecosystem structures are determined by top‐down exploitation and bottom‐up productivity. In contrast to MRH, EEH assumes that interference among predators has a negligible impact on the structure of ecosystems with three trophic levels.

3. We use the recolonization of a top predator in a three‐level boreal ecosystem as a natural experiment to test if large‐scale biomass distributions and population trends support MRH. Inspired by EEH, we also test if top‐down interference and bottom‐up productivity impact regional ecosystem structures.

4. We use data from the Finnish Wildlife Triangle Scheme which has monitored top predator (lynx Lynx lynx), mesopredator (red fox Vulpes vulpes) and prey (mountain hare Lepus timidus) abundance for 17 years in a 200 000 km2 study area which covers a distinct productivity gradient.

5. Fox biomass was lower than expected from productivity where lynx biomass was high, whilst hare biomass was lower than expected from productivity where fox biomass was high. Hence, where interference controlled fox abundance, lynx had an indirect positive impact on hare abundance as predicted by MRH. The rates of change indicated that lynx expansion gradually suppressed fox biomass.

6. Lynx status caused shifts between ecosystem structures. In the ‘interference ecosystem’, lynx and hare biomass increased with productivity whilst fox biomass did not. In the ‘mesopredator release ecosystem’, fox biomass increased with productivity but hare biomass did not. Thus, biomass controlled top‐down did not respond to changes in productivity. This fulfils a critical prediction of EEH.

7. We conclude that the cascade involving top predators, mesopredators and their prey can determine large‐scale biomass distribution patterns and regional ecosystem structures. Hence, interference within trophic levels has to be taken into account to understand how terrestrial ecosystem structures are shaped.
Complete compensation in Daphnia fecundity and stage‐specific biomass in response to size‐independent mortality
Authors: Nilsson Karin A. , Persson Lennart , Van Kooten Tobias
Published: March 2010

1. Recent theory suggests that compensation or even overcompensation in stage‐specific biomass can arise in response to increased mortality. Which stage that will show compensation depends on whether maturation or reproduction is the more limiting process in the population. Size‐structured theory also provides a strong link between the type of regulation and the expected population dynamics as both depend on size/stage‐specific competitive ability.

2. We imposed a size‐independent mortality on a consumer‐resource system with Daphnia pulex feeding on Scenedesmus obtusiusculus to asses the compensatory responses in Daphnia populations. We also extended an existing stage‐structured biomass model by including several juvenile stages to test whether this extension affected the qualitative results of the existing model.

3. We found complete compensation in juvenile biomass and total population fecundity in response to harvesting. The compensation in fecundity was caused by both a higher proportion of fecund females and a larger clutch size under increased mortality. We did not detect any difference in resource levels between treatments.

4. The model results showed that both stages of juveniles have to be superior to adults in terms of resource competition for the compensatory response to take place in juvenile biomass.

5. The results are all in correspondence with that the regulating process within the population was reproduction. From this, we also conclude that juveniles were superior competitors to adults, which has implications for population dynamics and the kind of cohort cycles seen in Daphnia populations.

6. The compensatory responses demonstrated in this experiment have major implications for community dynamics and are potentially present in any organisms with food‐dependent growth or development.
Contribution of complementary foods to the total daily water needs of urban Guatemalan infants
Authors: Enneman A. , Campos R. , Hernández L. , Palma A. V. , Vossenaar M. , Solomons N. W.
Published: March 2010

Background:  Estimates of adequate intake (AI) for water only became available in 2005. The daily water AI for 6–12‐month‐old infants of both sexes is 800 mL. The present study aimed to estimate the water intake of urban infants receiving both breast milk and complementary feeding (CF) and to compare them with the reference AI.

Methods:  Sixty‐four infants, 42 boys and 22 girls, aged 6–12 months on enrolment, from a low‐income district of Guatemala City, were recruited to the study. Quantitative 24‐h recalls and breastfeeding histories were collected in three serial interviews. The quantity of water was estimated from recipes and food composition moisture values for the CF items reported. The amount of breast milk needed to complement foods and beverages in meeting the individual energy needs was calculated, and breast milk’s water contribution was derived accordingly. The total quantity of water in beverages, including human milk, liquids in recipes and moisture of foods, was tabulated as the infants’ daily intake.

Results:  Some 56.3% of the water needs for boys and 41.1% for girls were satisfied by just water obtained from plain water, other complementary beverages and moisture of foods within CF, exclusive of breast milk. Adding the estimated breast milk intake, the median water intake for the infant sample was essentially equal to the 800 mL of the AI.

Conclusions:  The infants in this low‐income community are approximating the recommended AI for daily water through the currently selected pattern of lactation and CF.
Nasogastric tube feeding and percutaneous endoscopic gastrostomy tube feeding in patients with head and neck cancer
Authors: Nugent B. , Parker M. J. , McIntyre I. A.
Published: March 2010

Background:  For patients with a diagnosis of head and neck cancer, oral nutrition may not provide adequate nutrition during radical radiotherapy or chemoradiation treatment, resulting in enteral feeding initiation. Enteral feeding may be delivered via a nasogastric tube or by a gastrostomy tube. The present study aimed to determine how different treatment modalities impact on requirement for enteral feeding and which method of enteral feeding provided the most benefit to the patient, as demonstrated by weight loss and the number of unscheduled radiotherapy treatment interruptions.

Methods:  Patients who were treated with radical radiotherapy or chemoradiation between January 2004 and June 2007 were reviewed retrospectively (n = 196, male = 149, female = 47). Data were collected on demographics, diagnosis, T and N classification, nutritional status, unscheduled radiotherapy treatment interruptions, and type and duration of enteral feeding. Subjects were divided into three subgroups depending on the treatment received. Comparisons were then made between methods of enteral feeding.

Results:  Combined modality treatment (Induction Chemotherapy and Chemoradiation) results in a higher proportion of patients requiring enteral feeding (66–71% compared to 12% for radiotherapy). Patients fed via a prophylactic percutaneous endoscopic gastrostomy lost the least amount of weight during treatment (−4.6% to +1.4%), although the method of enteral feeding did not statistically influence weight difference at the end of treatment. The enteral feeding method did not influence unscheduled radiotherapy treatment interruptions.

Conclusions:  Combined modality treatment results in a greater requirement for enteral feeding, with these patient groups having the greatest weight loss. The findings obtained in the present study indicate that the method of enteral feeding did not statistically influence weight loss at the end of treatment or unscheduled radiotherapy treatment interruptions.
Assessment of obesity in children and adolescents: synthesis of recent systematic reviews and clinical guidelines
Authors: Reilly J. J.
Published: March 2010

This review summarises recent systematic reviews and evidence‐based guidelines that deal with the issue of how best to diagnose or define obesity in children and adolescents. A recent systematic review showed that parents typically fail to recognise obesity in their children and adolescents, and a good deal of other evidence suggests that health professionals under‐diagnose obesity in children and adolescents when using informal methods based on observation. There is therefore a need for practical, objective, methods that both identify the fattest children and adolescents adequately, and identify those who are at greatest risk of the ‘co‐morbidities’ of obesity. A large body of consistent evidence shows that a high body mass index (BMI) for age and sex identifies the fattest children adequately, with low–moderate false negative rate and a low false positive rate. Furthermore, children and adolescents at high BMI for age are at much greater risk of the co‐morbidities of obesity. A recent systematic review found that the use of BMI for age with national reference data and cut‐off points (such as the 95th percentile to define obesity) was superior to the Cole–International Obesity Task Force international approach for defining obesity based on BMI for age. The same systematic review also found no evidence that use of waist circumference for age improved the diagnosis of obesity, or the cardio‐metabolic co‐morbidities of obesity, in children and adolescents. Recent systematic reviews are therefore supportive of current guidelines that recommend percentile‐based cut‐offs relative to national reference data to (e.g. BMI at or above the 95th or 98th percentile in the UK) to define obesity for clinical applications in children and adolescents.
A localized multimeric anchor attaches the Caulobacter holdfast to the cell pole
Authors: Hardy Gail G. , Allen Rebecca C. , Toh Evelyn , Long Maria , Brown Pamela J. B. , Cole‐Tobian Jennifer L. , Brun Yves V.
Published: March 2010

Caulobacter crescentus attachment is mediated by the holdfast, a complex of polysaccharide anchored to the cell by HfaA, HfaB and HfaD. We show that all three proteins are surface exposed outer membrane (OM) proteins. HfaA is similar to fimbrial proteins and assembles into a high molecular weight (HMW) form requiring HfaD, but not holdfast polysaccharide. The HfaD HMW form is dependent on HfaA but not on holdfast polysaccharide. We show that HfaA and HfaD form homomultimers and that they require HfaB for stability and OM translocation. All three proteins localize to the late pre‐divisional flagellar pole, remain at this pole in swarmer cells, and localize at the stalk tip after the stalk is synthesized at the same pole. Hfa protein localization requires the holdfast polysaccharide secretion proteins and the polar localization factor PodJ. An hfaB mutant is much more severely deficient in adherence and holdfast attachment than hfaA and hfaD mutants. An hfaA, hfaD double mutant phenocopies either single mutant, suggesting that HfaB is involved in holdfast attachment beyond secretion of HfaA and HfaD. We hypothesize that HfaB secretes HfaA and HfaD across the outer membrane, and the three proteins form a complex anchoring the holdfast to the stalk.
A lipoprotein modulates activity of the MtrAB two‐component system to provide intrinsic multidrug resistance, cytokinetic control and cell wall homeostasis in Mycobacterium
Authors: Nguyen Hoa T. , Wolff Kerstin A. , Cartabuke Richard H. , Ogwang Sam , Nguyen Liem
Published: March 2010

The MtrAB signal transduction system, which participates in multiple cellular processes related to growth and cell wall homeostasis, is the only two‐component system known to be essential in Mycobacterium. In a screen for antibiotic resistance determinants in Mycobacterium smegmatis, we identified a multidrug‐sensitive mutant with a transposon insertion in lpqB, the gene located immediately downstream of mtrA–mtrB. The lpqB mutant exhibited increased cell–cell aggregation and severe defects in surface motility and biofilm growth. lpqB cells displayed hyphal growth and polyploidism, reminiscent of the morphology of Streptomyces, a related group of filamentous Actinobacteria. Heterologous expression of M. tuberculosis LpqB restored wild‐type characteristics to the lpqB mutant. LpqB interacts with the extracellular domain of MtrB, and influences MtrA phosphorylation and promoter activity of dnaA, an MtrA‐regulated gene that affects cell division. Furthermore, in trans expression of the non‐phosphorylated, inactive form of MtrA in wild‐type M. smegmatis resulted in phenotypes similar to those of lpqB deletion, whereas expression of the constitutively active form of MtrA restored wild‐type characteristics to the lpqB mutant. These results support a model in which LpqB, MtrB and MtrA form a three‐component system that co‐ordinates cytokinetic and cell wall homeostatic processes.
Gene position in a long operon governs motility development in Bacillus subtilis
Authors: Cozy Loralyn M. , Kearns Daniel B.
Published: March 2010

Growing cultures of Bacillus subtilis bifurcate into subpopulations of motile individuals and non‐motile chains of cells that are differentiated at the level of gene expression. The motile cells are ON and the chaining cells are OFF for transcription that depends on RNA polymerase and the alternative sigma factor σD. Here we show that chaining cells were OFF for σD‐dependent gene expression because σD levels fell below a threshold and σD activity was inhibited by the anti‐sigma factor FlgM. The probability that σD exceeded the threshold was governed by the position of the sigD gene. The proportion of ON cells increased when sigD was artificially moved forward in the 27 kb fla/che operon. In addition, we identified a new σD‐dependent promoter that increases sigD expression and may provide positive feedback to stabilize the ON state. Finally, we demonstrate that ON/OFF motility states in B. subtilis are a form of development because mosaics of stable and differentiated epigenotypes were evident when the normally dispersed bacteria were forced to grow in one dimension.
Gene position within a long transcript as a determinant for stochastic switching in bacteria
Authors: Veening Jan‐Willem , Kuipers Oscar P.
Published: March 2010

How cultures of genetically identical cells bifurcate into distinct phenotypic subpopulations under uniform growth conditions is an important question in developmental biology of relevance even to relatively simple developmental systems, such as spore formation in bacteria. A growing Bacillus subtilis culture consists of either cells that are motile and can swim or cells that are non‐motile and are chained together. In this issue of Molecular Microbiology, Cozy and Kearns show that the probability of a cell to become motile depends on the position of the sigD gene within the long (27 kb) motility operon. sigD encodes the alternative sigma factor σD that, together with RNA polymerase, drives expression of genes required for cell separation and the assembly of flagella. sigD is the penultimate gene of the B. subtilis motility operon and, in the control strain approximately, 70% of the cells are motile. When sigD was moved upstream within the operon, a larger fraction of cells became motile (up to 100%). This study highlights that the position of a gene within an operon can have a large impact on the control of gene expression. Furthermore, it suggests that RNA polymerase processivity or mRNA turnover can play important roles as sources of noise in bacterial development, and that gene position might be an unrecognized and possibly widespread mechanism to regulate phenotypic variation.
Structure determination and analysis of a haemolytic gingipain adhesin domain from Porphyromonas gingivalis
Authors: Li Nan , Yun Peter , Nadkarni Mangala A. , Ghadikolaee Nazila Babapoor , Nguyen Ky‐Anh , Lee Mihwa , Hunter Neil , Collyer Charles A.
Published: March 2010

Porphyromonas gingivalis is an obligately anaerobic bacterium recognized as an aetiological agent of adult periodontitis. P. gingivalis produces cysteine proteinases, the gingipains. The crystal structure of a domain within the haemagglutinin region of the lysine gingipain (Kgp) is reported here. The domain was named K2 as it is the second of three homologous structural modules in Kgp. The K2 domain structure is a ‘jelly‐roll’ fold with two anti‐parallel β‐sheets. This fold topology is shared with adhesive domains from functionally diverse receptors such as MAM domains, ephrin receptor ligand binding domains and a number of carbohydrate binding modules. Possible functions of K2 were investigated. K2 induced haemolysis of erythrocytes in a dose‐dependent manner that was augmented by the blocking of anion transport. Further, cysteine‐activated arginine gingipain RgpB, which degrades glycophorin A, sensitized erythrocytes to the haemolytic effect of K2. Cleaved K2, similar to that found in extracted Kgp, lacks the haemolytic activity indicating that autolysis of Kgp may be a staged process which is artificially enhanced by extraction of the protein. The data indicate a functional role for K2 in the integrated capacity conferred by Kgp to enable the porphyrin auxotroph P. gingivalis to capture essential haem from erythrocytes.
The development of Arabidopsis as a model plant
Authors: Koornneef Maarten , Meinke David
Published: March 2010

Twenty‐five years ago, Arabidopsis thaliana emerged as the model organism of choice for research in plant biology. A consensus was reached about the need to focus on a single organism to integrate the classical disciplines of plant science with the expanding fields of genetics and molecular biology. Ten years after publication of its genome sequence, Arabidopsis remains the standard reference plant for all of biology. We reflect here on the major advances and shared resources that led to the extraordinary growth of the Arabidopsis research community. We also underscore the importance of continuing to expand and refine our detailed knowledge of Arabidopsis while seeking to appreciate the remarkable diversity that characterizes the plant kingdom.
Small RNAs – secrets and surprises of the genome
Authors: Chen Xuemei
Published: March 2010

Small RNAs associated with post‐transcriptional gene silencing were first discovered in plants in 1999. Although this study marked the beginning of small RNA biology in plants, the sequence of the Arabidopsis genome and related genomic resources that were soon to become available to the Arabidopsis community launched the research on small RNAs at a remarkable pace. In 2000, when the genetic blueprint of the first plant species was revealed, the tens of thousands of endogenous small RNA species as we know today remained hidden features of the genome. However, the subsequent 10 years have witnessed an explosion of our knowledge of endogenous small RNAs: their widespread existence, diversity, biogenesis, mode of action and biological functions. As key sequence‐specific regulators of gene expression in the nucleus and the cytoplasm, small RNAs influence almost all aspects of plant biology. Because of the extensive conservation of mechanisms concerning the biogenesis and molecular actions of small RNAs, research in the model plant Arabidopsis has contributed vital knowledge to the small RNA field in general. Our knowledge of small RNAs gained primarily from Arabidopsis has also led to the invention of effective gene knock‐down technologies that are applicable to diverse plant species, including crop plants. Here, I attempt to recount the developments of the small RNA field in the pre‐ and post‐genomic era, in celebration of the 10th anniversary of the completion of the first plant genome.
Arabidopsis seed secrets unravelled after a decade of genetic and omics‐driven research
Authors: North Helen , Baud Sébastien , Debeaujon Isabelle , Dubos Christian , Dubreucq Bertrand , Grappin Philippe , Jullien Marc , Lepiniec Loïc , Marion‐Poll Annie , Miquel Martine , Rajjou Loïc , Routaboul Jean‐Marc , Caboche Michel
Published: March 2010

Seeds play a fundamental role in colonization of the environment by spermatophytes, and seeds harvested from crops are the main food source for human beings. Knowledge of seed biology is therefore important for both fundamental and applied issues. This review on seed biology illustrates the important progress made in the field of Arabidopsis seed research over the last decade. Access to ‘omics’ tools, including the inventory of genes deduced from sequencing of the Arabidopsis genome, has speeded up the analysis of biological functions operating in seeds. This review covers the following processes: seed and seed coat development, seed reserve accumulation, seed dormancy and seed germination. We present new insights in these various fields and describe ongoing biotechnology approaches to improve seed characteristics in crops.
Lipid biochemists salute the genome
Authors: Wallis James G. , Browse John
Published: March 2010

The biochemistry of plant metabolic pathways has been studied for many generations; nevertheless, numerous new enzymes and metabolic products have been discovered in the last 5–10 years. More importantly, many intriguing questions remain in all areas of metabolism. In this review, we consider these issues with respect to several pathways of lipid metabolism and the contributions made by the Arabidopsis genome sequence and the tools that it has spawned. These tools have allowed identification of enzymes and transporters required for the mobilization of seed storage lipids, as well as transporters that facilitate movement of lipids from the endoplasmic reticulum to the chloroplast in green leaf cells. Genomic tools were important in recognition of novel components of the cutin and suberin polymers that form water‐impermeable barriers in plants. The waxes that also contribute to these barriers are exported from cells of the epidermis by transporters that are now being identified. Biochemical and genetic knowledge from yeast and animals has permitted successful homology‐based searches of the Arabidopsis genome for genes encoding enzymes involved in the elongation of fatty acids and the synthesis of sphingolipids. Knowledge of the genome has identified novel enzymes for the biosynthesis of the seed storage lipid, triacylglycerol, and provided a refined understanding of how the pathways of fatty acid and triacylglycerol synthesis are integrated into overall carbon metabolism in developing seeds.
Getting to the root of plant biology: impact of the Arabidopsis genome sequence on root research
Authors: Benfey Philip N. , Bennett Malcolm , Schiefelbein John
Published: March 2010

Prior to the availability of the genome sequence, the root of Arabidopsis had attracted a small but ardent group of researchers drawn to its accessibility and developmental simplicity. Roots are easily observed when grown on the surface of nutrient agar media, facilitating analysis of responses to stimuli such as gravity and touch. Developmental biologists were attracted to the simple radial organization of primary root tissues, which form a series of concentric cylinders around the central vascular tissue. Equally attractive was the mode of propagation, with stem cells at the tip giving rise to progeny that were confined to cell files. These properties of root development reduced the normal four‐dimensional problem of development (three spatial dimensions and time) to a two‐dimensional problem, with cell type on the radial axis and developmental time along the longitudinal axis. The availability of the complete Arabidopsis genome sequence has dramatically accelerated traditional genetic research on root biology, and has also enabled entirely new experimental strategies to be applied. Here we review examples of the ways in which availability of the Arabidopsis genome sequence has enhanced progress in understanding root biology.
Arabidopsis and the plant immune system
Authors: Nishimura Marc T. , Dangl Jeffery L.
Published: March 2010

Understanding the fundamental mechanisms of plant disease resistance is of central importance to sustainable agriculture and human health. Use of the model plant Arabidopsis thaliana has resulted in an explosion of information regarding both disease resistance and susceptibility to pathogens. The last 20 years of research have demonstrated the commonalities between Arabidopsis and crop species. In this review, commemorating the 10th anniversary of the sequencing of the Arabidopsis genome, we will address some of the insights derived from the use of Arabidopsis as a model plant pathology system.