bluuebunny/crossref_metadata_2025 huggingface dataset:
Population views on access to community nursing services in Finland
Authors: Koponen Paivikki , Oksanen Hanna , Perttila Kerttu , DrMed Seppo Aro
Published: November 2003

The aim of this study was to evaluate potential access to personal community nursing services and the desirability of these services from the point of view of different population groups Potential access to personal community nursing services was defined as having one or more particular nurses to contact when needing help and advice in health matters The desirability of these services was defined as the respondents'estimation of how useful they considered it to be for them to have access to personal community nursing services A computer‐assisted telephone interview for the population living in the catchment areas of 10 health centres in Finland was conducted A random sample of the total population aged 16–79 years was drawn from the population register Logistic regression revealed that gender, type of community and employment status had best explanatory power in having potential access to personal nursing services and in considering these services desirable However, many of those who considered personal nursing services very desirable, indicated that they did not have potential access to such services Most of these persons were elderly and had a chronic disease or disability Developing access to personal community nursing services particularly for these population groups appears to be needed
Project 2000 students' perceptions of their training
Authors: Parker Tracy J , Carlisle Caroline
Published: November 2003

This paper reports on the findings of a study conducted into the perceptions of final year Project 2000 pre‐registration students towards their pre‐registration education programme The aim of the research was to discover how students perceive their training in terms of value, relevance, intellectual potency, teaching methods and organization Data were collected using the Hoste scale which has been developed for the evaluation of educational courses A convenience sample of students (n = 131) within one college of nursing were invited to participate Findings include a particularly high level of satisfaction with Project 2000 in terms of value, breadth and relevance Organization and liveliness of the course were perceived much less satisfactorily There was a trend for a statistically significant difference between the mean scores of the theoretical and practical components of the course The findings are discussed with particular reference to the perceptions of theory and practice within the educational programme
Nursing documentation in patient records: experience of the use of the VIPS model
Authors: Ehrenberg Anna , Ehnfors Margareta , Thorell‐Ekstrand Ingrid
Published: November 2003

The VIPS model for the documentation of nursing care in patient records was scientifically developed and published in 1991, with the aim of supporting the systematic documentation of nursing care and promoting individualized care As the model seemed to be accepted and used in many parts of Sweden, a study was conducted in order to gather further information on the validity of the model, to describe the clinical and educational experience of its use and to refine it Experience of the use of the model was gathered from a review of the scientific papers and other reports on it, from questionnaires addressed to nurses (n= 514), from comments by key informants, and from interviews with faculty members at all the nursing schools in the country The findings showed that an intense process of change and development was occurring regarding nursing documentation However, there were limitations in the use of the entire nursing process, especially in the specification of patient problems and the formulation of nursing diagnoses and nursing interventions The keywords (Swedish spelling) of the VIPS model had good content validity m different areas of nursing care The findings also indicated the need for further elaboration and revision of some of the keywords A revised version of the VIPS model based on these findings is presented
Selecting a database for literature searches in nursing: MEDLINE or CINAHL?
Authors: Brazier Hugh , Begley Cecily M
Published: November 2003

This study compares the usefulness of the MEDLINE and CINAHL databases for students on post‐registration nursing courses We searched for nine topics, using title words only Identical searches of the two databases retrieved 1162 references, of which 88% were in MEDLINE, 33% in CINAHL and 20% in both sources The relevance of the references was assessed by student reviewers The positive predictive value of CINAHL (70%) was higher than that of MEDLINE (54%), but MEDLINE produced more than twice as many relevant references as CINAHL The sensitivity of MEDLINE was 85% (95% CI 82–88%), and that of CINAHL was 41% (95% CI 37–45%) To assess the ease of obtaining the references, we developed an index of accessibility, based on the holdings of a number of Irish and British libraries Overall, 47% of relevant references were available in the students' own library, and 64% could be obtained within 48 hours There was no difference between the two databases overall, but when two topics relating specifically to the organization of nursing were excluded, references found in MEDLINE were significantly more accessible We recommend that MEDLINE should be regarded as the first choice of bibliographic database for any subject other than one related strictly to the organization of nursing
Pharmacological characterization of adrenoceptors in horse corpus cavernosum penis
Authors: Recio P. , López P. G. , Fernández J. L. G. , García‐Sacristán A.
Published: November 2003

1 The presence and types of α and β‐adrenoceptors in the corpus cavernosum of the horse were studied in vitro by using selected ligands of adrenoceptors and isometric tension recording.

2 Noradrenaline and phenylephrine induced concentration‐dependent contractions in corpus cavernosum preparations. B‐HT 920 had no effect.

3 Phentolamine and prazosin produced a shift to the right of the dose‐response curve of noradrenaline, while the α2‐antagonist, rauwolscine had no effect on the response to noradrenaline. Phenylephrine‐evoked contractions of corporal strips were significantly inhibited by the α1‐adrenoceptor antagonist, prazosin.

4 Isoprenaline and salbutamol each relaxed precontracted corpus cavernosum preparations in a concentration‐dependent manner; the isoprenaline effect was blocked by propranolol, practolol and butoxamine. The salbutamol effect was blocked by butoxamine.

5 These results suggest the presence of postjunctional α1‐adrenoceptors in horse corpus cavernosum. There is also a heterogenous population of β‐adrenoceptors in this tissue, belonging to the β1 and β2 subtypes.
Prevention by a somatostatin analogue of the hypertensive and cardiovascular structural changes induced by blockade of adenosine receptors
Authors: Calhau C. , Martel F. , Alçada M.N.M.P. , Azevedo I.
Published: November 2003

1 Long‐term administration of the adenosine receptor antagonist, 1,3‐dipropyl‐8‐sulfophenylxanthine (DPSPX), causes arterial hypertension and cardiovascular hypertrophic and hyperplastic changes (Matias, Albino‐Teixeira, Polónia & Azevedo, 1991). As somatostatin is a repressor of cell growth, and adenosine is a potent inducer of the somatostatin gene, we investigated the putative involvement of somatostatin in the cardiovascular effects of DPSPX.

2 DPSPX (90 μg kg−1 h−1, i.p.) or saline and the somatostatin analogue, octreotide (75 μg kg−1 day−1, s.c.), or saline were infused through Alzet minipumps to Wistar rats. Blood pressure was measured with the tail‐cuff technique. Seven days after implantation of the minipumps the rats were killed and the tissues prepared for microscopy.

3 DPSPX induced arterial hypertension and cardiovascular hypertrophic and hyperplastic changes as previously described (Matias et al., 1991). Treatment of the rats with octreotide alone had no effect either on blood pressure or in blood vessel morphology. However, octreotide prevented both the hypertensive and the cardiovascular morphologic effects of DPSPX.

4 The results are compatible with the involvement of somatostatin in the long‐term cardiovascular effects of adenosine.
Water‐soluble fullerene derivatives attenuate exsanguination‐induced bronchoconstriction of guinea‐pigs
Authors: Lai Y.‐L. , Chiang L. Y.
Published: November 2003

1 This study investigated the effects of increased antioxidants (administration of water‐soluble fullerenol‐1 and pre‐exposure to chronic hypoxia) as well as an iron‐chelating agent (deferoxamine) on exsanguination‐induced noncholinergic airway constriction in guinea‐pigs.

2 Fullerenol‐1 usually did not cause significant alteration in respiratory function (lung volumes, dynamic respiratory compliance, maximal expiratory flow at 50% total lung capacity (V¨max50), and forced expiratory flow at 0.1 s (FEV0.1)) at low (200 μg kg−1) or at high doses (2 mg kg−1), except that it produced a slight bronchial constricting action (decreases in both V¨max50 and FEV0.1) at high doses (2 mg kg−1) via intratracheal instillation.

3 Beginning 15 min after exsanguination, there was a marked temporal decrease in FEV0.1, indicating a gradual increase in airway constriction with time.

4 Administration of either fullerenol‐1 or deferoxamine, or pre‐exposure to chronic hypoxia significantly ameliorated the exsanguination‐induced bronchoconstriction. The results provide evidence that oxygen radicals play an important role in exsanguination‐induced airway constriction.

5 The significant effects of the increased antioxidants and deferoxamine, however, cannot be explained by the alteration in either tracheal neutral endopeptidase activity or lung tissue substance P level.
Comparative effects of calcium channel blockers and indomethacin on insulin secretion and blood pressure increase derived from α1‐adrenoceptor stimulation in the rabbit
Authors: García‐Barrado M. J. , Reverte M. , Palomero J. , Moratinos J.
Published: November 2003

1 In conscious, fasted rabbits the intravenous infusion of the α1‐adrenoceptor agonist, amidephrine (3 and 10 μg kg−1 min−1) induced a dose related increase in insulin plasma levels. This effect was accompanied by a minor hypo‐ or hyperglycaemic response, depending on the dose of agonist infused.

2 A dose related increase in mean arterial pressure and reduction in heart rate were also found after amidephrine administration.

3 The insulin secretory response to amidephrine was not prevented in rabbits previously treated with atropine (5.26 μg kg−1 min−1). However, in the presence of muscarinic receptor blockade the bradycardic effect of amidephrine was either suppressed or attenuated.

4 Pretreatment with the calcium channel antagonist elgodipine (35 ng kg−1 min−1) or with indomethacin (0.66 mg kg−1 min−1) clearly blocked the effect of amidephrine on insulin secretion.

5 The haemodynamic changes induced by amidephrine were preserved in the presence of either verapamil (0.17 μg kg−1 min−1) or indomethacin, whereas the hypertensive response was antagonized by elgodipine.

6 Our results suggest that the metabolic and haemodynamic changes mediated by amidephrine are two independent effects, insulin secretion requiring the presence of extracellular calcium and the synthesis of arachidonic acid metabolites.
Contribution of humoral systems to the recovery of blood pressure following severe haemorrhage
Authors: Ponchon P. , Elghozi J. L.
Published: November 2003

1 Profound haemorrhage activates a number of pressor mechanisms, including the release of catecholamines, angiotensin II and arginine‐vasopressin, which contribute to the subsequent cardiovascular recovery. Using specific single or combined blockade with prazosin, losartan and Manning compound (AVPX), the aim of this study was to evaluate the involvement of the three pressor systems in blood pressure recovery following severe heamorrhage (20 ml kg−1).

2 Haemorrhage of conscious, unrestrained rats resulted in a significant initial decrease in blood pressure of approximately 60 mmHg, and heart rate of approximately 70 bpm. Then, blood pressure tended to return to the control level within 10 min. The total cardiovascular recovery corresponded to increments of 52 ± 5 mmHg (81% of the acute fall) for systolic blood pressure, and of 92 ± 22 bpm (124%) for heart rate at 60 min post‐bleeding. Significant falls in haematocrit (‐10.5 ± 1.2%, P < 0.01), in plasma concentrations of proteins (‐10.3 ± 0.9 g l−1, P < 0.01) and haemoglobin (‐2.58 ± 0.72 g 100 ml−1, P < 0.05) were observed at 60 min post‐bleeding.

3 Pretreatment with one or two specific antagonists did not exaggerate the initial fall in blood pressure. The initial bradycardia was weakened only by combined blockade with losartan and AVPX.

4 The blood pressure recovery from a haemorrhage was delayed by approximately 25 min by the inhibition of vasopressin activity. The systolic blood pressure recovery in control animals (81% of the acute fall) was blunted by losartan (55% of the acute fall), prazosin (49%), combined losartan and AVPX (36%), prazosin and AVPX (36%), and also by prazosin plus losartan (13%). The diastolic blood pressure recovery was blunted only in the groups where the activity of angiotensin II was inhibited by losartan.

5 In conclusion, we have shown that neither catecholamines, angiotensin II nor vasopressin, although activated, individually compensate the acute hypotensive response to haemorrhage. The contribution of vasopressin to the blood pressure recovery post‐bleeding is transient and is rapidly replaced by the pressor activity of the catecholamines and angiotensin II. The full systolic blood pressure recovery from severe haemorrhage requires the combined activity of these two pressor systems, while the diastolic blood pressure recovery seems to be only dependent upon angiotensin II activity.
Patterns of forest insect distribution within a large city: microlepidoptera in St Peterburg, Russia
Authors: Kozlov Mikhail
Published: November 2003

Short‐scale distribution patterns of eight species and one species‐group of forest moths with low migratory abilities were studied within the city of St Peterburg, Russia. For species of native fauna which have either completely (spp.) vanished, at least in downtown, the city is considered as a lacuna within the primary distribution range. The opposite pattern (city as an island outside the primary area) was recorded for two invaders, Flkv. The distribution of Stt. was not altered by the city. Habitat fragmentation affected survival of populations of small moths by decreasing colonization rate more than by decreasing patch size. For eurytopic species limited mostly by host plant range (like ), lacunae can disappear if host plants are planted over the city; extinction of stenotopic species (like Micropterix) or species with very limited dispersal (like Stigmella) is practically irreversible. Changes in moth distribution in the city have a strong historical background; they can be both reconstructed and predicted.
Flightless insects: a test case for historical relationships of African mountains
Authors: Brühl Carsten
Published: November 2003

Flightless insects give a clearer view of former distribution of montane habitat in Africa compared with highly mobile animals as birds and butterflies because passive long distance transport and long distance dispersal can be discounted. Only a few species in the twenty‐one genera under study are shared between neighbouring mountains which can be explained in all cases by a Pleistocene lowering of the montane habitat by 850 m. Therefore a montane forest cover connecting the mountains at colder times as suggested by the pluvial theory can be refuted which is in correspondence with palynological findings suggesting a dry corridor between the mountains. No montane refuge for flightless insects can be identified, because the most species‐rich mountain of a genus differs among the genera under study. Instead, each mountain served as a species refuge with a stable habitat. The requirement of a smaller habitat compared to vertebrates is indicated by endemic species on each single mountain suggesting pre‐Pleistocene speciation which results even in endemic genera to one mountain. Different small patches of suitable habitat on one mountain could also explain the radiations found in some genera of flightless insects. In some genera species are lacking on Mt Kenya which indicates—with the findings of no endemic passerine bird on the mountain—a probably very dry condition during colder times. On Mt Cameroon no species of the flightless insect genera occurring on the Eastern mountains are found. This contrasts with the existing patterns of birds, grasses and butterflies.
Where does the Mediterranean Sea begin? Zoogeographical affinities of the littoral sponges of the Straits of Gibraltar
Authors: Carballo J. L. , Naranjo S. , García‐Gómez J. C.
Published: November 2003

A geographical study of the littoral sponges from the Straits of Gibraltar was undertaken, where the origin of these sponges is observed to be a transition between the different geographic regions that meet in the Straits. A great affinity was also observed between the Mauretanian fauna, the fauna from the Straits of Gibraltar and that from the entire Spanish Peninsular Mediterranean, thus conforming a very homogeneous block within the group of areas studied. On the other hand, a numerous group of species traditionally considered endemic to the Mediterranean, such as: Haliclona mucosa, H. valliculata, H. cratera, H. fulva, H. aqueductus. H. mediterranea, Dendroxea lenis, Phorbas tenacior, Hexadella racovitzai, Ircinia oros, Dictyonella incisa, Acanthella acuta, Diplastrella bistellata, etc. are believed to have an origin in tropical or subtropical Alantic waters.
Dispersal mechanism and transcontinental naturalization proneness among Mediterranean herbaceous species
Authors: Malo J. E. , Suarez F.
Published: November 2003

The percentage of central Iberian herbaceous species introduced into the Mediterranean zone of Chile is analysed in terms of the most usual types of dispersal: endo‐ and exo‐zoochory and anemochory. Almost 15% of the herbaceous species from Central Iberia are naturalized in Chile. This proportion is significantly higher for the endo‐ and exozoochorous species (21% and 23%), and not significantly for the anemochorous species (20%). In contrast, only 8% of the species not covered by these three groups have been introduced to Chile. Consequently, the percentage of anemochorous, endo‐ and exozoochorous species is somewhat higher in the dispersive spectrum of the alien species introduced in Chile. These results suggest that the seed dispersal systems associated with animals are particularly favourable for the introduction of species, and that herbivores have facilitated the naturalization and spread of alien herbaceous species from their initial points of introduction.
Four centuries of forest clearance and regeneration in the hinterland of a large city
Authors: Matlack Glenn
Published: November 2003

In the last 350 years, forests of eastern North America have experienced widespread clearance and regrowth with local variation in timing and extent determined by patterns of human land use. This paper describes the history of forest in the hinterland of a large city (Wilmington, Delaware) surrounded by fertile soils and having access to a navigable estuary. Forests were cleared between 1650 and 1780 to accommodate shifting cultivation of cereal crops and to provide fuelwood for nearby cities. Proximity to urban markets supported a vigorous agricultural economy through the 19th century and delayed widespread forest regeneration. Reforestation began on a large scale following the local decline of agriculture 1920–1940. In the late 20th century, forest competes for land with suburban housing. Although a similar sequence has occurred throughout eastern North America, the study area is unique in that a larger proportion of original forest was cleared and reforestation began much later than in other regions. Today, the history of land use is evident in the high proportion of young, successional forest and the very small area of long‐established forest.
Chrysophyte cyst biogeographical and ecological distributions: a synthesis
Authors: Duff Katharine , Zeeb Barbara , Smol John
Published: November 2003

The distributions of chrysophyte stomatocysts in the sediments of 221 lakes from four study areas located in British Columbia, Canada (two datasets), New York, U.S.A., and south central Siberia were examined. The combined lake set spanned a wide range of chemical and morphometric variables. Approximately 400 cyst morphotypes were identified, from which we selected sixty‐three common types for further analysis. Canonical ordination (detrended canonical correspondence analysis (DCCA) and constrained DCCA) showed that four environmental variables (pH, conductivity, depth and total phosphorus (TP) ) were significant (Monte Carlo permutation test, P=0.01 for all four variables) and independent determinants of the cyst distributions. Weighted averaging (WA) inference models were developed for each variable. The best models, in terms of their r2, were developed for pH and conductivity (r2=0.78 and 0.73, respectively). The models for depth and TP were less robust (r2=0.47 and 0.46, respectively). We discuss the relative importance of conductivity and salinity, lakewater acidity and metal concentrations, lake morphometry and trophic status as determinants of chrysophyte population distributions, and possible causal mechanisms for each variable. We identify assemblages of cysts that appear to be associated with six different groups of lakes: (1) very acidic (pH <6.5) lakes; (2) acidic (pH <7.0), softwater lakes; (3) circumneutral (pH 7–8), oligo‐ to mesotrophic lakes; (4) alkaline, hardwater, meso‐ to eutrophic lakes; (5) shallow, alkaline (pH 8–8.5), meso‐ to eutrophic lakes; and (6) shallow, very alkaline (pH >8.5) lakes, including sub‐ and hyposaline lakes. Finally, we suggest further possible avenues for research that will improve the usefulness of chrysophyte stomatocysts as paleolimnological indicators.
Predicting savanna vegetation structure on the basis of plant available moisture (PAM) and plant available nutrients (PAN): a case study from Australia
Authors: Walker Brian , Langridge Jenny
Published: November 2003

The use of the plant available moisture (PAM)/plant available nutrients (PAN) concept to compare savanna structure was examined using data from twenty Australian sites. Above‐ground biomass was regressed on various combinations of seventeen different estimates of PAM (plant available moisture) and two estimates of PAN (plant available nutrients). The ratios of actual transpirational loss from the subsoil to potential evapotranspiration (PET), and total annual rainfall to PET, were most highly correlated with total biomass. Grass biomass is poorly predicted by PAM on its own, and requires inclusion of woody leaf biomass in the regression. PAN had little effect on total biomass, although it is likely to be important for other, functional aspects of vegetation. The woody : grass ratio is best predicted by an index involving the ratio of subsoil : topsoil moisture. For biomass comparisons the use of a detailed water‐balance model to estimate PAM is not warranted.
Habitat selection and ecology of Xanthoria elegans (Link) Th. Fr. in glacier forefields: implications for lichenometry
Authors: McCarthy Daniel
Published: November 2003

Habitats occupied by the largest Xanthoria elegans (Link) Th. Fr. thalli at seven glacier forefields in the Canadian Rockies were studied to investigate the lichenometric assumption that large thalli occupy ideal sites for growth. The largest thalli were found on steep or overhanging facets at the base of grey limestone clasts that were embedded in moraines. These thalli were unfragmented, had nearly circular outlines, were bordered by barren rock and had SSE to S orientations. This is consistent with the general expectation that south‐facing sites offer high solar input and a long snow‐free season. Orientations other than south could result by chance or may reflect the importance of microscale factors (e.g. reflected rather than direct solar input). Closure of X. elegans communities and coalescence of thalli was only found at sites that were naturally fertilized with dung. It is concluded that all clasts do not afford homogeneous or ideal environments for lichen growth and do not have an equal chance of being colonized. This raises doubts concerning the validity of statistical normality assumptions in lichenometry and the use of grids to assess closure in lichen communities.
Environmental change, extinction and human activity: evidence from caves in NW Madagascar
Authors: Burney David , James Helen , Grady Frederick , Rafamantanantsoa Jean‐Gervais , Ramilisonina  , Wright Henry , Cowart James
Published: November 2003

In the last 2000 years, changes on the island of Madagascar have resulted in the modification of key environments and the extinction of nearly all large native animals. Humans have long been suspected as the primary cause of this ecological catastrophe, but the exact mechanisms of the island's rapid transformation and the role of natural factors such as climate change remain uncertain. Caves in northwestern Madagascar are helping researchers to disentangle these factors, by providing many types of datable information concerning the past in close physical proximity. U‐series dated pollen spectra from the caverns of Anjohibe provide a 40,000‐year record of vegetation in the vicinity. Bone deposits from caves in the region provide new site records for extinct taxa, including Babakotia radofilai Godfrey et al. 1990, Plesiorycteropus madagascariensis Filhol 1895, and Mullerornis sp. Several extant taxa that were present in the region in the late Holocene are now locally extinct. Archaeological evidence from the caves suggests little or no human activity in the vicinity or interaction with the fauna at these sites until recent centuries.
Constructing collaborative learning activities for distance cal systems
Authors: Chang C‐K. , Chen G‐D.
Published: November 2003

Many existing Computer Assisted Learning (CAL) systems use computer programs to simulate a teacher for individual learning. However, regardless of how good the CAL system is, a student should also interact with learning companions and human teachers. Due to the popularity and ease of access to computer networks and communication tools, network facilities can be incorporated into a CAL system to make it a distance CAL system. To attain an effective learning outcome, a distance CAL system must be able to: define a group learning model; constrain and advise the students to learn according to the model, and have query facilities which provide the teacher with information about what a student has done and learned, and what a student should do next. A rule‐based system that is conventionally used cannot sufficiently provide those required functions. This paper suggests why this is the case and how an active database system can achieve those goals. Distance CAL
Entitlement through IT in mathematics classrooms
Authors: Povey H.
Published: November 2003

This paper is motivated by the need to find oppositional opportunities within the status quo of mathematics classrooms and the secondary school mathematics curriculum. The document from the National Council for Educational Technology (Mathematics and IT) suggests six ways in which information technology can provide opportunities to which students learning mathematics are 'entitled'. The article is an attempt to draw out ways in which these opportunities might be interpreted which point to more liberatory practices in mathematics classrooms. Each of the information technology opportunities is paralleled with opportunities to begin to develop a social justice curriculum in and through the teaching and learning of mathematics, a curriculum designed to enable students to participate in a democracy more effectively.
Promoting reflective interactions in a CSCL environment
Authors: Baker M. , Lund K.
Published: November 2003

Engaging in reflective activities in interaction, such as explaining, justifying and evaluating problem solutions, has been shown to be potentially productive for learning. This paper addresses the problem of how these activities may be promoted in the context of computer‐mediated communication during a modelling task in physics. The design principles of two different communication interfaces are presented. The first allows free text to be exchanged, and the second structures the interaction by providing a restricted set of communicative possibilities. Comparative analyses of interaction corpora produced with the two communication interfaces are then described. The analyses show that use of the second structured interface in performing the problem‐solving task is feasible for students, and that it promotes a task‐focussed and reflective interaction. In conclusion the different resources provided by different media and the relative degrees of effort that their use requires are discussed.
Modelling students collaborating while learning about energy
Authors: Brna P. , Burton M.
Published: November 2003

Continuing work is described that is aimed at developing a model and a computer‐based simulation of a student learning to model which has the potential for providing better computer‐based support in the future — both in respect of providing improved quality dialogues and in terms of comprehending the student's activities. Such a model needs to take into account factors such as individual differences, task requirements and the context in which the student is working. The current (implemented) model focuses on how individual students build a model of energy flow. The recent work outlined here is aimed at extending the model to include two further issues connected with aspects of the student's environment: how collaboration with another student in the model building process affects the processes of learning and problem solving, and how the diagrammatic representations utilised affect model building. A brief review is given of the progress made in implementing this model.
Inter‐university cooperative learning: an exploratory study
Authors: Calvani A. , Sorzio P. , Varisco B. M.
Published: November 2003

This paper presents some preliminary findings from continuing action research involving university students of Education and examines the creation of a community of learners through the use of electronic media for remote collaboration. The main goal of this community was the design and implementation of a Web site about the curricula content of two parallel courses. The research focussed on the evaluation of the impact of technologies on communication processes among local peers and remote peers, and on the role of experts in the learning process. Qualitative analyses were conducted on information gathered from videorecordings of local interactions, personal portfolios, and cognitive maps. Students also completed rating scales on their perceptions of desired and actual function fulfilment (direct instruction, cognitive scaffolding, and affective scaffolding) by local and remote peers and tutors in the accomplishment of goals.
Interpreting health outcomes
Authors: Davies Huw Talfryn Oakley , Crombie Iain Kinloch
Published: November 2003

Interest in outcomes is universal. To patients, good outcomes represent their highest hopes for therapy; to health care professionals, good outcomes are the desired end‐point of a complex web of care. More recently, politicians and health care managers too have shifted their emphasis away from health service activity and towards what is termed ‘health gain’. The rise of the outcomes movement appears irresistible. However, the difficulties in interpreting outcomes data will not go away. Outcomes measured using routine data are subject to numerous biases and many practical difficulties. Despite recent statistical, methodological and technological advances, comparisons of outcomes at best provide us with weak evidence of either the effectiveness or the quality of health care. And sometimes they may frankly mislead. The apparent intuitiveness of outcomes monitoring has broad public appeal. But enthusiasm for outcomes needs to be tempered with a clear understanding of their limitations.
Advancing the standards of clinical research: the urgent need for new methods and better data
Authors: Herman Joseph
Published: November 2003

Some of the weaknesses of the randomized controlled trial (RCT) are pointed out, among them unavoidable biases, the possibility of coming to erroneous conclusions by the ‘luck of the draw’ and the fact that most such experiments lack a doctor/patient relationship and are of little assistance in clinical decision making. An exaggerated propensity on the part of the medical profession to regard the RCT as the only ‘scientific’ method for research into therapeutics is noted. The potential advantages of post‐marketing surveillance of new interventions in a physician‐centred manner are outlined. Such a data base could ultimately be expanded into a data base that records all activity in a given practice. The PACE strategy, employed by haematologists in the north of England, and the sentinel practice primary care research networks used by family doctors contain elements of the system proposed here. However, each possesses disadvantages that limit its applicability to special cases. Random choice of practices for any particular observational study of a new intervention could lend it some of the features of an experiment.
Monitoring the performance of general practices
Authors: Aveyard Paul
Published: November 2003

Performance indicators for general practice which reduce complex processes to simple counts can have little validity. Additionally, performance indicators are often statistically unreliable in small populations like general practices. Instead, it is possible to combine these measures of performance by using multiple regression to predict the outcome from a set of processes. This allows one to adjust the outcome for differences in the practice populations. It also improves the statistical reliability, because data from all practices are used to predict the outcome. This approach has statistical problems, because it is an ecological analysis, and does not pick out the poor performers (‘bad apples’). The regression approach is similar to the concepts of continuous quality improvement (CQI). It is arguable that using CQI to improve quality is more likely to lead to cooperation from general practices than trying to pick out the poor performers.
The use of maternal weight measurements during antenatal care. A national survey of midwifery practice throughout the United Kingdom
Authors: Ellison George T. H. , Holliday Mary
Published: November 2003

The aim of the present study was to examine the use of maternal weight measurements during antenatal care throughout the United Kingdom. A postal questionnaire and follow‐up letter were sent to 1500 midwives throughout the United Kingdom, selected at random from the UKCC register. The postal survey achieved a response rate of 44.8% (672/1500 questionnaires), and obtained responses from at least 10 midwives in all but the lowest grade. Respondents were representative of midwives practising throughout the country, in terms of their gender, working hours and grade, although there were fewer midwives in community settings than those in a contemporary representative English sample.

The questionnaire obtained information on the background, training and experience of each midwife, together with their attitudes towards antenatal weighing. For those midwives currently involved in antenatal care, additional information was collected on the schedule of antenatal weight measurements, the criteria used to identify ‘abnormal’ weight gain, and the action taken in response to ‘abnormal’ weight gain. 61.8% of the midwives thought that the pattern of maternal weight gain was ‘not important’ in antenatal care, and only 51.5% of those who currently provided antenatal care weighted women at every antenatal visit. However, most midwives (86.1%) cited at least one clinical condition to explain why women are routinely weighed during pregnancy, and over a third of midwives thought that maternal weight gain could detect seven clinical conditions, including obesity, oedema, pre‐eclampsia and polyhydramnios. Midwives with more advanced qualifications (degrees and teaching qualifications) and those working in educational or community settings were least likely to believe that weight gain was good at detecting clinical outcomes. Differences in the perceived utility of antenatal weighing influenced whether midwives would act in response to ‘abnormal’ maternal weight gain, and whether they advised women to gain or lose weight during pregnancy. However, the criteria that midwives used for identifying ‘abnormal’ weight gain were variable, and often inappropriate, so that different midwives are unlikely to intervene consistently or to give consistent advice on the basis of maternal weight gain. These differences in practice may lead to extensive and inappropriate variation in antenatal care. Clear guidelines are urgently required to ensure that, if maternal weight measurements are collected during antenatal care, they are collected and used consistently.
Beyond health outcomes: the advantages of measuring process
Authors: Crombie I. K. , Davies H. T. O.
Published: November 2003

The use of process measures in the assessment of the quality of care has been neglected of late. The outcomes movement has gathered momentum and process measurement appears to have been left trailing in the wake. Yet process measures can be sensitive indicators of the quality of care and have many advantages over outcomes. They are readily measured and can easily be interpreted; comparisons are not essential (as they are with outcomes monitoring) but even if used they are little bothered by the case‐mix arguments which bedevil outcomes assessment. Further, the direct measurement of process can directly indicate deficiencies of care which need to be remedied. Finally, there are some aspects of care which are only amenable to study using measures of process. These benefits come at a price: first there must be good evidence that links the processes of care to desirable outcomes. This paper explores the advantages of measuring processes of care in quality assessment and advocates a balanced approach to the process vs. outcome debate.
Snyder v. American Association of Blood Banks: a re‐examination of liability for medical practice guideline promulgators
Authors: Noble Alice , Brennan Troyen A. , Hyams Andrew L.
Published: November 2003

Medical practice guidelines are playing an increasingly important role in both the medical and the legal context. As tools for the health practitioner, it is thought that medical practice guidelines may contribute to an increase in the quality of patient care and cost‐effectiveness. In the legal setting, guidelines may improve the functioning of the medical malpractice system by creating more rational, predictable standards of care. The development and promulgation of medical practice guidelines, while increasing, are still evolving. A number of concerns, especially in the areas of physician autonomy, physician control, and ethics, as well as efficacy, need to be resolved. The use of such guidelines as the legal standard of care in malpractice cases evokes similar concerns, along with fears that the use of guidelines at trial may either lower the standard of care, or, conversely, raise the standard of care to levels that are difficult to meet. Adding to this controversy is the recent case of Snyder v. American Association of Blood Banks (1996), in which the New Jersey Supreme Court upheld a jury finding that the American Association of Blood Banks (AABB) was liable to a plaintiff who contracted AIDS from an HIV‐tainted transfusion, for negligent failure to adopt guidelines requiring blood testing for surrogate markers. This opinion is significant as the first to find a duty of care running from a medical guideline promulgator to a third person, the injured patient. The opinion is examined in depth and within the context of other relevant case law. The impact the opinion will have is difficult to gauge. The somewhat unique facts of the case, as well as the court's unusually stinging critique of the defendant, AABB, and its motivations informing its response to the concerns about blood contamination, may limit its value as precedent. However, precedent does exist in analogous non‐medical cases for promulgator liability. The pros and cons of promulgator liability are weighed. While closer regulation of guideline development and promulgation or promulgator immunity may be warranted, it is premature to consider either seriously until the impact of the Snyder opinion can be appreciated.
Nutritional status assessed in groups off smolting Atlantic salmon, Salmo salar L., developing cataracts
Authors: Waagbø R , Bjerkås E , Sveier H , Breck O , Bjørnestad E , Maage A
Published: November 2003

There has been an increasing number of reports on cataracts in Norwegian and international salmon farming. The present study was undertaken to examine physiological and nutritional conditions during an outbreak of cataracts observed in rapidly growing Atlantic salmon, Salmo salar L., smolt with emphasis on zinc status. During this study, the cataracts were classified as irreversible. The outbreak of cataracts was positively related to fish growth and negatively related to the condition factor of the fish. Zinc concentrations in liver, eye and plasma were recorded in fish with cataract and in healthy fish from December to May. Lower zinc status (around 20%) was found in fish with cataracts compared to healthy fish, both over time and with regard to severity of the cataract. The decline in organ zinc concentrations seems to be explained by increased relative liver size, lower dry matters in liver and eye, and lower plasma protein. From the present data, the incidence of cataracts could not be directly related to zinc or any of the other nutrients (vitamin A, iron) examined, although relative deficiencies caused by other unknown rearing factors cannot be excluded. The lower condition factor and differences in organ water composition in fish with cataracts indicate that the cataracts may be related to the smoltification processes. Smoltification in the fish population was most probably accelerated by elevated water temperatures.
Morphogenesis of the membranous labyrinth in penaeid shrimp cells infected with Penaeus monodon bacuiovirus (MBV)
Authors: Lu C C , Tang K F J , Chen S N
Published: November 2003

The morphogenesis of a highly organized cellular membrane structure, a membranous labyrinth (ML), in the cells of penaeid shrimp infected with Penaeus monodon baculovirus (MBV) is described. The ML possibly originates from dilated Golgi apparatus, endoplasmic reticulum (ER) or the outer nuclear membrane. The ML apparently grows by proliferation of the cellular membranes of these systems. In addition, its degree of development was correlated with stages of MBV reproduction.
Characterization of rainbow trout, Oncorhynchus mykiss (Walbaum), serum creatine kinase isoenzymes and isoforms by means of electrophoresis and isoelectric focusing
Authors: Williams J , Stewart P , Timpson P
Published: November 2003

Serum samples were obtained from rainbow trout, Oncorhynchus mykiss (Walbaum), from a commercial fish farm. Creatine kinase (CK; EC 2.7.3.2) isoenzymes and sub‐bands (isoforms) were studied using agarose gel electrophoresis and polyacrylamide gel isoelectric focusing. Creatine kinase isoenzymes and isoforms (sub‐bands) were found to display disparate electrophoretic mobility and isoelectric points, respectively, when compared with CK patterns of human origin. The CK‐BB isoenzyme, rarely detected in human serum, was detected in all trout samples assayed. Up to eight CKMM isoforms were detected by the polyacrylamide gel IEF method described.
Viral nervous necrosis (VNN) associated with mass mortalities in cage‐reared sea bass,Dicentrarchus labrax (L.)
Authors: Le Breton A , Grisez L , Sweetman J , Ollevier F
Published: November 2003

Mass mortalities of the European sea bass, Dicentrarchus labrax (L.), occurred in different ongrowing units in Greece. A presumptive diagnosis of viral nervous necrosis (VNN) was made on the basis of the light microscopic observations of a vacuolating encephalopathy and retinopathy. Positive peroxidase reaction with VNN antiserum confirmed nodavirus as the causative agent. Usually recorded in larvae and juvenile stages of different marine fish species, VNN is described in adult sea bass and sea bass reared in floating cages in the Mediterranean for the first time. The horizontal transmission of the disease has been strongly suspected. Histological analyses clearly demonstrate that cells other than nerve cells are also infected. Some epidemiological aspects of the disease are described and their implications for the establishment of prophylactic guidelines are discussed.
Isolation and characterization of fish Aeromonas hydrophila adhesins important for in vitro epithelial cell invasion
Authors: Lee S Y , Yin Z , Ge R , Sin Y M
Published: November 2003

The molecular mechanisms involved in the invasion of Aeromonas hydrophila (strain PPD 134/91) into host cells were studied in vitro using a carp epithelial cell line. Bacterial fractions were extracted with potassium thiocyanate (KSCN) to investigate the adhesins involved. Two groups of adhesins were found. The major group was high molecular weight proteins with the largest component being a 43‐kDa protein. Amino terminal sequence analysis indicated that this may have been an outer membrane porin. This supports previous suggestions that a 43‐kDa outer membrane protein may be important in adhesion of a human isolate of A. hydrophila. The minor group of adhesins were low molecular weight proteins likely to be less effective in mediating bacterial adhesion and invasion into carp epithelial cells.
Antibody production in Japanese eels, Anguilla japonica Temminck & Schlegel
Authors: Hung H‐W , Lo C‐F , Tseng C‐C , Kou G‐H
Published: November 2003

Adult Japanese eels, Anguilla japonica Temminck & Schlegel, (200–250 g, 45–55 cm) were immunized by intramuscular injection with goat IgG. After 5 weeks, eel immunoglobulin (Ig) was purified using affinity chromatography. The purified eel Ig was used to immunize rabbits to produce anti‐eel Ig antibody. The highest antibody ELISA value in eels was reached 3 weeks after initial immunization with goat IgG, and then gradually decreased. The antibody could still be detected at 140 days post‐immunization. The optimal temperature for antibody production was 30°C. Freund’s complete adjuvant and secondary immunization both increased antibody production in eels.
Liver damage in brown trout, Salmo trutta L., and rainbow trout, Oncorhynchus mykiss (Walbaum), following administration of the cyanobacterial hepatotoxin microcystin‐LR via the dorsal aorta
Authors: Bury N R , McGeer J C , Eddy F B , Codd G A
Published: November 2003

Purified microcystin‐LR (MC‐LR) was administered via the dorsal aorta to brown trout, Salmo trutta L., or rainbow trout, Oncorhynchus mykiss (Walbaum), and, within 24 h, a dose of 300 μg MC‐LR kg–1 caused increased activities in the blood by enzymes originating mainly from the liver, i.e. lactate dehydrogenase (LDH) and alanine transaminase (ALT). A dose of 75 μg MC‐LR kg–1 significantly increased liver enzyme activities in the blood of brown trout at 24 h, but was without effect on rainbow trout, whereas 25 μg MC‐LR kg–1 had no effect on blood LDH or ALT activities in either species. However, histopathological analysis of liver from both species following administration of the lowest toxin dose showed hepatocyte swelling and necrosis. Liver damage was more severe in brown trout compared to rainbow trout following administration of 300 μg MC‐LR kg–1, showing disruption of the parenchymal architecture. After 48 h, there was a dose‐dependent increase in the hepatosomatic index in both species. It is concluded that brown trout are less tolerant to MC‐LR than rainbow trout.