bluuebunny/crossref_metadata_2025 huggingface dataset:
Can a zero defects philosophy be applied to drug errors?
Authors: Cooper Mark C
Published: May 2006

The literature reveals that errors of drug administration are a widely distributed and common occurrence The frequency of errors and their underlying causes are discussed, and the literature is surveyed to determine reasons for mistakes and possible remedial measures Ideas are drawn from industrial sources to describe a model of preventing mistakes at source, by making errors impossible The ideas of Crosby and Shingo are discussed and a ‘zero defects philosophy’ is described and developed This paper attempts to determine if this quality model developed and used in industry can be transferred to the health service, and concludes that it needs adaptation and cautious application Recommendations are made for improved practices and improvements, both clinical and managerial The author recommends a multidisciplinary review of all practices and systems to develop a radically different procedure with no drug errors as its aim It is questioned whether this is possible in the present health service environment, as this would require sustained management commitment to both the idea and the quality system However, the author believes that some of the principles can be applied as individual quality initiatives
The concept of caring: a review of the literature
Authors: Kyle Tanya V
Published: May 2006

Caring is viewed in the literature as the central focus of nursing This paper examines the literature on the concept of caring, reviewing the various theoretical perspectives presented, and the research studies which have investigated this phenomenon in nursing practice The choice of research methods in the study of the concept is a major focus for discussion Consequently, the author elucidates the strengths and limitations of the qualitative and quantitative approaches in the investigation of the concept of caring
Quality assurance for contracting of education: a delegated system involving consortia of British National Health Service trusts
Authors: Humphreys John , Davis Karlene
Published: May 2006

With the creation of the market for education, some regional health authorities (RHAs) in England are inclined to formally involve National Health Service (NHS) trusts in decisions with regard to the nature and location of education contracts This paper describes a delegated system developed for the South East Thames Regional Health Authority and now being introduced within the Eastern Sector of the South Thames Regional Health Authority Key features of the system include delegated contract review and a quality levels analysis in which the interests of the RHA and trusts (in both individual and consortium configurations) are accommodated
Women's experience of living with cancer
Authors: Colyer Hazel
Published: May 2006

This paper is drawn from a piece of empirical research which set out to give three women the opportunity to speak on their own behalf about how they experience having cancer in a sexual organ, using a feminist methodology to produce autobiographical stones The stories describe the process of diagnosis and treatment and also convey the catastrophic nature of a diagnosis of cancer, which leads to a painful, existential crisis and feelings of bewilderment, powerlessness and isolation The work was prompted by attendance at a workshop about cancer, body image and sexuality for sufferers and carers, which had indicated a depth of pain greater than is usually acknowledged This pain suggested a fundamental link between body image and the posited concept of woman image, the existence of a common identity through the category woman as it is traditionally structured in society This link is explored in relation to the evident changes in body image and the compromised sexualities of the women The disabling consequences of female sexual stereotyping are elaborated and discussed as synergistic with the more fundamental stigma shadow cast by the prospect of dying The paper discusses possible reasons for this in the context of a transformative rather than restorative model of living with cancer It suggests that being thrown into self‐conscious living could be a source of energy for renegotiation for women especially The inadequacy of the medical model of disease is exposed and a more holistic approach is shown to be essential to address the needs of cancer patients, as is a critical appraisal and adjustment of existing social attitudes and relations
The theory/practice ‘gap’: taking issue with the issue
Authors: Rafferty Anne Marie , Allcock Nick , Lathlean Judith
Published: May 2006

Theory/practice issues have a long‐standing history in nurse education, and are a chronic source of controversy to which there is no easy or perfect solution We have argued that it is the tension between theory and practice and research which can be usefully exploited in teaching and research Students need to be introduced to the debates surrounding the genesis and generation of nursing knowledge They need to gain an appreciation of what counts as nursing knowledge at different points in time and the politics which drive the legitimation of nursing theory and practice Such an approach has much to offer in helping students deal with reality shock and make sense of their experience as they confront the ambiguities, uncertainties and contradictions that characterize the stock‐in‐trade of professional life
Case study of a female client on a regional secure unit
Authors: Duff Annette
Published: May 2006

Reported in this paper is a single‐case experimental design study on the behaviour of a 32‐year‐old schizophrenic female inpatient, presenting with maladaptive behaviours necessitating care in a medium secure environment A baseline of her observed behaviour on the unit was taken The information gathered was used to assist in deciding the differential effects of psychosis vs behavioural manipulation on her presentation and to assist in planning her immediate and future management/treatment Situational factors portrayed as likely indicators of maladaptive behaviours proved difficult to influence, owing to the nature of the subject's environment Cognitions and learnt behaviours were targeted Recent research indicates that for some schizophrenics cognitive‐behavioural treatment of hallucinations/delusions using a focusing strategy is effective in reducing the symptoms' frequency Frequency of the behaviours was recorded whilst this cognitive approach to symptom reduction was used A marked decrease in her maladaptive behaviours was noted
The effect of ward design on the well‐being of post‐operative patients
Authors: Pattison Helen M , Robertson Claire E
Published: May 2006

Changes in the design of hospital wards have usually been determined by architects and members of the nursing and medical professions, the views and preferences of patients have seldom been sought directly The Hospital Anxiety and Depression scale and the Disturbance Due to Hospital Noise questionnaire were administered to 64 female patients on bay and Nightingale wards together with a questionnaire designed for this study Perceptions of social and physical factors of ward design were examined, and their relationship to psychological well‐being and sleep patterns The results show that the bay ward seemed to offer a more favourable environment for patients but some of the disadvantages of bay wards are balanced by better staffing levels and better and more modern facilities Visibility to nurses was lower on the bay ward The Nightingale ward was perceived as significantly noisier than the bay ward and noise levels were significantly correlated to anxiety scores Paradoxically the increase in noise levels appeared to improve the perceived level of privacy on the Nightingale ward Seventy‐five per cent of patients were found to prefer the bay ward design, and since neither design appears to have major disadvantages their continued introduction should be encouraged However, recommendations are made concerning the optimizing of patients' well‐being within the bay ward setting
Australian registered nurse medical device education: a comparison of simple vs. complex devices
Authors: McConnell Edwina A , Cattonar Margaret , Manning Judith
Published: May 2006

As the primary users of medical devices in direct patient care, registered nurses must be competent both with simple and complex devices because any device improperly used can have serious consequences Results of a cross‐sectional survey of registered nurses (n= 238) working at a large South Australian tertiary care centre on units with high usage both of indwelling urethral (Foley) catheters and intravenous infusion pumps revealed that participants were significantly more likely to have learned to use the indwelling urethral (Foley) catheter in nursing school than they were to have learned how to use an intravenous infusion pump Participants differed significantly on most (13 of 17) items about what they learned, with nurses being more likely to learn various factors about the indwelling urethral catheter than the infusion pump Registered nurses were more likely to feel stressed when using an intravenous infusion pump than when using an indwelling urethral catheter, but were more likely to have used an indwelling urethral catheter that caused a patient harm than an intravenous infusion pump that caused a patient harm The most frequently identified reasons for incidents of patient harm resulting from use of an intravenous infusion pump were user error and inadequate device education The most frequently identified reasons for incidents of patient harm resulting from use of an indwelling urethral catheter were the patient's condition, particularly confusion, user error, equipment malfunction, and inadequate device education
A qualitative evaluation of the post accident notification system to health visitors
Authors: Reynolds Linda
Published: May 2006

Childhood accidental injuries are a major public health problem, whether measured in terms of morbidity or mortality, and accident prevention is subsequently a priority issue The Accident and Emergency Notification System to health visitors provides them with vital information and statistics with which to plan accident prevention work, both on an individual basis or in group work This small study aimed to look at this system from the health visitor's perspective and explore the action taken The grounded theory approach was used to uncover the processes used by the health visitors Data were collected using unstructured interviews and by writing notes These were transcribed on the same day as recorded Nine categories were identified and an analysis of the processes involved when receiving the notification slip is presented The categories included‘knowing the family’,‘age and development’,‘pressure of work’and‘gut feeling/extra sensory perception’This study is a small contribution to our understanding of the processes involved in everyday health visiting practice
Mycoplasma genitalium mg200 and mg386 genes are involved in gliding motility but not in cytadherence
Authors: Pich Oscar Q. , Burgos Raul , Ferrer‐Navarro Mario , Querol Enrique , Piñol Jaume
Published: May 2006

Isolation and characterization of transposon‐generated Mycoplasma genitalium gliding‐deficient mutants has implicated mg200 and mg386 genes in gliding motility. The proposed role of these genes was confirmed by restoration of the gliding phenotype in deficient mutants through gene complementation with their respective mg386 or mg200 wild‐type copies. mg200 and mg386 are the first reported gliding‐associated mycoplasma genes not directly involved in cytadherence. Orthologues of MG200 and MG386 proteins are also found in the slow gliding mycoplasmas, Mycoplasma pneumoniae and Mycoplasma gallisepticum, suggesting the existence of a unique set of proteins involved in slow gliding motility. MG200 and MG386 proteins share common features, such as the presence of enriched in aromatic and glycine residues boxes and an acidic and proline‐rich domain, suggesting that these motifs could play a significant role in gliding motility.
Masked, controlled study to investigate the efficacy of aStaphylococcus intermediusautogenous bacterin for the control of canine idiopathic recurrent superficial pyoderma
Authors: Curtis C. F. , Lamport A. I. , Lloyd D. H.
Published: May 2006

A masked, controlled study was designed to investigate the clinical efficacy of a staphylococcal autogenous bacterin for the control of canine idiopathic recurrent pyoderma (IRP). Ten dogs with at least three prior episodes of recurrent superficial pyoderma were recruited. All were screened and found to be free of ectoparasitic and fungal disease and failed to respond favourably to a dietary trial. Those exhibiting signs of pruritus responded completely to antibacterial therapy. Haematological and biochemical parameters were generally unremarkable and all dogs were euthyroid.Staphylococcus intermediuscultures from lesions were used to produce an autogenous bacterin for each animal. A numerical ‘lesion score’ was allocated and dogs were randomly divided into two groups of five (groups 1 and 2). Both groups received a 4‐week course of antibiotic; group 1 also received concurrent s/c injections of bacterin, which continued until week 10. Group 2 received no additional therapy. All dogs were re‐examined and rescored at weeks 5 and 10 and repeat blood samples were submitted at week 10 to screen for adverse effects. Comparison of scores at week 0 and week 5 (Mann–WhitneyU‐test) revealed no significant differences between the groups. At week 10, group 2 (control group) individual lesion scores were significantly higher compared with the group receiving bacterin (P < 0.05) and there was a significantly greater increase in the sum of the individual lesion scores for group 2 compared with group 1, from week 5 to week 10 (P < 0.05). No adverse reactions to bacterin therapy were detected. These results suggest that autogenous bacterins may provide an alternative, safe, effective method for the control of canine IRP. Further studies using larger groups of dogs and for a longer follow‐up period are now warranted.
The effect of root‐absorbed PSII inhibitors on Kautsky curve parameters in sugar beet
Authors: ABBASPOOR M , TEICHER HB , STREIBIG JC
Published: May 2006

The effects of the photosystem II inhibitors metamitron and terbuthylazine on the shape of the Kautsky (chlorophyll fluorescence induction) curve were investigated in sugar beet grown in hydroponic culture. The objective of the study was to trace recovery processes following herbicide injury using Kautsky curve parameters. Metamitron is used for selective weed control in sugar beet because it is metabolized in this crop. In contrast, terbuthylazine is toxic to sugar beet. Two hours after treatment, various fluorescence induction curve parameters, such as maximum quantum efficiency (FV/Fm), the relative changes at the J step (Fvj) and area (the area between the Kautsky curve and maximum fluorescence, Fm), were affected by metamitron at concentration ranges of 70–280 mg active ingredient (a.i.) L−1 in plants treated at the four‐true‐leaf stage. Shortly after herbicide application, Fv/Fm was more affected by the hydrophilic metamitron [log(Kow) = 0.83] than by the lipophilic terbuthylazine [log(Kow) = 3.21], but these differences between compounds were alleviated as metamitron was metabolized and terbuthylazine was not. Terbuthylazine at 1 mg a.i. L−1 affected sugar beet at the four‐ and six‐true‐leaf stages to the same extent, whereas metamitron at a dose of 140 mg a.i. L−1 affected much more at four‐ than at the six‐true‐leaf stage. Sugar beet recovered from metamitron injury even at high doses (140 and 280 mg a.i. L−1). Fluorescence induction curve parameters were similarly affected by terbuthylazine and, although sugar beet recovered from terbuthylazine injury at low doses (<0.2 mg a.i. L−1), the Kautsky curve was irreversibly affected at higher doses (1–10 mg a.i. L−1), leading finally to plant death. Older plants were affected later, and recovered sooner, from both herbicides.
Molecular cloning and characterization of pig, cow and sheep MAdCAM‐1 cDNA and the demonstration of cross‐reactive epitopes amongst mammalian homologues†
Authors: Tachedjian M. , Yu M. , Lew A. M. , Rockman S. , Boyle J. S. , Andrew M. E. , Wang L.
Published: May 2006

Full‐length cDNA clones for the pig, cow and sheep mucosal addressin cellular adhesion molecule (MAdCAM)‐1 homologues were isolated from Peyer's patches by a combination of reverse transcription (RT)‐polymerase chain reaction and 5′ and 3′ RACE strategies. Degenerate primers based on conserved amino acid (aa) sequences within the N‐terminal immunoglobulin (Ig)‐like domains of the human and rodent MAdCAM‐1 molecules were used for initial sequencing of the Ig‐like domains. MAdCAM‐1 transcripts of 1425 bp, 1525 bp and 1510 bp obtained for the pig, cow and sheep contained an open‐reading frame for proteins of 390, 424 and 418 aa, respectively. The pig and ruminant MAdCAM‐1 had two N‐terminal Ig‐like domains, a mucin‐like region and a third Ig‐like domain found in rodent but not human MAdCAM‐1. Antibodies raised against bacterially expressed N‐terminal Ig‐like domains of pig, human and sheep MAdCAM‐1 demonstrated the existence of cross‐reactive epitopes, raising the possibility of producing monoclonal antibodies which can be used as multi‐species MAdCAM‐1‐targeting reagent for the development of mucosal vaccines.
Distribution and abundance of uncultured heterotrophic flagellates in the world oceans
Authors: Massana Ramon , Terrado Ramon , Forn Irene , Lovejoy Connie , Pedrós‐Alió Carlos
Published: May 2006

Heterotrophic flagellates play fundamental roles in marine ecosystems as picoplankton grazers. This recognized importance contrasts with our ignorance of the taxonomic composition of this functional group, which remains mostly unidentified by microscopical and culturing approaches. Recent molecular marine surveys based on 18S rDNA genes have retrieved many sequences unrelated to cultured organisms and marine stramenopiles were among the first reported uncultured eukaryotes. However, little is known about the organisms corresponding to these sequences. Here we determine the abundance of several marine stramenopile lineages in surface marine waters using molecular probes and fluorescent in situ hybridization. We show that these protists are free‐living bacterivorous heterotrophic flagellates. They were widely distributed, occurring in the five world oceans, and accounted for a significant fraction (up to 35%) of heterotrophic flagellates in diverse geographic regions. A single group, MAST‐4, represented 9% of cells within this functional assemblage, with the intriguing exception of polar waters where it was absent. MAST‐4 cells likely contribute substantially to picoplankton grazing and nutrient re‐mineralization in vast areas of the oceans and represent a key eukaryotic group in marine food webs.
Abstract no.: 2 Caspase inhibitor z‐VAD‐fmk induces nonapoptotic cell death in macrophages but not in smooth muscle cells: an opportunity to stabilize atherosclerotic plaques?
Authors: Martinet W. , De Meyer G.R.Y. , Herman A.G. , Kockx M.M.
Published: May 2006

Several lines of evidence suggest that macrophages play a key role in atherosclerotic plaque destabilization and rupture. Selective removal of macrophages from plaques via pharmacological therapy could therefore represent a promising approach to stabilize ‘vulnerable’, rupture‐prone lesions. Yet, how macrophages can be eliminated from plaques without influencing other cell types, including smooth muscle cells (SMCs), is unknown. In the present study, we report that benzyloxycarbonyl‐Val‐Ala‐DL‐Asp(O‐methyl)‐fluoromethylketone (z‐VAD‐fmk), a caspase inhibitor with broad specificity, induces nonapoptotic cell death of macrophages, but not of SMCs. Cell death was characterized by bulk degradation of long‐lived proteins, processing of microtubule associated protein light chain 3, and cytoplasmic vacuolization, which are all markers of autophagy. However, also necrosis occurred and the number of necrotic cells rapidly increased during z‐VAD‐fmk treatment. Western blots revealed that receptor interacting protein 1 (RIP1) is less abundantly expressed in SMCs as compared with macrophages, which may explain the different sensitivity to z‐VAD‐fmk. Selective degradation of RIP1 in macrophages by geldanamycin protected cells against z‐VAD‐fmk induced death, whereas overexpression of RIP1 in SMCs stimulated z‐VAD‐fmk mediated cell death. Importantly, upon z‐VAD‐fmk treatment macrophages overexpressed and secreted several chemokines and cytokines, including tumor necrosis factor‐α (TNFα). The combination of z‐VAD‐fmk and TNFα but not TNFα alone, induced SMCs necrosis via a mechanism that required RIP1 expression. These results suggest that z‐VAD‐fmk, despite its selective cell death inducing capacity, would be detrimental for the stability of atherosclerotic plaques due to enlargement of the necrotic core, stimulation of inflammatory responses and indirect induction of SMC death.
Abstract no.: 4 Experimental inflammation of the colon modulates stomach motility via neuronal pathways
Authors: De Schepper H.U. , De Man J.G. , Van Nassauw L. , Herman A.G. , Timmermans J.P. , Pelckmans P.A. , De Winter B.Y.
Published: May 2006

Patients with IBD often suffer from impaired gastrointestinal motility, even at sites remote from the inflammation. We previously reported diminished gastric emptying associated with reduced gastric fundus contractility in rats with TNBS‐induced colitis. The aims of the present study were (1) to exclude local gastric inflammation using MPO measurements and to rule out direct systemic influences on gastric neuromuscular function by examining the effect of TNBS‐induced colitis on contractions of aortic vascular rings. Secondly (2) we tested the involvement of neuronal ganglionic (nicotinic) transmission and of extrinsic reflex pathways in impaired gastric emptying in rats with TNBS‐induced colitis. Distal colitis was induced by rectal instillation of 30 mg trinitrobenzene sulphate (TNBS) in 50% ethanol 72 h prior to experiments. Gastric emptying (GE) and the geometric center (GC) of intestinal transit were measured 30 min after intragastric injection of a semiliquid bolus of Evans blue. TNBS colitis reduced gastric emptying from 38.4 ± 3.6% in controls to 22.7 ± 4.4% but had no effect on small intestinal transit. (1) Myeloperoxidase (MPO) measurements revealed no acute inflammatory changes in the stomach whereas MPO was significantly increased in the colon of TNBS rats. The study of aortic ring contractility showed no differences between control rats and rats with TNBS colitis. (2) The nicotinic receptor blocker hexamethonium (20 mg/kg ip 1 h prior to experiment) inhibited GE by 31% in controls (P < 0.05) whereas it increased GE by 37% in TNBS rats (P < 0.05). The GC of gastrointestinal transit was similarly affected. Extrinsic afferent innervation was abolished by capsaicin pre‐treatment (50 mg/kg SC 14 days prior to experiment). Capsaicin reduced GE by 71% in control rats (P < 0.05) while in TNBS rats its effect on GE was no longer significant (40% reduction). Capsaicin pre‐treatment had comparable effects on the GC of gastrointestinal transit in controls and TNBS. In conclusion, we showed that TNBS colitis induces a pronounced gastroparesis which is not due to local gastric inflammation nor to systemic impairment of neuromuscular function. Moreover, it involves nicotinic synapses embedded in autonomic reflexes. A role for extrinsic afferent pathways sensitized by inflammatory mediators seems plausible.
Abstract no.: 8 Endothelium‐dependent relaxation in atherosclerotic aorta segments of apolipoprotein E‐deficient (apoE‐/‐) mice
Authors: Van Assche T. , Guns P.‐J. , Van Hove C. , Herman A.G. , Bult H. , Fransen P.
Published: May 2006

The present study investigated whether lesion‐free aorta segments of young apoE‐/‐ mice, which will later show endothelial dysfunction when atherosclerotic lesions develop, display normal endothelial function in comparison with ‘wild‐type’ (wt) C57Bl/6J mice. Endothelial function was assessed by studying endothelium‐dependent relaxation to acetylcholine (ACh) and concomitant elevations of endothelial internal calcium (Ca2+i). Therefore, atherosclerosis‐prone aorta strips were mounted in a myograph with the endothelial side down and loaded with fura2‐AM (340/380 excitation emission ratio in relative units, RU) to measure Ca2+i simultaneously with isometric force. In 90% of WT females (n = 10), 31% of WT males (n = 13), 100% of apoE‐/‐ females (n = 14) and 82% of apoE‐/‐ males (n = 11), relaxation of precontracted (1 μM phenylephrine, PE) strips by ACh (2 × 10−6 M) was accompanied by a contemporary increase of Ca2+i. ACh‐induced Ca2+i increase was not different between WT and apoE‐/‐ mice, but was greater in females than in males (0.14 ± 0.03 RU vs. 0.04 ± 0.03 RU, P < 0.05). Dose‐response curves for ACh (10−9 to 3 × 10−6 M) revealed EC50‐values for ACh‐induced relaxations, which were significantly smaller in apoE‐/‐ than in wt (respectively 21 ± 7 nM vs. 61 ± 30 nM for females and 51 ± 22 vs. 82 ± 14 nM for males, P < 0.05), pointing to a higher sensitivity of apoE‐/‐ segments to ACh. Except for wt males, in which relaxation seemed to be uncoupled from endothelial Ca2+i mobilization, EC50 values of ACh for calcium increase were similar for the three other groups (116 ± 47, 124 ± 16 and 117 ± 7 nM, respectively). It is concluded that before development of atherosclerotic lesions, apoE‐/‐ mice are more efficient than wt mice in transducing an increase of internal calcium upon muscarinic receptor stimulation into a nitric‐oxide dependent vasodilator response.
Abstract no.: 9 Nitric oxide donors and oxysterol‐induced smooth muscle cell death
Authors: Schrijvers D. , Fret H. , Martinet W. , Bult H.
Published: May 2006

Objective  Macrophage‐derived mediators (nitric oxide (NO), TNFα) and environmental factors (oxysterols) can induce smooth muscle cell (SMC) death in atherosclerotic plaques, thereby increasing the risk of plaque rupture. Since NO donors are used by angina pectoris patients, we investigated their effects on vascular SMC death induced by 7‐ketocholesterol (7‐KC).

Methods  SMCs derived from the rabbit aorta (150 000; passage 2–6) were seeded in six well plates in HAM F10 with 10% foetal bovine serum (FBS). The next day, they were exposed to 25 μM7‐KC and various concentrations of S‐nitroso‐N‐acetyl‐penicilamine (SNAP), SIN‐1 (linsidomine) or spermine‐NONOate (SPNO) in the presence of 2% FBS. Uptake of neutral red (0.01%, added 16 h later) was measured for 2 h as viability index; the protein content of the adherent SMCs was measured using the BCA method.

Results  7‐KC caused 50.7 ± 1.5% (n = 12) decrease of viability, SMC loss was less pronounced (control 90 ± 2, 7‐KC 74 ± 2 μg protein/monolayer, n = 12). Exposure to 100 μM SIN‐1 or SNAP for 2 or 18 h did not change viability or protein content, either alone or in combination with 25 μM 7‐KC. In contrast, 100 μM SPNO caused a transient viability loss in control cells (from 100% to 74 ± 4% at 2 h and 95 ± 3% at 18 h) and in SMCs treated with 7‐KC (from 51 ± 3% to 39 ± 2% at 2 h and 49 ± 3% at 18 h). Interestingly, the effect of SPNO was less pronounced in SMCs treated with 7‐KC, particularly at higher concentrations (e.g. decrease of viability at 300 μM SPNO 25 ± 5% in control, and 3 ± 3% in 7‐KC‐treated SMCs).

Conclusion  The results indicate that effects of NO donors on SMC viability in an atherogenic environment cannot be predicted from experiments with normal SMCs. S‐Nitrosylation of the catalytic cysteine residue of caspases, thereby suppressing apoptosis, could explain why the effects of 7‐KC and SPNO were not additive.
Developing Public Health Competence Among RN‐to‐BSN Students in a Rural Community
Authors: Ouzts Karen N. , Brown Julie Watson , Diaz Swearingen Connie A.
Published: May 2006

ABSTRACT
A new RN/BSN nursing program offers rural students in a western state the opportunity to address significant health care needs on a local level by developing public health leadership competencies in their home communities. The innovative program, funded by a grant from the Health Resources and Services Administration, makes it possible for RNs to complete their BSN degrees without travel, as they position themselves to provide critically needed health care leadership in their local areas. Partnerships between the university, community colleges, and local health agencies allow students in the RN‐to‐BSN program to benefit from a streamlined BSN admission process, onsite mentoring, and newly developed courses that lead students to reflect on health needs in their home communities. On the basis of Public Health Nursing Competencies as defined by the Nursing Quad Council (2004), the re‐designed curriculum prepares students for public health leadership by encouraging application of competencies while participating in the delivery of essential public health services in their communities. Initial response to this new opportunity indicates that students can develop as leaders by developing public health competencies, and facets of the program may encourage more students to commit to completing the BSN while increasing capacity among PHNs.
Is Prolactin a Clinically Useful Measure of Epilepsy?
Authors: Ben-Menachem Elinor
Published: May 2006

Use of Serum Prolactin in Diagnosing Epileptic Seizures: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

Chen DK, So YT, Fisher RS

Neurology 2005;65(5):668–675 (Review)

Objective

The purpose of this article is to review the use of serum prolactin assay in epileptic seizure diagnosis.

Methods

The authors identified relevant studies in multiple databases and reference lists. Studies that met inclusion criteria were summarized and rated for quality of evidence, and the results were analyzed and pooled where appropriate.

Results

Most studies used a serum prolactin of at least twice baseline value as abnormal. For the differentiation of epileptic seizures from psychogenic nonepileptic seizures, one Class I and seven Class II studies showed that elevated serum prolactin was highly predictive of either generalized tonic–clonic or complex partial seizures. Pooled sensitivity was higher for generalized tonic–clonic seizures (60.0%) than for complex partial seizures (46.1%), while the pooled specificity was similar for both (approximately 96%). Data were insufficient to establish validity for simple partial seizures. Two Class II studies were consistent in showing prolactin elevation after tilt-test–induced syncope. Inconclusive data exist regarding the value of serum prolactin following status epilepticus, repetitive seizures, and neonatal seizures.

Recommendations

Elevated serum prolactin assay, when measured in the appropriate clinical setting at 10 to 20 minutes after a suspected event, is a useful adjunct for the differentiation of generalized tonic–clonic or complex partial seizure from psychogenic nonepileptic seizure among adults and older children (Level B). Serum prolactin assay does not distinguish epileptic seizures from syncope (Level B). The use of serum PRL assay has not been established in the evaluation of status epilepticus, repetitive seizures, and neonatal seizures (Level U).
How Independent Are Initiation, Propagation, and Termination of Epileptiform Activity?
Authors: Dudek F. Edward
Published: May 2006

Initiation, Propagation, and Termination of Epileptiform Activity in Rodent Neocortex In Vitro Involve Distinct Mechanisms

Pinto DJ, Patrick SL, Huang WC, Connors BW

J Neurosci 2005;25(36):8131–8140

Waves of epileptiform activity in neocortex have three phenomenological stages: initiation, propagation, and termination. We use a well studied model of epileptiform activity in vitro to investigate directly the hypothesis that each stage is governed by an independent mechanism within the underlying cortical circuit. Using the partially disinhibited neocortical slice preparation, activity is induced and modulated using neurotransmitter receptor antagonists and is measured using both intracellular recordings and a linear array of extracellular electrodes. We find that initiation depends on both synaptic excitation and inhibition and entails a slow process of recruitment at discrete spatial locations within cortical layer 5 but not layer 2 or 3. Propagation depends on synaptic excitation but not inhibition and is a fast process that involves neurons across the spatial extent of the slice and in all cortical layers. Termination is modulated by synaptic excitation and inhibition. In space, termination occurs reliably at discrete locations. In time, termination is characterized by a strong depolarizing shift (block) and recovery of neurons in all cortical layers. These results suggest that the phenomenological stages of epileptiform events correspond to distinct mechanistic stages.
Effectiveness of human T‐lymphotropic virus (HTLV) recipient tracing (lookback) and the current HTLV‐I and ‐II confirmatory algorithm, 1999 to 2004
Authors: Stramer S.L. , Foster G.A. , Dodd R.Y.
Published: May 2006

BACKGROUND:  This study reports on the efficacy of an investigational human T‐lymphotropic virus (HTLV)‐I and ‐II lookback program in the context of differing confirmatory testing algorithms.

STUDY DESIGN AND METHODS:  The results of testing approximately 35 million donations for anti‐HTLV‐I and ‐II were evaluated for two recent periods reflecting the use of two different confirmatory algorithms. The number of seroconverting donors was established for the entire period, and the results of lookback on their prior donations were investigated.

RESULTS:  The dual enzyme immunoassay (EIA) strategy was used throughout both study periods and resulted in a 57 to 76 percent reduction in the number of samples requiring confirmatory testing. From May 2000 to February 2002, a total of 9138 samples were repeatedly reactive by the primary screening test; of the concordant EIA‐reactive samples, 461 (12%) were confirmed by Western blot, whereas 3083 (79%) were indeterminate. From March 2002 to December 2004, a total of 21,291 samples were repeatedly reactive; of the concordant EIA‐reactive samples, 1099 (22%) were confirmed by the State of California’s reference laboratory and only 273 (5%) were equivocal. Overall, 38 or 1 in 921,000 donations were from a seroconverting donor with 32 prior donations within the lookback period. Of those 32, components from only 11 were transfused to recipients who survived; of these, 4 were tested and all were nonreactive for HTLV‐I and ‐II antibodies.

CONCLUSION:  Use of creative algorithms can increase the efficacy of anti‐HTLV‐I and ‐II confirmatory testing and reduce the number of indeterminate results. Currently, lookback for HTLV‐I and ‐II has a very low yield, and its public health benefit is questionable.
Augmented Designs to Assess Immune Response in Vaccine Trials
Authors: Follmann Dean
Published: May 2006

Summary This article introduces methods for use in vaccine clinical trials to help determine whether the immune response to a vaccine is actually causing a reduction in the infection rate. This is not easy because immune response to the (say HIV) vaccine is only observed in the HIV vaccine arm. If we knew what the HIV‐specific immune response in placebo recipients would have been, had they been vaccinated, this immune response could be treated essentially like a baseline covariate and an interaction with treatment could be evaluated. Relatedly, the rate of infection by this baseline covariate could be compared between the two groups and a causative role of immune response would be supported if infection risk decreased with increasing HIV immune response only in the vaccine group. We introduce two methods for inferring this HIV‐specific immune response. The first involves vaccinating everyone before baseline with an irrelevant vaccine, for example, rabies. Randomization ensures that the relationship between the immune responses to the rabies and HIV vaccines observed in the vaccine group is the same as what would have been seen in the placebo group. We infer a placebo volunteer's response to the HIV vaccine using their rabies response and a prediction model from the vaccine group. The second method entails vaccinating all uninfected placebo patients at the closeout of the trial with the HIV vaccine and recording immune response. We pretend this immune response at closeout is what they would have had at baseline. We can then infer what the distribution of immune response among placebo infecteds would have been. Such designs may help elucidate the role of immune response in preventing infections. More pointedly, they could be helpful in the decision to improve or abandon an HIV vaccine with mediocre performance in a phase III trial.
Surgical bone marrow aspiration in Aotus lemurinus griseimembra
Authors: Llanos Cesar , Quintero Gustavo , Castellanos Alejandro , Arevalo‐Herrera Myriam , Herrera Sòcrates
Published: May 2006

Aotus lemurinus griseimembra are highly susceptible to infection by human malaria parasites and reproduce some of its clinical manifestations, including anemia. We developed a new surgical technique to obtain bone marrow samples from Aotus by surgical aspiration of the femur. First, we determined that the femur offered advantages over other bones, primarily due to lower fracture vulnerability. We tested a surgical technique using 20 G IV catheters in formaldehyde‐preserved animals, then conducted the procedure on 27 live animals. This technique provided easy, quick surgical access to adequate volumes of bone marrow and was safe for almost all animals: only one died; another developed nervous impairment of the lower limb. Adequate cell samples were obtained in all animals and allowed cytological studies. This procedure offers a useful tool for bone marrow research in Aotus and helps overcome current limitations of such research in human where these studies are limited by ethical and technical issues.
Imaging RNA polymerase–amelogenin gene complexes with single molecule resolution using atomic force microscopy
Authors: Crampton Neal , Thomson Neil H. , Kirkham Jennifer , Gibson Carolyn W. , Bonass William A.
Published: May 2006

The AMELX gene encoding the enamel matrix protein, amelogenin, is located within (and in the opposite orientation to) the first intron of the ARHGAP6 gene, which encodes a GTPase‐activating protein. The orientation of these two genes with respect to each other raises the possibility that they may undergo simultaneous convergent transcription during amelogenesis. The aim of this study was to use atomic force microscopy (AFM) to study a transcriptionally active amelogenin DNA template and to investigate the binding of RNA polymerase to convergently aligned promoters. Images of RNA polymerases stalled on DNA templates were obtained following incubation of the template with RNA polymerases and ribonucleotide triphosphates. A linear DNA template incorporating an intact rat amelogenin cDNA flanked by convergently aligned coliphage T7 and T3 promoters was constructed and shown to be transcriptionally active in vitro. Atomic force microscopy images of transcription complexes revealed globular structures, corresponding to single RNA polymerase molecules bound at specific locations on the DNA templates. These results indicate that AFM allows the visualization of individual RNA polymerases on DNA templates, offering a realistic approach to investigating the concept of convergent transcription of nested genes, which may lead to an understanding of whether the simultaneous expression of AMELX and ARHGAP6 is possible during the formation of tooth enamel.
Transcription factor sumoylation and factor YY1 serve to modulate mouse amelogenin gene expression
Authors: Xu Yucheng , Zhou Yan L. , Ann David K. , MacDougald Ormond A. , Shum Lillian , Snead Malcolm L.
Published: May 2006

Amelogenin proteins are essential in the control of enamel biomineralization and the amelogenin gene therefore is spatiotemporally regulated to ensure proper amelogenin protein expression. In this study, we examined the role of sumoylation to alter CCAAT/enhancer‐binding protein alpha (C/EBPα) activity, and performed a search using a protein/DNA array system for other proteins that act co‐operatively with C/EBPα to alter amelogenin expression. We observed that C/EBPα was modified by sumoylation, and that this modification played an indirect inhibitory role on the regulation of C/EBPα activity which appeared to act through other transcription factors. The protein/DNA array allowed us to single out the transcription factor, YY1, which acts in the absence of direct DNA binding to repress both the basal amelogenin promoter activity and C/EBPα‐mediated transactivation. Taken together, these pathways may account for part of the physiological modulation of the amelogenin gene expression in accordance with tooth developmental and enamel biomineralization requirements.
Sensitivity Analysis of Entrance Design Parameters of a Backward-Inclined Centrifugal Fan Using DOE Method and CFD Calculations
Authors: Behzadmehr A. , Mercadier Y. , Galanis N.
Published: May 2006

Centrifugal fans with an electric motor included in the hub are commonly used in HVAC (heating, ventilation, and air conditioning) systems. A design of experiments (DOE) has been performed to study the effect of the entrance conditions of a backward-inclined centrifugal fan on its efficiency. The parameters involved are the base radius of the motor hub, the radius of the fan entry section, the deceleration factor throughout the entry zone (from the entry of the fan to the entry of the blade), and the solidity factor. Numerical simulation coupled with the DOE has been used for the sensitivity analysis of the entrance parameters. Initially, a complete factorial plan (24) was performed to screen the most influent parameters and interactions. This has shown that the motor’s cap radius, as well as its interactions with other parameters, is not significant. A second DOE, using composite central design (CCD which has a second order of accuracy) has then been performed on the remaining parameters (radius of the fan entry section, deceleration factor, and the solidity factor). The effects of these parameters and their interactions on the fan efficiency are now presented. A linear regression with three parameters has been performed to establish the efficiency distribution map. The methodology employed is validated by comparing the predicted results from the DOE and those from the numerical simulation of the corresponding fan.
The Thermodynamic Evaluation and Optimization of Fuel Cell Systems
Authors: Woudstra N. , van der Stelt T. P. , Hemmes K.
Published: May 2006

Energy conversion today is subject to high thermodynamic losses. About 50% to 90% of the exergy of primary fuels is lost during conversion into power or heat. The fast increasing world energy demand makes a further increase of conversion efficiencies inevitable. The substantial thermodynamic losses (exergy losses of 20% to 30%) of thermal fuel conversion will limit future improvements of power plant efficiencies. Electrochemical conversion of fuel enables fuel conversion with minimum losses. Various fuel cell systems have been investigated at the Delft University of Technology during the past 20 years. It appeared that exergy analyses can be very helpful in understanding the extent and causes of thermodynamic losses in fuel cell systems. More than 50% of the losses in high temperature fuel cell (molten carbonate fuel cell and solid oxide fuel cell) systems can be caused by heat transfer. Therefore system optimization must focus on reducing the need for heat transfer as well as improving the conditions for the unavoidable heat transfer. Various options for reducing the need for heat transfer are discussed in this paper. High temperature fuel cells, eventually integrated into gas turbine processes, can replace the combustion process in future power plants. High temperature fuel cells will be necessary to obtain conversion efficiencies up to 80% in the case of large scale electricity production in the future. The introduction of fuel cells is considered to be a first step in the integration of electrochemical conversion in future energy conversion systems.
Hydrogen Production From Methane by Using Oxygen Permeable Ceramics
Authors: Takamura Hitoshi , Aizumi Yusuke , Kamegawa Atsunori , Okada Masuo
Published: May 2006

Oxygen permeable ceramics based on mixed conductors are attracting much attention for use in partial oxidation of hydrocarbons as a novel technique for syngas and pure hydrogen production. This paper describes the preparation and oxygen permeation properties including the methane reforming property of a novel member of oxygen permeable ceramics. The materials used are solid solutions of (La0.5Ba0.3Sr0.2)(FexIn1−x)O3−δ. The single phase of perovskite-type (La0.5Ba0.3Sr0.2)(FexIn1−x)O3−δ is obtained in the range of x=0.4 to 0.9. The highest oxygen flux densities of 2.2 and 11μmol∕cm2s (membrane thickness, L=0.2mm) are attained for (La0.5Ba0.3Sr0.2)(FexIn1−x)O3−δ(x=0.6) at 1000°C under He/air and CH4/air gradients, respectively. The electrical conductivity of (La0.5Ba0.3Sr0.2)(Fe0.6In0.4)O3−δ is dominated by p-type conduction having a slope of 1∕4 under the high P(O2) region. The oxide-ion conductivity of the same sample is estimated to be 0.05S∕cm at 800°C. Even though the oxygen flux density slightly decreases with increasing time, high CO selectivity of 90% is kept for 100h. The oxygen flux density of the solid solution is also discussed in the context of surface exchange kinetics.
Fuel Cell Hybrids, Their Thermodynamics and Sustainable Development
Authors: Winkler Wolfgang
Published: May 2006

The increasing demand on primary energy and the increasing concern on climatic change demand immediately a sustainable development, but still there remain open questions regarding its technical realization. The second law of thermodynamics is a very simple but efficient way to define the principle design rules of sustainable technologies in minimizing the irreversible entropy production. The ideal, but real process chain is defined by a still reversible structure or logic of the process chain—the reversible reference process chain—but consisting of real components with an irreversible entropy production on a certain level. It can easily be shown for energy conversion and for transportation that hybridization in general can indeed be a measure to meet the reversible process chain and to minimize the entropy flow to the environment. Fuel cells are principal reversible converters of chemical energy and thus a key element within hybridization. Depending on application, combined heat and power process (CHP) may be a hybridization step or only a slight improvement. There is a fundamental difference in heating a house or in supplying an endothermic chemical reaction with reaction entropy. The use of heat recovery and isolation is a necessary measure to minimize the entropy flow to the environment and can be described by a reversible reference process as well. The application of reversible reference process chains shows that hybrid systems with fuel cells are a technical feasibility to approach very closely the thermodynamic potential. This development differs from the past where the technical possibilities of materials and manufacturing limited the technology to meet reversibility and thus sustainability.